Some Physicians Elect Not To Accept Gifts From Industry

It is no secret that the federal government is very interested in the connection between gifts and other remuneration from drug and device manufacturers and physician decision-making when it comes to ordering those items.  At least one Senator has gone so far as to introduce legislation which would require disclosure of these financial relationships.  According to a recent article in the Baltimore Sun, some doctors are voluntarily refusing to accept gifts from industry. 

While the legal ramifications of accepting remuneration from industry for goods and services covered by federal payor programs are quite severe under the federal anti-kickback statute, the line between what will be tolerated (e.g., low cost meals coupled with an educational program) and what will land a physician in hot water has become blurred.  This confusion is likley due, at least in part, to the pharmaceutical and device industries' efforts to self-police through their own codes of conduct which permit conduct not expressly permitted under the anti-kickback statute. 

As the Baltimore Sun article illustrates, some doctors are beginning to recognize that even if a compensation arrangement with industry is permissible -- or at least tolerated -- under federal law, there may still be negative consequences to particpating.  In particular, the public may be left with the perception -- right or wrong -- that a doctor with industry ties has a conflict of interest.  The legal implications are no doubt important, but doctors should remember that how something will look on the front page of the newspaper may be just as important.

Meet the New Doc: Researchers Develop Computerized Anesthesiologist

Canadian researchers may have solved the looming physician shortage crisis -- at least as it would apply to the administration of  surgical anesthesia.  According to an article in the Canadian Press, scientists at McGill University in Montreal have developed a software system that administers anesthesia during surgery.  Not possible you say?  According to the article, the system has been successfully tested and actually performed better than its human counterparts in some respects.  The researchers at McGill are quick to point out in the article that the machine will not replace human anesthesiologists but there are undoubtedly more than a few managed care and hospital executives rooting for this technology.

Healthcare in the Workplace - Walgreen Announces Plans

According to a recent online Wall Street Journal article, Walgreen Co. is taking definitive steps to expand further into the workplace health center arena. Specifically, Walgreen has announced its plans to acquire two worksite health-center companies in an effort to build its business as a manager of on-site health centers at large companies. The work-site health centers are in addition to Walgreen’s in store clinics.  According to the WSJ article, once the deals are completed, Walgreen will have more than 500 worksite and retail health centers in 40 states. Walgreen’s announcement further confirms the growing trend by big box and national chain stores (e.g., Walmart) to try to reach health care consumers where they work and shop instead of making consumers seek out health care providers.

Be On the Lookout for Better Educated Patients

According to an article in the New York Times, Aetna will soon begin offering a new service to help enable patients to research their own specific medical conditions. Specifically, Aetna’s SmartSource Service will allow patients to link online research with their own medical records and claims data.  While a better patient educated patient population holds hope for cutting down on unnecessary medical expenses, there is also the possibility that patients will use this kind of service to exercise self-help rather than seeking professional care. Nevertheless, Aetna’s move is a sign of the times and Aetna is not the only one delving into this arena. According to the Times article, other companies like Google and Microsoft have similar plans. Physicians should begin preparing to deal with patients who are better educated about their own health care conditions than ever before.

Medical Society Predicts Doctor Shortage in Pennsylvania

More not-so-good news for Pennsylvania: according to an article in the Times Tribune, Pennsylvania Medical Society officials are predicting a shortage of physicians in Pennsylvania in the foreseeable future.  Citing the Society's recently released demographic report (See The State of Medicine in Pennsylvania), the article suggests that Pennsylvania could be short 10,000 doctors within 10 years.  Pennsylvania's physician population is aging, with a large percentage of physicians approaching retirement age.  According to the article, 50% of Pennsylvania's physicians are over the age of 50.

Physicians Called Upon to Identify Patients with Pre-Existing Conditions

According to an article in the Los Angeles Times, a dispute is brewing in California over what one insurer is calling an “outreach effort” but others are calling an attempt to pit physicians against their patients. Specifically, Blue Cross of California has sent letters to physicians with a copy of patient insurance coverage applications, asking the physicians to identify patients who had pre-existing conditions at the time insurance coverage was extended to them. Presumably Blue Cross of California would use the information to rescind coverage for patients deemed to have pre-existing conditions. While Blue Cross of California says physician participation in the survey is voluntary, many physicians are concerned that enlisting physicians as moles in the effort could cause patients to withhold critical clinical information from their physicians. While HIPAA would likely permit the disclosure of this information, physicians considering making such disclosures should also check their participation contracts carefully to determine whether they have any duty to provide the data to an insurer.

CIGNA Reaches Settlement on Doctor Ranking

Several month ago I posted an entry on this Blog about a lawsuit the New York Attorney General was threatening to file to prevent United Healthcare from ranking its participating physicians.  Well, according to an article on USAToday.com, CIGNA and the Attorney General have reached a settlement in a similar case.  While CIGNA will move forward with its public ranking system, it has agreed to do the rankings on factors other than cost alone and to make available to the public details of how the ranking is performed including the relative weight placed on various cost and non-cost factors.   

Clearly physician ranking systems are the waive of the future.  How much weight patients will actually place on these systems remains to be seen but physicians should monitor these developments closely and gain a firm understanding of how these systems will apply to their practices.  

Microsoft Launches "HealthVault"

Just when physicians thought it was safe to start investing in electronic medical records systems, Microsoft may be changing the ground rules altogether.  On October 4, 2007, Microsoft took a giant leap into the health information arena by announcing the launch of it's new web site "HealthVault".  According to the web site, HealthVault will serve as a secure electronic repository for where patients can "collect, store, and share" their health information with their physicians and other treating providers.   Data accuracy and privacy issues aside, a national shared electronic health record may not be so far off!

Watch Out for Physician Rating Systems

More and more payors are instituting rating systems for their participating physicians and at least one state attorney general has taken issue with the practice.  According to a recent article on CNNMoney.com, the New York Attorney General has threatened an injunction against United Healthcare if it implements a physician rating system in New York.   The Attorney General has apparently cited a number of concerns with the rating system, including that the rating data may be faulty and that patients may choose doctors based on cost rather than quality. 

Hospitals Facing Coverage Shortages

According to a recent article in the Naples Dailey News (Here), hospitals across the Country are facing a shortage when it comes to specialty physician coverage for the emergency room.   Fifty-five percent of hospitals surveyed by the American Hospital Association have experienced a coverage shortage and a third compensate physicians for ER coverage.  Specialty areas of particular concern include orthopedics and neurosurgery.

Foreign Doctors Worried Over British Terror Attacks

Details continue to emerge over the terror attacks in Great Britain allegedly carried out by a group of physicians.  According to a recent article (See Foreign Doctors in U.S. Concerned After British Terror Plot Implicates Physicians), foreign physicians practicing in the U.S. are concerned over what the fallout on our shores might be.   While there have yet to be any formal changes to U.S. immigration policy regarding foreign physicians, we are advising our physician practice clients who employ foreign-born physicians (as well as foreign-born physician clients) to consider having an audit of their physician immigration status performed as well as to consider instituting training on immigration issues for key management and hiring personnel.

Doctors: Do you know what's in your trash?

According to an article today in the Greenwich Post (found here), a box full of paperwork containing patient information, including names and contact information, was found in a dumpster outside of a medical office building.  Not only that, the good citizen who found the box decided the most appropriate course of action was to turn it over to the Greenwich Post!  The HIPAA privacy rules may not be making the headlines they did a few years ago, but they are very much still in effect.  Failing to abide by the rules when it comes to the disclosure of protected health information can result in substantial fines, so don't forget to revisit you HIPAA compliance policy from time to time.

Walmart Dives Into the Doctor Business

According to a Walmart spokesperson, Walmart foresees opening more than 6,000 in-store medical clinics over the next five (5) years.  Walmart already has 75 clinics in 12 states and envisions that the clinics could serve as the basis for a national electronic medical record platform.  The clinics, which will likely accept walk-in patients and have extended hours, will almost certainly present a new and unique challange to existing primary care practices in Walmart's markets. 

So It's Time To Dissolve Your Practice

For any number of reasons longtime (and sometimes not-so-longtime) medical practice partners may decide that they can no practice together.  Diverging practice styles and patterns, unexpected health problems, and mounting economic and administrative burdens are only a few examples of issues that can drive a wedge between practice colleagues.  Unfortunately, as with many small businesses, dissolving a medical practice can be fraught with emotion -- in addition to a host of legal and ethical considerations.  The following article from Physician's News Digest discusses some the issues likely to arise in a medical practice split-up and offers suggestions for addressing them. www.physiciansnews.com/law/1004.html