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Department: Strategy

Quality Measurement Aids Practices
The pursuit of quality measurement and quality improvement has become an imperative for all medical practices, says John I. Allen, MD, MBA, the medical director of Minnesota Gastroenterology in St. Paul. “Assessing a practice’s performance according to defined clinical and service quality measures is critical to improving patient care and will be required by both patients and payers in the future,” he explains. Allen serves as chair of both the Institute for Clinical Systems Improvement in Bloomington, Minn., and the American Gastroenterology Association (AGA) Institute’s Clinical Practice and Quality Management Committee in Bethesda, Md.

Reform Exacerbates PCP Shortages
Few experts disagree that the U.S. health system needs to be reformed. Currently, more than 45 million Americans have no health insurance, and with a weakening economy and increasing numbers of Americans losing jobs, that number is likely to grow. Whether one believes in government mandates or free-market solutions, these experts argue that significant changes need to be made to the current health care reimbursement system.

Aside from the increased costs inherent in any reform plan, especially universal health coverage mandates, a significant issue is who will provide care for the potential wave of the newly insured. Any health reform in the United States that includes increased or mandatory coverage for the uninsured will underscore the question of physician-related supply and demand. There are likely to be many more patients and a lot fewer primary care physicians (PCPs).

CKD Clinics Spreading Slowly
Nelson Kopyt, DO, believes CKD clinics using a team of caregivers to care for patients with chronic kidney disease will help improve the quality of care these patients receive. He also believes CKD clinics can help expand access to care for patients with CKD. Since opening a CKD clinic in 2002, the nephrologist has made presentations for the National Kidney Foundation on the benefits of such arrangements. Kopyt’s practice, Nephrology Hypertension Associates of the Lehigh Valley, in Easton, Pa., has six physicians. Five work full-time and one is part-time.

Some clinics operate in large practices or academic settings, and a few smaller private practices also have started CKD clinics. Although Kopyt acknowledges that no one knows how many CKD clinics are operating nationwide, these arrangements have not caught on widely. “My impression is that they have not taken off as we had hoped,” he comments.

MN Group Focuses on Care Quality
Recognizing that health care organizations are focusing on ways to improve the quality of care physicians deliver, the 50-physician Minnesota Gastroenterology, PA, is fostering a quality-oriented approach to patient care. “The real essence of quality is value,” says Scott R. Ketover, MD, president and chairman of the board of Minnesota Gastroenterology, PA, a group with 11 clinics in the Twin Cities. “We have to ensure that the services we provide have value to our patients as well as to the organizations that are paying for these services.” While gastroenterologists are driven to pursue high quality for the same reasons as other physicians, growing competition from other providers makes proving that the physicians are indeed providing high quality care particularly important in gastroenterology. “By embracing quality improvement and reporting initiatives, gastroenterologists can solidify their position as the premier providers of certain services,” Ketover notes. “Our field requires us to straddle two worlds. We provide cognitive services, which involve consultative medicine in the office and in the hospital, as well as procedural services, which require exemplary endoscopic skill.

Seven Questions Managers Should Ask
Given the pressures gastroenterology practices confront everyday, many gastroenterologists are finding it is critical to strive for effective and efficient management of every aspect of their practices. “Per-service revenue continues to decline, expenses keep rising, and the demand for services remains high,” explains Cecile M. Katzoff, MGA, CGCS, vice president of the American Gastroenterological Association (AGA) in Bethesda, Md. “Taken together, these factors make practice efficiency a critical goal for all gastroenterologists.” An expert in gastroenterology practice management and director of the Center for GI Practice Management and Economics, Katzoff says, “Typically, gastroenterologists are concerned about scheduling patient appointments and procedures as quickly as possible. The long wait times that are typical of most gastroenterology practices are detrimental to patient care, relationships with referring physicians, and patient satisfaction.”

PCPs Pursuing Aesthetic Medicine
Seeking new sources of revenue, physicians are entering the medical spa business. The International Spa Association (ISA) estimates that as of the middle of last year, physicians had opened more than 900 medical spas in the United States. In addition, thousands of physicians have left their practices to work for or affiliate with a physician-owned medical spa or have added aesthetic medical services to their practices. Two complementary trends are fueling the growth of these physician-owned spas. First is growing consumer demand, particularly among baby boomers, for less-invasive and non-surgical procedures to help fight the external manifestations of the aging process. Second is an increasing supply of motivated physicians, who are frustrated with the hassles inherent in the insurance-based reimbursement system. Once considered the domain of dermatologists and facial/plastic surgeons, aesthetic medicine is attracting an increasing number of primary care physicians, ob-gyns, gastroenterologists, and emergency room physicians. While this trend attracts a rising number of clinicians, it is also controversial, especially because of the growing shortage of PCPs. Additionally, there are legal, ethical, and competency issues regarding medical spa ownership.

Redesign Fosters Quality Improvement
Many medical and professional organizations, including the Institute of Medicine, the Institute for Healthcare Improvement, and the American College of Rheumatology, have recognized that the redesign of patient care processes is critical to making necessary improvements in care quality, efficiency, and service. In its landmark 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine identified important deficiencies in quality of care and highlighted process redesign as an imperative. In light of this imperative, practice redesign should be a priority for all medical specialties, including rheumatology, says Eric D. Newman, MD, director of the Department of Rheumatology, and vice chairman of the Division of Medicine at Geisinger Medical Center in Danville, Pa. “All practices have quality care gaps we need to address,” he asserts. “Aside from our responsibility to our patients, physicians should understand that their practices will not remain viable into the future if they do not learn to improve their efficiency, effectiveness, and quality. Virtually every governing body and professional organization involved in patient care is scrutinizing physicians and measuring our performance, using its own metrics if we can’t provide them ourselves.”

Physicians Join the Blogosphere
Benjamin Kruskal, MD, PhD, misses the days when he had time to sit with his colleagues over a cup of coffee to discuss clinical and practice-related concerns. A pediatrician, Kruskal has joined several physician-only online communities and started his own blog to interact with physicians and
others in health care. In March, Kruskal launched his blog (at http://drbensblog.com) to add his voice to the debate about how “to improve our health care system from the micro to the macro level.”
A blog (short for “web log”) is an online journal or personal diary that can be updated regularly with easy-to-use content management software. Typically, blogs include a front, or home page, with dated posts starting with the most recent, a list of topic categories, a dated archive, and links to other related online content. Most blogs allow visitors to post comments in response to the blogger, often leading to an ongoing dialogue about issues.

Take Steps to Avoid Claim Denials
Few medical practices can afford to give away income as a result of claims denials. Yet, some practices ignore denied claims, finding the cost and effort of pursuing them not to be worth the time and expense. Consultants estimate that the average practice loses about 10% of gross billings due to lost, forgotten, or incorrectly prepared charges. Experts estimate that reviewing, revising, and resubmitting claims costs at least $4.40 for each rejected claim. “For this reason, it’s very important to make sure claims are accurate the first time around,” says Roberta L. Buell, a reimbursement consultant in Sausalito, Calif.

Payers Call for More Focus on Quality
In the past few years, health care organizations have begun to define quality of care and to establish quality measurement tools to assess the processes and outcomes of care. Some of these initiatives have focused on data collection and measurement and have resulted in the identification of significant variations in how care is delivered. These efforts are affecting physicians in every specialty including oncologists, rheumatologists, pulmonologists, and allergists. A number
of these efforts are aimed at improving care for patients with chronic conditions in part because such care is costly and there is a rising number
of patients needing such care. But other specialists have been affected as well. The American College of Rheumatology, in Atlanta, says the focus on quality will affect how physicians treat patients and how physicians are reimbursed for services.