Copyright

(c) 2010-2024 Jon L Gelman, All Rights Reserved.
Showing posts with label Physician. Show all posts
Showing posts with label Physician. Show all posts

Wednesday, August 20, 2014

Questions About Who Should Perform In-Office Surgeries

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

One of the hopes embedded in the health law was to expand the role of nurse practitioners and physician assistants in addressing the nation’s shortage of primary care providers. But a new study questions whether that’s actually happening in doctors’ offices.
Of the more than 4 million procedures office-based nurse practitioners and physician assistants independently billed more than 5,000 times in a year to Medicare – a list including radiological exams, setting casts and injecting anesthetic agents – more than half were for  dermatological surgeries.

That’s not surprising, according to Ken Miller, president of the American Association of Nurse Practitioners, because when patients are older, skin problems such as “boils, skin tags and warts” are pretty  typical.
“I think that’s where you’re going to see the majority of procedures that are occurring both in primary care and in some of the other specialties like geriatric clinics,” he said.
The Aug. 11 study, published in the JAMA Dermatology analyzing 2012 Medicare claims, is suggesting that nurse practitioners and physician assistants should face higher regulation if performing surgical procedures.
The study’s lead author, Dr. Brett Coldiron, a dermatologist and clinical assistant professor at the University of Cincinnati, said while the “intent for...

Monday, February 3, 2014

Substantial Credible Evidence Remains the Rule

Despite the informality of  a workers compensation hearing, the evidence relied upon by the hearing official must be substantially credible in order to meet the burden of proof to assess disability. When the claimant has had a history of a multitude of back injuries, sorting out the claims maybe a complicated and difficult process. The compensation judge is compelled to ascertain which accident  is the ultimate triggering incident that resulted in permanent disability

The last back claim of a worker did not meet the evidential standards to sustain a claim for disability when the diagnostic tests, as interpreted by the treating physician, did not support the evidential requirements to establish the assessment of permanent disability. 

A worker in New Jersey, who has a long history of back injuries, both at work and at home, was unable to meet the evidential requirements to to establish a case for increased disability. An MRI, interpreted by the treating physician, demonstrated no change in the injured workers medical condition following the last incident at work.

Accordingly, The NJ Appellate Division sustained the ruling by the compensation judge, who had held that proofs offered at trial were insufficient to meet the requirement of the statutory credible evidence standard. The trial judge was held to have correctly relied upon the treating physician’s diagnostic MRI taken subsequent to the last accident to rule out the final incident as the triggering episode that generated the claimant’s disability. 

Beausejour v Chamberlin Plumbing & Heating, Inc.,  2014 WL 300929 (N.J. Super. A.D.), Jan. 29, 2014

Saturday, January 11, 2014

DWC's IMR Meetings Premature

The noise over the volume of Independent Medical Review requests and Maximus' inability to cope with that volume is at top level and the California Workers' Compensation Institute's latest research paper is certainly going to add to the fury.

The Division of Workers' Compensation has scheduled round table meetings with interested groups for Monday and Tuesday. CWCI's release couldn't be more timely.

CWCI says that basically IMR (and underlying Utilization Review) are working as intended.

The say that only 5.9% of requested medical procedures are delayed, denied or modified through utilization review, and that three out of every four medical treatment requests are approved by claims adjusters without the need for additional oversight.

Moreover, CWCI found 76.6% of the 919,370 treatment requests it evaluated that were sent out for physician review were approved, 6.6% were modified and 16.9% were denied.

One-in-four treatment requests being sent for physician review and one-in-four of those physician-reviewed requests denying or modifying the recommendation means that 94.1% of treatments are approved and 5.9% are denied.

CWCI also reviewed 1,141 independent medical-review decisions that had been issued as of Jan. 2 and found 78.9% of denials are upheld by the administrative review and 21.1% are overturned.

Of the 919,370 medical treatment requests reviewed by CWCi researchers, "pharmacy" garnered fully 43% of all events - this is an astounding number and debunks quite a...
[Click here to see the rest of this post]

Friday, December 27, 2013

Friday, December 13, 2013

How Clinical Guidelines Can Fail Both Doctors and Patients

Today's post was shared by The Health Care Blog and comes from thehealthcareblog.com



Any confusion over the recent news of cholesterol guidelines in the U.S. is perfectly understandable. On the one hand, the guidelines suggest that nearly half the population should use statins to stave off heart attacks and strokes. On the other, use of the drugs is not with potential side effects and, to many, will offer no substantive benefits. The controversy highlights a problem mired in an outdated way of thinking about health care and the doctor-patient relationship.
Guidelines came about after generations of physicians wanted to bring something more than “opinion and experience” to the patient’s bedside. In the late 1960s legislation for the U.S. Food and Drug Administration was amended to call for a demonstration of efficacy and an assessment of benefits and risk as prerequisite to the licensing of any pharmaceutical. Modern clinical science resulted, first slowly and now with an avalanche of clinical trials, each pouring forth outcome data galore.
The Burden of Clinical Data
Clinicians are expected to stay current with this wealth of information. The modern medical curriculum instructs all budding physicians on how to evaluate the quality and the clinical relevance of all such contributions to the body of clinical science. Because some (or perhaps many) find this exercise overwhelming, there are organizations—many academic and some without any discernible relationships with purveyors that could pose...
[Click here to see the rest of this post]

It’s Doctors versus Hospitals Over Meaningful Use

Today's post was shared by The Health Care Blog and comes from thehealthcareblog.com



The Massachusetts Medical Society may be the first to notice that Meaningful Use EHR mandates favor large providers and technology vendors. Control over the Nationwide Health Information Network sets the stage for how physicians refer, receive decision support, report quality, and interact with patients. State health information exchanges and policy makers are caught in the cross-fire over health records interoperability. Are the federal regulations over Stage 2 being manipulated to put physicians and the public at a disadvantage?
On Dec. 7, the Massachusetts Medical Society took what might be the first formal action in the nation. A resolution stating:
“That the Massachusetts Medical Society advocate for a more open, affordable process to meet technology mandates imposed by regulations and mandates; e.g., that all Direct secure email systems, mandated by Meaningful Use stage 2, including health information exchanges and electronic health record systems, allow a licensed physician to designate any specified Direct recipient or sender without interference from any institution, electronic health record vendor, or intermediary transport agent.”
Scott Mace’s column Direct Protocol May Favor Large Providers and Vendors is the first to report on this unusual move by a professional society. Full disclosure: I’m a member of the MMS and the initiator of what became this resolution.
Meaningful Use is intended to support health reform by...
[Click here to see the rest of this post]

Wednesday, November 13, 2013

Professionalism and Caring for Medicaid Patients — The 5% Commitment?

Today's post was shared by NEJM and comes from www.nejm.org

Interview with Prof. Sara Rosenbaum on the health care safety net, Medicaid expansion, and access to care.
Interview with Prof. Sara Rosenbaum on the health care safety net, Medicaid expansion, and access to care.
Medicaid is an important federal–state partnership that provides health insurance for more than one fifth of the U.S. population — 73 million low-income people in 2012. The Affordable Care Act will expand Medicaid coverage to millions more. But 30% of office-based physicians do not accept new Medicaid patients, and in some specialties, the rate of nonacceptance is much higher — for example, 40% in orthopedics, 44% in general internal medicine, 45% in dermatology, and 56% in psychiatry.1 Physicians practicing in higher-income areas are less likely to accept new Medicaid patients.2 Physicians who do accept new Medicaid patients may use various techniques to severely limit their number — for example, one study of 289 pediatric specialty clinics showed that in the 34% of these clinics that accepted new Medicaid patients, the average waiting time for an appointment was 22 days longer for children on Medicaid than for privately insured children.3
Physicians have good reasons for not accepting Medicaid patients, as I learned from direct experience as a member of a nine-physician primary care practice in California. We accepted Medicaid patients, but it was difficult. Medicaid's payment rate was very low — we lost money on each Medicaid visit. When referrals were necessary, we often had to personally ask specialists to accept our patient....
[Click here to see the rest of this post]

Thursday, October 24, 2013

US Inspector General Wants More Disclosure By Back Surgeons Who Implant their Own Devices

Back surgery is a big business and the selling of implanted medical devices are costly transactions. The US Office of Inspector General has issued a report today that their should be more disclosure to patients when back surgeons implant their own devices.

"PODs have a substantial presence in the spinal device market. PODs
provided devices used in nearly a fifth of the spinal surgeries billed to
Medicare in FY 2011, and over a third of the hospitals in our sample
purchased spinal devices from PODs. Many of these hospitals began
purchasing from PODs after 2009. Also, few hospitals in our sample
required physicians to disclose their ownership in device companies,
such as PODs, to their patients.

"In FY 2012, hospitals that purchased from PODs performed more spinal
surgeries and had slightly more complex spinal surgery caseloads than
hospitals that did not purchase from PODs. After they began purchasing
from PODs, hospitals experienced increased rates of growth in the
number of spinal surgeries performed as compared to the growth rate for
hospitals overall. Determining the cause for the increased rate of spinal
procedures was beyond the scope of our review.

"In addition, our findings raise questions about PODs’ claims that their
devices cost less than other suppliers. Within the device categories we
examined, PODs’ devices either cost the same as or more than devices
from companies not owned by physicians. This, combined with the
volume of spinal surgeries we found at hospitals that purchase from
PODs, may increase the cost of spinal surgery to the Medicare program
and beneficiaries over time. Further, hospitals inconsistently required
physicians to disclose ownership interests in PODs to either the hospitals
or their patients. Thus the ability of hospitals and patients to identify
potential conflicts of interest among these providers is reduced.

"The Sunshine Act may improve the ability of hospitals and patients to
identify physicians’ investment in device companies. The Act will
require most PODs to report to CMS all physician ownership and
investment interests.18 CMS plans to list these companies and their
payments on a publicly available Web site.

Click here to read the complete report.

Sunday, September 8, 2013

Price of Vicodin Three Times More in Maryland and Pennsylvania When Dispensed by a Physician

Today's post was shared by WCBlog and comes from www.claimsjournal.com


New studies from Cambridge-based Workers Compensation Research Institute (WCRI) says the average price paid for physician-dispensed Vicodin, a commonly dispensed narcotic pain medication in Maryland and Pennsylvania, was three times more than the price paid for the same drug dispensed at a pharmacy ($1.46 versus $0.37 per pill in Maryland and $1.22 versus $0.37 per pill in Pennsylvania).

According to the studies, the average prices paid to physician-dispensers were often more than double the prices paid for the same drugs dispensed at a pharmacy. Issues related to physician dispensing in Maryland have been debated, but no change has been made.

Physician dispensing has been growing rapidly in Pennsylvania. In 2011, physicians dispensed 23 percent of workers’ compensation prescriptions and were paid 38 percent of what was spent for all prescriptions for injured workers. This was an increase from 17 percent of all prescriptions and 18 percent of total prescription costs three years earlier.

“In many states across the country, policymakers are debating whether doctors should be paid significantly more than pharmacies for dispensing the same drug,” said Dr. Richard Victor, WCRI’s executive director. “One question for policymakers is whether the large price difference paid when physicians dispense is justified by the benefits of physician dispensing.”

The Maryland  study found that prices paid to physician-dispensers for many common drugs...
[Click here to see the rest of this post]

Thursday, July 28, 2011

Deal or No Deal: Judge Relies on Court Appointed Physician

An Appellate Court has rule that a Judge of Compensation can select an independent physician to review the need for medical treatment. It doesn't matter whether or not the parties agreed formally or informally as to the binding effect of the physician's opinion as to causal relationship and the need for treatment.


The Court has discretion to merely rely upon the physician's opinion and reach a reach a decision based upon the report. The cost  of the evaluation is to be paid for by the employer /insurance carrier. Furthermore, the Court need not hold a hearing for oral argument on the issue and can reach a binding on the papers alone.


Thompson v. Quality Et al., 2011 WL 3107767, Docket No. A-1177-10T1 (NJ App. Div.) decided July 27, 2011.