Business of Medicine
Capitation | Contracting | Credentialing | Drugs/drug makers | Employment | Hospitalists | Liability | Managed care trends | New models of care | News | News briefs archive | Nonphysician providers | Pay | Physician organizations | Physician workforce | Preventive care | Primary Care | Regional focus | Reimbursement | Research | Unions | Miscellaneous
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Capitation
Amid tough times with capitation, doctors struggle to balance risk
Reimbursement cuts and the rising costs of drugs and hospital services put new pressures on physicians who take risk (May 2000)
What you need to understand about global capitation
Accepting risk for all patient care may seem like a good idea, but don't underestimate the pitfalls (April 1998)
Capitation: how not to lose your shirt
Physicians avoid catastrophic economic loss by passing the risk on to someone else or by insuring against it (November 1995)
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Contracting
In negotiations with health plans, some doctors taking a tough stance
Hospitals and physician groups have begun to walk away from contracts they say are unprofitable or too burdensome (July-August 2001)
How to detect trouble spots in contract negotiations
Even if your practice is not a big player, you don't have to be stuck with the first deal a health plan offers (June 1999)
Rising premiums may open door to direct contracting
Integrated delivery systems, specialty networks and large medical groups are in the best position to contract directly with employers (June 1999)
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Credentialing
Obstacles hurting states' efforts to revamp physician credentialing
In many states, efforts to streamline credentialing have been weakened (January 2000)
Are you ready for the new physician credentialing?
How new quality measures—not just the diplomas on your wall—will affect how you practice (March 1998)
Physician credentialing heats up
From for-profits to the AMA, everyone wants to dig into your background—sometimes for a price (April 1997)
New breed of report cards turns up the heat on doctors
HMOs and health plans are poised to release a new breed of report cards to do whatever it takes to change the way physicians practice medicine (January 1995)
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Drugs/drug makers
These drug reps come bearing facts, not freebies
Early results show that the 'unsales' approach is changing physician prescribing behavior. (July-August 2007)
Top five
classes of drugs prescribed for adults. (July-August 2007)
Drug-safety issues spur debate over monitoring
Physicians and policy-makers consider how new medications should be watched. (March 2005)
Letters
Readers discuss drug detailers. (October 2003)
Too close for comfort? How some physicians are re-examining their dealings with drug detailers
In the midst of greater attention on doctors' relationship with the drug industry, individual physicians' responses have been mixed. (July-August 2003)
Drug shortages raise new fears about patient care
As supply problems force physicians to substitute drugs, some worry about the risk of mistakes (December 2001)
New breed of gifts from drug makers: Good for care or crossing the line?
Drug makers are giving away services that can help physicians run their practices, but some worry whether medicine is crossing the line (January 2001)
Samples: cost-driver or safety net?
Drug samples are useful for treating the uninsured, but do they build demand for the most expensive medications? (January 2001)
Drug switching: lowering costs vs. adverse interactions, potential errors
Do pharmacy benefit managers' 'therapeutic interchange' schemes endanger patients? (July-August 2000)
How direct-to-consumer advertising is putting the squeeze on physicians
While patients are pressuring physicians to write scripts for inappropriate drugs, health plans are ordering doctors to hold the line on spiraling costs (March 1999)
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Employment
Think about exit strategies before signing that contract
Specific language should focus on noncompete clauses and your ability to tell patients that you are leaving. (April 2005)
When clinical practice isn't enough, some physicians find new careers
The job market for ex-clinicians is brisk—if you have the right stuff (March 2001)
As doctors leave hospital practices, some are finding a 'soft landing'
As they part ways, some hospitals are helping physicians make the jump to keep patient referrals coming (January 2001)
Walking away from corporate medicine
Fed up with the hassles of managed care, some are going it alone (October 1999)
Is the primary care market shrinking?
As some struggle to find work, there is talk about an oversupply (December 1998)
Corporate medicine's huge losses produce doctor layoffs, chaos
Around the country, physicians who sold their practice or simply contracted with a sinking health system are struggling (December 1998)
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Hospitalists
Beaming images overseas sparks controversy at home
Outsourcing trend promises savings and access but some worry that remote contracts take a toll on quality. (May 2006)
Hospital research moves from the basement to the bedside
The success of research at a community hospital depends on administrative buy-in and a multidisciplinary approach. (October 2005)
New role for hospitalists: managing other physicians
As hospitalist groups continue to grow, a new challenge has emerged: Hospitalists are now being called upon to learn personnel management skills. (Web Only)
Hospital medicine: New factors drive dramatic growth
Managing greater numbers of surgical and post-op patients are just two of many forces expanding the field. (June 2005)
Hospitalist leader looks at the new field's evolution
A growing body of evidence shows that inpatient physicians deliver efficient, cost-effective care. (October 2004)
Goodbye 'inpatient physicians,' hello 'hospital medicine'
The organization representing hospitalists has changed its name to reflect growth and changes in the field (April 2003)
Despite their booming numbers, hospitalists face growing pains
While the emerging specialty is growing and gaining acceptance, it faces some challenges in the coming years (May 2001)
Are hospitalists suffering from an identity crisis?
Hospitalists need to concentrate on how to better describe themselves to the public (June 2000)
Will woes of new management companies hurt hospitalists?
Many of the practice management companies that employ hospitalists appear to be struggling financially (February 1999)
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Liability
Steering clear of hospitalists' unique malpractice risks
The key is setting up systems to identify and avoid miscommunication, overreaching and work overload. (September 2006)
Philly's liability-rate crisis is far from over
Top schools are still a big draw, but staying is a tough sell for residents, subspecialists. (April 2006)
Why the nation's toughest elder abuse laws make some California physicians nervous
Problems include onerous reporting requirements and threats from malpractice attorneys (March 2003)
Letters
Members share their views on liability insurance and attracting students to internal medicine (February 2003)
As the malpractice crisis enters year two, doctors and insurers flee some markets
In addition to facing double-digit premium hikes, doctors in some states are losing access to malpractice coverage as insurers flee (April 2002)
Drug shortages raise new fears about patient care
As supply problems force physicians to substitute drugs, some worry about the risk of mistakes (December 2001)
With malpractice costs skyrocketing, some physicians are talking 'crisis'
Fallout of the litigious environment includes recruiting problems and defensive medicine (April 2001)
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Managed care trends
Changes in ambulatory medical care—1995 to 2005 (September 2007)
This Issue: Mandatory health coverage. (May 2007)
Vermont pilot tries home care for frail elderly and disabled. (March 2007)
Big employers bring health care in-house
Convenient clinics encourage workers to get all of their preventative care at work. (January-February 2007)
More doctors tell patients, 'We'll see you today'
Physicians who offer open access report happier patients and healthier revenues. (November 2006)
Physician fees are put under microscope
Price 'transparency' helps patients choose, but may not reflect the true cost of care. (September 2006)
Key 'medical home' model elements hit the market
More insurers are putting new money on the table to cut costs and improve care. (April 2006)
Tiered physician networks spark controversy
Doctors worry that health plans may use too little data to determine who's in and who's out. (September 2004)
California's new bonus programs: good news for doctors?
Will health plans truly reward physicians for quality or simply shift existing reimbursement to bonus pools? (March 2003)
A sampling of quality incentive programs
California is not alone in offering physicians incentives for quality (Web Only)
As they struggle to improve quality, HMOs try a new incentive: bonuses
Insurers have learned that financial rewards are an effective way to encourage innovation (June 2001)
Strategies to talk about managed care conflicts
Talking through fears about managed care issues can strengthen the patient-physician relationship (September 2000)
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New models of care
Home health link helps avoid costly hospitalizations. (May 2007)
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News
Will HSAs lead to smarter spending or sicker patients?
Internists are giving health savings accounts a mixed welcome. (May 2006)
Key health spending
A quick look at national health care spending. (May 2006)
Taking a tough stand on nonbillable care
Fed up, some physicians are charging patients for services they once gave away (February 2003)
Letters
Members share their views on liability insurance and attracting students to internal medicine (February 2003)
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News briefs
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Nonphysician providers
Letters
Readers comment on physician assistants' scope of practice and accommodating cultural differences. (June 2003)
Practices feel pain of industry-wide nursing shortage
Hiring and retaining nurses is becoming harder than ever (September 2001)
Doctor-pharmacist collaborations: cure for errors or threat to autonomy?
Questions about control and reimbursement make the idea a hard sell (March 2000)
Hippocrates beware: NPs eroding practice of medicine
Using NPs to supplant physicians goes against the Hippocratic oath and our views about practicing medicine responsibly (April 1998)
Too much independence for NPs?
At one N.Y. clinic, HMOs are treating—and paying—nurses like doctors (January 1998)
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Pay
A look at physician compensation
Median compensation for general internists rose almost 3% in 2003. (December 2004)
College calls on Calif. insurer to stop recoding E/M services. (December 2003)
A look at trends in physician pay
While overall pay remains flat, doctor-employees may face trouble (February 2001)
Physician pay remains stagnant
Despite some gains, inflation and workforce issues are eroding income (November 1998)
Specialists, not generalists, taking home more pay
In 1996, all physicians, regardless of their specialty, had to work harder for smaller pay increases (November 1997)
Physician pay: the bottom line
Despite the widespread belt-tightening, evidence shows that the situation is not so dire for all physicians (April 1996)
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Physician organizations
In tough markets, three primary care groups are learning how to make their size count
Making sure that bigger is better (October 2002)
IPAs down—but not out—with doctors
Despite a rash of recent IPA failures, physicians may have few other options (September 2001)
PSOs: Can they survive competition from Medicare HMOs?
Optimists view Medicare provider-sponsored organizations as the latest way to cut out the middleman and funnel health care dollars directly to physicians (October 1998)
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Physician workforce
Avoiding common scheduling and staffing mistakes
The seven-day-on/seven-day-off schedule is popular but it can lead to staff burnout, says expert. (September 2006)
Kaiser: California's big kid on the block
Bay Area physicians applaud the HMO's technology, lifestyle and team approach. (April 2005)
Should vaccinations be required for health care workers? (July-August 2004)
College endorses recommendations to expand physician workforce. (July-August 2004)
ACP leaders seek ways to revitalize internal medicine
Attracting more students and alleviating the frustrations of practicing internists are core concerns. (May 2003
What can internal medicine do to attract more students to careers in primary care?
Concerns about income and lifestyle are driving some students away from the specialty (December 2002)
Wanted: doctors willing to take ER call
Specialists and generalists say low pay and hassles are driving them away (November 2001)
A coming shortage of foreign-trained doctors?
Residencies have enough IMGs, but some see trouble ahead (September 2001)
How six medical trends will shape the new millennium
From physician supply to medical computing, these developments promise to guide physicians' future (January 2000)
Is the primary care market shrinking?
As some struggle to find work, there is talk about an oversupply (December 1998)
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Preventive care
Boom times for disease management leave doctors wanting more control
Physicians worry that vendors could interfere with doctor-patient relations (October 2000)
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Primary Care
Making the case for 'big doctoring' in primary care
A primary care advocate claims that generalists should take a broad view to strengthen their role in American medicine—and speak with one voice. (December 2003)
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Regional focus
Why the nation's toughest elder abuse laws make some California physicians nervous
Problems include onerous reporting requirements and threats from malpractice attorneys (March 2003)
California's new bonus programs: good news for doctors?
Will health plans truly reward physicians for quality or simply shift existing reimbursement to bonus pools? (March 2003)
In Philadelphia, survival strategies blur lines between for-profit and nonprofit medicine
In a tough health care climate, the city's nonprofit health systems have responded as aggressively as any for-profit corporation (March 2002)
Hard times for medicine in the heartland
Drastic cutbacks are forcing rural providers to make tough choices (November 1999)
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Reimbursement
Doctors debate P4P, address impact on primary care. (July-August 2007)
The CMS is now accepting new provider ID applications. (July-August 2005)
TRICARE: Is the military program turning around?
Some TRICARE beneficiaries find it tough to find physician services because the program's provider networks are overburdened or inadequate. (March 2005)
Letters
Readers discuss overhead, internal medicine crisis, performance measures. (May 2004)
Medicare's new office-drug payment policy has oncologists concerned about access
Because of reduced fees, physicians say office infusion services may be at risk. (April 2004)
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Research
Getting the most out of community-based research
By paying attention to ethics and logistics, physicians can find intellectual and financial rewards in research. (April 2004)
Wanted: physicians interested in clinical research
While you'll have to retool parts of your practice to meet new challenges, you can expect payoffs—including new revenues (April 2002)
Marriage of town and gown brings clinical research to busy practices
While academic centers' new research networks have enticed some community physicians to get involved in clinical trials, the networks are experiencing growing pains. (February 2001)
Community-based trials under scrutiny
Critics worry about conflicts of interest and quality of research (July/August 1999)
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Unions
Cultural conflicts and antitrust laws dog collective bargaining by doctors
Even as organized labor appears to be gaining a foothold in medicine, cracks are forming (December 1999)
Physicians and unions: a good match?
Despite victories for doctors, some worry the profession will suffer (July/August 1998)
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Miscellaneous
Dispensing drugs on site may help with patient compliance
March ’08
Will bylaws' clash change physicians' admitting privileges?
The current debate may radically affect the relationship between primary care physicians and hospitals. (April 2005)
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