Page Title

From Applied Neurology March 2006
Profiling and Pay-for-Performance: Is It Quality or Cost That
Matters?

Managed care has a new angle to contain physician costs: physician
profiling to select or exclude clinicians from tiered networks. It was no
surprise to me last month when I received 5 insurance spreadsheets
detailing my practice profile. In essence, I was given a breakdown of
treatment costs for my patients (compared with those of my peers) in the
hope that I would change my management and referral habits.

Of course, I had known for some time that claims data were being mined.
But what came as a shock was that most of the expenses associated with
the episode of treatment group (ETG) methodology applied to my practice
were attributed to charges that were not under my control. For example, an
MRI scan of the brain-which cost the insurer an average of $391.11 per
study on my patients-was 186.78% more expensive than the average
$136.38 per study for patients going to other Metro New York-area
neurologists. Data like this are now being studied by managed care
companies to determine which providers are least cost-effective and to
discourage patients from going to them. In some cases, the doctors to
whom they are redirected are dubbed as providers of "higher quality of
care." As this strategy is tested in various parts of the country, many
physicians are wondering just how valid is this information, and how such
ratings will affect their patients.

To read more

From Neurology Today October 2005
Neurologists Shine in Darkness at Charity Hospital

On Saturday, August 27th at Charity Hospital in downtown New Orleans,
Dan Dumitru, MD, made his rounds somewhat distractedly. He'd heard the
news: Katrina, a Force-Five hurricane, was amassing energy in the Gulf and
poised to blast the city. As Chief Resident in Neurology, he had a choice to
make. Should he discharge his patients, all nine of them, the very poorest
and ill of New Orleans? Or should he and his staff just hunker down in the
massive stone structure and wait it out? Charity had withstood many storms
in its 200-year history. Dr.Dumitru decided to stay.

By week's end - after five days of operating without plumbing, electricity,
food, or sleep - Dr. Dumitru had reason to question that decision more than
once. "I kept wondering if I had made a mistake," he said.
Dr. Dumitru was lucky, however, in one respect: The two residents who
showed up Sunday turned out to be not only incredibly resilient but also
singularly resourceful, managing to care for incapacitated patients without
the benefit of monitors, often in total darkness, without water for washing
and without any offer of relief.

To read more

From Applied Neurology May 2005
Mobile Computing in Neurologic Practice

When Gordon R. Kelley, MD, was called to the ICU in Kansas City, Mo, to
evaluate a deteriorating patient who had apparently overdosed on
methadone, he was puzzled. CT and MRI scans revealed an obstructive
hydrocephalus associated with abnormal signals throughout the
cerebellum, basal ganglia, and hippocampi. He knew that these findings
were not consistent with a typical cerebrovascular injury, but he and other
treating physicians were unsure of the cause of the findings. Reaching for
his handheld computer, he entered several key words into his favorite
program, NERVLINE: cerebellum . . heroin . . . leukoencephalopathy.

Within seconds he found the first of a series of papers describing
symmetric lesions in the cerebellar and cerebral hemispheres of illicit drug
users who heat heroin on tinfoil and inhale the thick white smoke, a
technique dubbed "chasing the dragon."

To read more

From Medscape Neurology & Neurosurgery March 2005
Guest Editorial: Magic Bullets and Economic Realities

...And perhaps the most vexing conundrum, the one that often ultimately
exerts the greatest influence on physician behavior, was the harsh
economic reality related to any new drug's administration. Who was going
to pay for the drug? Would the costs of administration exceed the
reimbursement? Would the variability in payer responses be too difficult for
the practitioner to manage? In a healthcare environment where so many
issues have turned topsy-turvy, rather than asking who would fit the bill,
many were first asking who would foot the bill?

With a reimbursement system that often makes no sense, one that
continues to overweight the rewards for procedures while creating
disincentives for cognitive services, and whose policies limit, without any
clear logic, the locations in which services will be paid, who would wonder
why physicians are becoming increasingly dissatisfied? In the end, of
course, it is the patients who will bear the ultimate burdens resulting from
the lack of medical consensus, the proliferating bureaucratic roadblocks,
and the uncertainties surrounding new drugs.

To read more

From Neurology Today May 2004
How to Communicate Effectively with Patients: Advice from
the US Surgeon General

I learned one of my first lessons on the importance of clear health
communication when I was a Special Forces Medic in Vietnam
delivering care to the indigenous people of a small Montagnard village,”
US Surgeon General Richard Carmona, MD, told Neurology Today in a
phone interview. "Before I was allowed to see any patients, the village
chief invited me to his thatched hut, asked me many questions, and
wanted me to share a meal and drink the local wine.

“Only after that did he allow me access to his people. I was brought to see
the chief’s daughter, who had skin infections on her arm. I thought I would
look brilliant because I knew how to treat impetigo. I gave instructions that
I thought were clear – wash with Phisohex at the river
several times a day and take these penicillin pills four times per day. The
little girl got better, and the villagers wanted to express their gratitude, so
when we sat at the next reception ritual, they brought me
gifts – a crossbow and a bracelet.

“Then they brought out a ceremonial box containing a necklace with 28
Pen VK pills strung on it. Each day, they had put four pills on the string and
since that time, they had been placing the ‘beads’ around the neck of any
villager who became ill.”

Although Dr. Carmona’s story is 30 years old, the experience still holds
true. As neurologists, we recognize the value of engaging our patients in
thorough discussion of medication use, as well as disease management
and prevention. But perhaps what we fail to
recognize is that our attempts to get the message across are often
unsuccessful.

To read more

From The SureScripts Leadership Series
Testing the EHR Waters with Electronic Prescribing

Andrew Baumel, MD, one of six pediatricians at Framingham Pediatrics,
began using e-prescribing software in January of 2003. “One of the
greatest things about electronic prescribing is speed,” he noted. “Refills
are a snap, prescription history is readily accessible and I have the
confidence of knowing that patients get exactly what was prescribed
before.”

Ready access to a patient’s prescription history goes a long way in
ensuring patient safety, especially when the doctor is on-call covering
one of the other five members of his practice. When a patient calls in for a
prescription, Dr. Baumel is able to pull up their medication history and
verify which dosage and strength has been prescribed before.

To read more

From Applied Neurology September 2006
How Does Your Practice Compare? A How-To Guide to
Practice Benchmarking

Your paycheck has fallen steadily over the past few years. Everyone is
talking about the decline in reimbursements and the increase in overhead
costs. Although it is frustrating, it is not surprising. But before going back to
work with a business-as-usual attitude, consider this: While most
practices are faltering, some are quite successful--that is, they are
economically thriving. So what makes the difference?

Medical practices that perform well, even in rough economic times,
continually evaluate their operations. They ask: How are we doing? How
do we compare with others? Are we using the best practices? What can
we do better?

To get the answers, practices focus on benchmarking--the process of
analyzing indicators of business performance--and apply the information
toward improvements. Nearly all businesses do this to evaluate
productivity, utilization, financial status, and level of quality compared with
peers and competitors and to monitor operations over time. Benchmarks
can be applied to gauge a medical practice's success and critically
evaluate its shortcomings.

To read more

From Neurology Now March/April 2007
Virtual Support

Karen Cormac-Jones took her 9-year-old son, Ted, to 22 doctors over two
years, but no one could find the cause of his nausea, vomiting, and weight
loss. Bobbi Jerome had been going to the same rheumatologist for 10
years, but still had no definitive diagnosis. She didn't respond to anti-
inflammatory medications, so her doctors decided that the problem was
psychological and referred her for psychiatric evaluation.

What these two women have in common is that they ended up receiving
help from people they had never met-members of online communities who
had become experts in their neurological conditions.

Cormac-Jones found the Celiac/Gluten Sensitivity forum on BrainTalk
(brain.hastypastry.net/forums ) one day while doing an Internet search for
her son's symptoms. This forum saved my son's life, she says. Had I not
stumbled across this community, I would never have learned about the
tests that led to Ted's cure.

In Jerome's case, a BrainTalk member-physician detected tell-tale signs of
ankylosing spondylitis, a form of arthritis affecting the spine and joints. He
urged her to get screened for it with the HLA-B27 blood test. My doctors
reacted with stunned disbelief when it came back positive, says Jerome. It
was as if a dark cloud suddenly lifted-the symptoms were no longer
disjointed but had a cohesiveness that finally made sense.

To read more