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Preventive Health Examinations Account for Approximately 1 in 12 Outpatient Visits Among U.S. Adults

An estimated 63.5 million U.S. adults visited a physician for a preventive health or gynecological examination each year between 2002 and 2004, at an annual cost of approximately $7.8 billion, according to a report in a recent issue of Archives of Internal Medicine.

“The value of many preventive health services is well established, but the role of preventive health examinations (PHEs) (also called periodic health evaluations) for health promotion and screening of disease risk factors and subclinical illness remains controversial,” the authors write. Two-thirds of patients and physicians believe it is important for patients to receive a yearly checkup; however, strictly preventive general health or gynecological examinations are not recommended by major North American clinical organizations.

Ateev Mehrotra, MD, MPH, of the University of Pittsburgh School of Medicine and RAND Health in Pittsburgh, and colleagues, analyzed data from a nationally representative survey of office based physicians conducted between 2002 and 2004. Randomly selected physicians completed a one page form detailing their encounters with each of 30 randomly selected patients during an assigned reporting week.

Over the three years of the survey, 181,173 outpatient visits occurred, of which 5,387 were preventive health examinations and 3,026 were preventive gynecological examinations. Nationwide, this is equivalent to 44.4 million adults (20.9 percent of the population) receiving preventive health examinations and 19.4 million women (17.7 percent of adult women) receiving preventive gynecological examinations each year.

The rates of preventive health examinations varied by region, with individuals in the Northeast 60 percent more likely to receive one than those in the West, and by insurance type, with the uninsured half as likely to receive one as those with private insurance or Medicare.

Preventive services such as mammograms, cholesterol screening and smoking cessation counseling were provided at 52.9 percent of preventive health examinations and 83.5 percent of preventive gynecological examinations. However, only 19.9 percent of eight preventive services were provided at these examinations as opposed to other types of physician visits.

“For example, mammograms ordered at preventive health examinations and preventive gynecological examinations accounted for 22.9 percent and 44.7 percent of all mammograms, respectively,” the authors write. “In contrast, of all visits with weight reduction counseling, only 8.8 percent were preventive health examinations and 1.1 percent were preventive gynecological examinations.”

“Preventive health examinations and preventive gynecological examinations are among the most common reasons adults see a physician,” they conclude. “These visits frequently include preventive services, but most preventive services are provided at other visits. These findings provide a foundation for continuing national deliberations about the use and content of preventive health examinations and preventive gynecological examinations.” 

Reference 

1. Arch Intern Med. 2007;167(17):1876-1883. 1.

Facing the Unanticipated Consequences of Healthcare Information Technology

Researchers at the University of Pennsylvania School of Medicine and the Agency for Healthcare Research and Quality (AHRQ) have developed a framework to help healthcare facility managers, physicians, and nurses handle the tough challenges of implementing health information technology (HIT) by directly addressing the unintended consequences that undermine safety and quality.

As documented in a 2005 JAMA article by Penn’s Ross Koppel, PhD, computerized physician order entries (CPOE) reduce medication errors due to transcription or handwriting deficiencies but produce many unintended consequences. For example, in some CPOE systems, physicians must enter the patient’s weight before ordering some types of medications. Physicians will often insert an estimated weight just to order the desired medication, without being able to indicate it as an estimation. That number is then used by subsequent physicians for medications requiring more careful weight measurements. Koppel is the principal investigator of an AHRQ-supported study of hospital workplace culture and medication error at Penn’s Center for Clinical Epidemiology and Biostatistics and a faculty member in Penn’s Sociology Department.

In this new paper, co-authors Koppel, AHRQ’s Michael I. Harrison, PhD, and Shirly Bar-Lev, PhD, from the Ruppin Academic Center in Israel, show managers and clinicians how to avoid or catch unintended consequences before they cause lasting harm. This study appears in the September issue of the Journal of American Medical Informatics Association.

Use of sophisticated HIT in healthcare facilities is increasing dramatically. In addition to CPOE, other examples in which unintended consequences can occur are decision support systems and electronic medical records. Healthcare facilities are investing millions of dollars in HIT as they seek to improve patient care, safety, efficiency, and cost savings. Yet the results are often disappointing, say the researchers.

“Managers and clinicians need to prevent more undesirable side effects and recognize unforeseeable consequences early on,” says lead author Harrison. “Then they can take steps to remedy them before damage mounts.”

The authors demonstrate how new HIT changes workplace processes and how practitioners alter these technologies during use. The authors call their new paradigm “Interactive Sociotechnical Analysis.”

“We are strong proponents of HIT,” say Harrison and Koppel. “But introducing HIT is not like adding a fax machine. HIT involves a whole set of activities and interactions with existing IT, people, the built environment, and with other systems. These interactions generate unpredictable developments. We map these developments to inspire greater awareness of IT implementation problems and increased action to improve new IT systems.”

“Decision makers are taking unnecessary risks if they wait for HIT projects to run for a year or two before doing a posthoc evaluation,” observes Harrison. “Real time evaluations can reveal unintended consequences as they emerge, allowing remedial action to be taken.” 

Source 

1. University of Pennsylvania School of Medicine 

Financial Losses in Most Regions, Despite Increases in Physician Compensation

According to findings in the American Medical Group Association’s 2007 Medical Group Compensation and Financial Survey, most specialties saw modest increases in compensation in 2006. In that year, 92 percent of the specialties experienced increases in compensation, with the overall average increase around 4.8 percent.

The primary care specialties saw about a 4 percent increase in 2006, while other medical and surgical specialties averaged around 6 percent. The survey also found that, on average, only organizations in the Western region were operating at a profit ($17,317 per physician), whereas organizations in the Southern region were operating at a significant loss (-$6,049 per physician).

The survey found that during 2006 the specialties experiencing the largest increases in compensation were pulmonary disease (11.51 percent), infectious disease (9.63 percent), psychiatry (7.54 percent), and cardiology — cath lab (7.08 percent). Interestingly, cardiac/thoracic surgery saw one of the largest decreases in compensation in 2006 (- 2.13 percent), after having one of the largest increases in 2005 (11.47 percent), and cardiology saw only a modest increase in 2006 (1.99 percent) after a substantial increase in 2005 (10.21 percent).

“The survey indicates that compensation increases continue to fluctuate only marginally for most specialties,” says Donald W. Fisher, PhD, president and CEO of the American Medical Group Association (AMGA). “With the negative impact of declining reimbursements, competition for specialists, the cost of new technology, and other factors on practice revenues in most parts of the country, this situation is clearly unsustainable. Quality care and quality outcomes remain the highest priorities of these medical group practices, regardless of the downswings and negative variances in financial compensation.

Increased capital outlays by the groups continue to be directed toward more robust health information technology to serve patients more effectively and efficiently, as well as toward enhancing patient educational programs and assessing patient satisfaction. The invested costs by medical groups in these enhancements remain in direct inverse proportion to the relevant compensation — if any — received from public and private payers.”

The section of the survey that examines financial operations found that medical groups were operating at an average loss of $119 per physician (median performance per physician). Although this is a clear improvement over last year’s findings (-$1,264 per physician) and most regions experienced improvement, medical groups in the Southern region continue to operate at a significant loss (-$6,049 per physician). In 2005, these groups were operating at an average loss of $1,539 per physician, and in 2004 they were operating at an average loss of $1,365 per physician. Medical groups in the Eastern and Northern regions also continue operating at a loss (-$3,727 and -$2,944 per physician, respectively), although Northern groups have seen substantial improvement since 2005 (-$8,111 per physician). Groups in the Western region were performing much better — at $17,317 per physician — a significant improvement over last year ($7,970 per physician).

“In the face of the current economic climate, medical groups are rising to the challenge of delivering the highest quality, coordinated care to the patients they serve,” commented Fisher. “One of the components contributing significantly to the trends in financial performance of medical groups is the current payment model, and groups will face an additional burden with changes in work RVU values. Most of the groups represented in the survey are large organized systems of care that make substantial investments in technology, operations, and the most innovative care processes to best serve populations under their care, and are able to achieve remarkable results for their patients. Our current transaction-based reimbursement system is indifferent to these results and to the efforts of medical groups to elevate the standard of care in the U.S. Currently AMGA is working to address the inequities of the current payment model and develop a model that incorporates a substantial component reflecting achievement of quality results and rewards the effective coordination of patient care.”

The AMGA 2007 Medical Group Compensation and Financial Survey gives a complete financial picture of medical group operations in one volume, providing compensation, productivity, and financial operations data from approximately 43,000 healthcare providers throughout the United States, including 111 specialties, 30 other healthcare provider positions, and 17 administrative positions. The survey data includes starting salaries by specialty; medians, means, and percentiles; compensation/productivity ratios; and comparative data from previous surveys, as well as providing analysis by group size and geographic region. In the financial section, profiles are provided per physician FTE, square footage, and work RVU. In addition to staffing profiles, the financial data includes medians, capitation impact, accounts receivable analysis, and department level analysis. A section examines data specific to the academic/faculty practice environment. This year, a special section examines the impact of 2007 CMS work RVU changes. The 20th annual AMGA compensation and financial survey was conducted by the national accounting firm of RSM McGladrey, Inc. 

Source

1. AMGA

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