Denying patient requests lowers physician ratings, UC Davis study finds Patients who ask for specialist referrals, laboratory tests or certain medications and don’t get them tend to be less satisfied with their physicians than those whose requests are fulfilled, new research from UC Davis Health shows. The study, “Association of Clinician Denial of Patient Requests with Patient Satisfaction," was published in the January 2018 issue of JAMA Internal Medicine. Based on the results, the study’s authors recommend communications training for physicians that fosters positive experiences for patients without agreeing to all requests for particular diagnostics or treatments. “It is common for patients to come to the doctor’s office with specific requests in mind,” said lead author Anthony Jerant, M.D., chair of the Department of Family and Community Medicine at UC Davis Health. “Many of those requests are highly reasonable, but some are for services of questionable or low value that are unlikely to improve health or could even be harmful. Physicians rarely receive training on how to deal with those situations, which is crucial given the importance placed on patient-satisfaction survey results in improving health care and, in some cases, to determine physician compensation.” The study included over 1,100 patients in the family and community medicine clinic at UC Davis Health. Over the course of nearly a year, they answered survey questions about office visits with their doctors, including their requests for medical services, assessments of physician communications and understanding, and overall physician ratings. Patients in the study made nearly 1,700 specific requests of their doctors. When fulfilled – which was about 85 percent of the time – satisfaction with clinicians was generally high. However, when patient requests for referrals, pain medications, other medications or tests were denied, clinician satisfaction ratings significantly lowered – by 10 to 20 percentage points. The authors now hope to study whether training physicians to effectively manage patient requests could improve this situation. Based on previous research, mostly related to antibiotic use, Dr. Jerant believes a strategy known as watchful waiting — a middle ground between a flat denial and immediate “yes” – could be useful to physicians. “It is challenging for primary care clinicians to balance patients’ needs, good stewardship of health care resources and time efficiency during office visits,” said Dr. Jerant. “Training clinicians to effectively handle patient requests could help them achieve that balance in their practices.” January 30, 2018 General Physician-Patient Relationship, Quality of Care 0 0 Comment Read More »
CHPI publishes physicians' quality ratings for cycle 2 On March 22, 2017, the California Healthcare Performance Initiative System (CHPI) released its second cycle of physician quality ratings to the public. The ratings can be accessed at CHPI’s newly launched website, CAqualityratings.org, which allows consumers to search ratings on approximately 10,000 California physicians. As previously reported in September 2016, approximately 13,000 physicians in California received their individual quality measurement scores for the second cycle of the CHPI quality rating program. The program rates physicians using claims data from Medicare fee-for-service, Anthem Blue Cross, Blue Shield of California and UnitedHealthcare. This claims data includes both commercial and self-funded health plan data from HMO, PPO, POS and Medicare Advantage products. The individual quality measurement scores were based on claims data for patient care provided January 1, 2012, through December 31, 2014. Physicians were assigned a star rating of one to four stars, based on where they fall as a percentile within a “peer group,” for each measure as well as a composite score. For more information on the CHPI Cycle 2 rating methodology, visit the CHPI website at www.chpis.org. CHPI has also published an FAQ on its rating program. If you have questions or concerns about the CHPI rating results, email chpicorrections@pbgh.org and expect a response within 48 hours. April 19, 2017 Managed Care, Medicare Managed Care, Medicare, CHPI, Quality of Care 0 0 Comment Read More »
Physicians encouraged to verify CHPI data by November 11 Earlier this month, approximately 13,000 physicians in California received their individual quality measurement scores for the second cycle of the California Healthcare Performance Initiative System (CHPI) quality rating program. Physicians can review and verify the accuracy of the data used to calculate their scores through the CHPI online portal through November 11, 2016. The program rates physicians using claims data from Medicare fee-for-service, Anthem Blue Cross, Blue Shield of California and United Healthcare. This claims data includes both commercial and self-funded health plan data from HMO, PPO, POS and Medicare Advantage products. The individual quality measurement scores were based on claims data for patient care provided January 1, 2012, through December 31, 2014. Physicians were assigned a star rating of one to four stars, based on where they fall as a percentile within a “peer group,” for each measure, as well as a composite score. Physicians who wish to verify the accuracy of the data used to calculate their scores can do so through the CHPI Review and Corrections portal. To access the review and correction portal, physicians will have to register using their username and registration token – both listed at the top left of each page of the report. Once registered, you will receive a confirmation email with instructions to create a password. According to CHPI, it will treat the data as complete and accurate if no corrections are made. This means that even if a physician has not logged into the online portal during the review and correction period, CHPI will still publish the physician's data. Physicians who review their data and identify errors have until November 11, 2016, to report any discrepancies via the CHPI online portal. At the close of the physician review and correction period, discrepancies will be evaluated and corrected, with the results recalculated prior to the public release of the ratings. After November 11, the review and correction period will close, and physicians will be unable to review or report discrepancies. CHPI has advised the California Medical Association (CMA) that in addition to publishing the ratings publicly, it will also release an aggregated data file to the aforementioned participating plans following the review and correction period later this year. CMA inquired as to how the data would be utilized by the plans, but as of the time of publication, it was not known. For more information on the CHPI rating methodology, visit the CHPI website at www.chpis.org. CHPI has also published an FAQ on its rating program and a step-by-step review and corrections tutorial. Physicians who did not receive a letter but would like to confirm whether they are included in CHPI’s rating results can use the CHPI physician lookup at https://provider.medinsight.milliman.com/clients/CHPI/Public/Lookup. If you have questions or concerns about the CHPI rating results, you may email chpicorrections@pbgh.org and you should receive a response within 48 hours. Physicians who do not hear back within 48 hours or who identify a high volume of discrepancies in the data used to calculate their scores are encouraged to contact CMA at (916) 551-2061 or jwilliams2@cmanet.org. CMA will also be hosting a webinar on October 5 where CHPI staff will provide an overview of the quality rating project, along with step-by-step instructions on how physicians can review their data for accuracy before the quality scores are published. The webinar is free to CMA members ($99 for non-members). To register, visit the CMA website at www.cmanet.org/events. September 22, 2016 Managed Care, Medicare Medicare, Quality of Care, United Healthcare, Anthem Blue Cross, Blue Shield, CHPI 0 0 Comment Read More »
United Healthcare to delay Premium Designation assessment until January 2017 United Healthcare (UHC) has announced it will delay the next version of its Premium Designation physician quality and cost assessment program until January 2017. The program uses clinical information from health care claims to evaluate physicians against various quality and cost-efficiency benchmarks. Originally scheduled to publish its latest results in January 2016, UHC has stated it is delaying in order to allow for improvements to the quality measures and cost-efficiency metrics in response to feedback provided by physicians. This means that the currently posted ratings will remain in place through the end of 2016. Although the California Medical Association (CMA) recognizes that this additional delay may frustrate some physicians, UHC reports it is a necessary delay in order to allow it to make system changes to benefit physicians going forward. The most recent results were released publicly via UHC's online physician directory on January 1, 2015, and were based on claims data from January 1, 2011, through February 28, 2014. CCMA had previously voiced concerns about the UHC Premium Designation program citing reliance on data that was more than a year old to determine current physician cost and quality designations and for failing to adequately account for the performance of physicians who have modified their practice patterns since their last Premium Designation assessment. Premium Designation assessment results are accessible online on the United Healthcare website at www.unitedhealthcareonline.com. Physicians wishing to still dispute their 2015 Premium Designations may do so by submitting an online reconsideration request via the UHC website through July 2016. Physicians who encounter problems with their physician assessment reports or who have concerns regarding their Premium Designation can contact United Healthcare at (866) 270-5588. Practices that are unable to obtain answers to their questions or resolve their issues with United Healthcare directly should contact CMA. December 7, 2015 Managed Care Quality reporting, United Healthcare, Quality of Care 0 0 Comment Read More »
State issues new report cards for HMOs, PPOs, and large medical groups The California Office of the Patient Advocate (OPA) recently released its 15th annual “California Health Care Quality Report Cards,” which rates the state's health plans and medical groups on a four-star scale. Available in English, Spanish and Chinese, the report cards allow consumers to compare the quality of care that more than 16 million commercially insured consumers receive from the state’s 10 largest HMOs, six largest PPOs and more than 200 medical groups. The data for the report cards is drawn from claims data and patient surveys from 2013. Users can drill-down online to see specific plan performance on topics of greatest interest to them, such as chronic disease management, pediatric care and mental health care. The report cards have been released to coincide with the fall open enrollment period for many Californians and their families, including those purchasing coverage through Covered California, the state's health benefit exchange. Covered California's next open enrollment period runs from November 1, 2015, to January 31, 2016. The report cards are part of a larger national push to bring greater transparency to the health care industry and help consumers choose services that best fit their needs. The report cards are available at the Office of the Patient Advocate's website. October 31, 2015 General, Managed Care Quality of Care, Commercial Insurance, HMOs, PPOs 0 0 Comment Read More »
Deadline to verify CHPI quality data accuracy is July 31 In late May, approximately 18,000 physicians in California received a notice and their individual quality measurement scores for a new quality rating program through the California Healthcare Performance Initiative System (CHPI). The program rates physicians using claims data from Medicare fee-for-service, Anthem Blue Cross, Blue Shield of California and United Healthcare. Physicians will be assigned a star rating of one to four stars for each measure, based on where they fall as a percentile within a “peer group," plus a composite score. The individual quality measurement scores were based on claims data for patient care provided January 1, 2010, through December 31, 2012. Physicians can review and verify the accuracy of the data used to calculate their scores through the CHPI online portal through July 31, 2015. Physicians who did not receive a letter but would like to confirm whether or not they are included in CHPI’s rating results can use the CHPI physician lookup at https://lookup.medinsight.milliman.com. Click here for more information. July 24, 2015 General Quality of Care, Quality Reporting 0 0 Comment Read More »
Dementia communication conference coming to northern and southern California in July The California Partnership to Improve Dementia care is presenting a one-day conference, “I Already Told You...Don't You Remember,” a guide to excellence in dementia communications and behavior prevention without antipsychotic medication, in both northern and southern California in July. The conference will be offered in Sacramento on July 29 and in Lake San Marcos on July 30. The program will demonstrate dementia communication skills known to prevent or reduce the intensity of challenging behaviors, offer tips for coaching these skills in your own organization and share experiences from communities that have found these communications skills to be the “missing link” to antipsychotic reduction and culture transformation. Physicians, nurses, nursing home administrators and social workers are encouraged to attend. (Continuing education credits will be available for nursing home administrators, nurses and social workers.) The featured speaker will be internationally-known dementia educator and dementia communication coach Erin Bonitto, who will provide concrete strategies for this dilemma and demonstrate specific dementia communication skills. The California Partnership to Improve Dementia Care was formed in 2012 to improve dementia care and eliminate the misuse of antipsychotic medication in nursing homes. The partnership was launched by the Centers for Medicare & Medicaid Services, the California Department of Public Health and a diverse group of stakeholders, including the California Medical Association. The partnership offers numerous resources to assist nursing homes with culture change practices that improve dementia care, including workshops, videos and training materials designed to teach providers about models that enhance the care experience and empower residents and staff through best practices that achieve national and state goals. For more information or to register for the event, click here. July 20, 2015 General Quality of Care, Seniors and Persons with Disabilities, Aging 0 0 Comment Read More »
Bills to expand nurse practitioners', optometrists' scope of practice stall in Assembly committee A bill that would have allowed nurse practitioners (NP) to practice independently and prescribe drugs without physician oversight is finished, at least for the year. Senate Bill 323 was voted down 8-4 on June 30 in the Assembly Business and Professions (B&P) Committee. The committee agreed to take it up again on July 14, but the bill was pulled from the hearing by its author, Senator Ed Hernandez (D-Azusa). The California Medical Association (CMA) and the California Academy of Family Physicians led the fight against SB 323. Senator Hernandez also pulled a separate scope of practice bill, SB 622, that would have allowed optometrists to perform an array of supplementary procedures with little additional training. That measure would have permitted optometrists to perform scalpel surgeries, laser surgeries and intraocular injections. It was pulled on July 14 for the second time this month, ending its run in this year’s legislative session. CMA partnered with the California Academy of Eye Physicians and Surgeons along with a robust coalition, including local county medical societies, to warn lawmakers and the public about the dangers of this bill. “It’s clear that members of the committee saw the potential dangers of SB 622,” said CMA President Luther F. Cobb, M.D. CMA strongly believes that simply expanding the scope of practice of allied health practitioners to give them independent and/or expanded practice will do nothing to improve access to care or quality of care in our state. Allowing practitioners to perform procedures they simply aren’t trained to do can only lead to unpredictable outcomes, higher costs and greater fragmentation of care. Lowering certification standards and oversight puts the safety and health of patients at risk. This was the case a few years ago when eight veterans suffered “significant” vision loss, and another 23 suffered progressive vision loss, after optometrists at the Palo Alto Veterans Affairs Health Care System ignored requirements to refer glaucoma patients so their treatment could be monitored by ophthalmologists. During the June 30 hearing, former CMA President Paul Phinney, M.D., told the committee that in addition to the association's concerns about allied health professionals performing procedures for which they are not adequately trained, there is nothing in SB 323 that would augment the productivity of the state's NPs. About half of nurse practitioners in California do not practice primary care, he said, while the remainder practice in “large, integrated health care delivery systems.” “I worked in one of those health care delivery systems for almost 30 years, and I can tell you that the nurse practitioners in those systems are already very busy,” Dr. Phinney said. “There’s nothing in SB 323 that will augment the productivity of NPs in those systems, which represent a large percent of the remainder of NPs in our state that do primary care.” Assemblymember Jim Wood (D-Healdsburg) called SB 323 a “tough bill” and said he had concerns regarding oversight — particularly whether nurse practitioners would be overseen by an entity other than the Medical Board of California, which oversees physicians. “To have oversight from different entities that are overseeing the practice of medicine is problematic to me,” Assemblymember Wood said. Much debate also revolved around an amendment suggested by the B&P Committee — and refused by Hernandez — that would have applied the corporate bar on the practice of medicine to nurse practitioners — a provision of law that prevents lay corporate entities from interfering with the independent medical judgment of physicians. Organizations voicing their opposition to SB 323 at the hearing included the California Academy of Eye Physicians and Surgeons, the Medical Board of California, California Psychiatric Association, California Orthopaedic Association, California Society of Dermatology and Dermatologic Surgery, and the California Society of Anesthesiologists, in addition to CMA. “Today was a good day for the health of Californians,” Dr. Cobb said in response to the vote. “We commend the Assembly for rejecting SB 323, which would have significantly compromised patient safety.” July 20, 2015 General Scope of Practice, Advocacy, Nurse Practitioners, Optometrists, Quality of Care 0 0 Comment Read More »
Congress allows veterans to seek care outside VA system Congress yesterday sent a $17 billion landmark bill to President Obama that will help U.S. veterans avoid long waits for health care within the U.S. Department of Veterans Affairs (VA). There was overwhelming support in both the Senate (91-3) and House (unanimous) for the bill, which will provide $10 billion in emergency spending over the next three years to allow veterans to seek care from private doctors and other health professionals due to delays in the VA system. Veterans would have access to private doctors if they could not get an appointment with the VA within 30 days or if they live more than 40 miles from a VA clinic. The bill also includes $5 billion for hiring more VA doctors, nurses and other medical staff; and another $1.3 billion to open 27 new VA clinics across the country. The legislation also makes it easier to fire hospital administrators and senior VA executives for negligence or poor performance. The American Medical Association (AMA) applauded the move. “The AMA believes that all Americans should have timely access to health care, especially those who bravely serve our country,” said AMA President Robert M. Wah, M.D. “Our nation’s physicians can and should be a part of the solution to ensure America’s veterans can access the care they need and deserve.” August 4, 2014 General Hospitals/Health Care Facilities, Quality of Care, Veterans, Federal Legislation 0 0 Comment Read More »
DEA makes tramadol a Schedule IV drug Effective August 18, 2014, tramadol will be classified as a Schedule IV drug, according to a rule recently published by the U.S. Drug Enforcement Agency (DEA). The drug had been a non-controlled substance under federal law for almost 20 years. According to the DEA, the abuse of tramadol products has increased over the last several years, with it being used as a substitute for other opioids such as hydrocodone. Tramadol is a centrally acting synthetic opioid analgesic used in the management of moderate to moderately severe pain in adults. Tramadol is a novel analgesic having both opiate agonist activity and monoamine reuptake inhibition that contribute to its analgesic efficacy. Tramadol was first approved by the U.S. Food and Drug Administration (FDA) in 1995 under the trade name ULTRAM. Subsequently, the FDA approved generic, combination and extended release tramadol products. Tramadol is manufactured and distributed in various forms including tablets, capsules and liquid. The final rule imposes the regulatory controls and administrative, civil and criminal sanctions applicable to schedule IV controlled substances on persons who handle (manufacture, distribute, dispense, import, export, engage in research, conduct instructional activities with, or possess) or propose to handle tramadol. Physicians should be aware of the following: The change becomes effective on Monday, August 18, 2014. After that, all regulatory requirements applicable to schedule IV controlled substances will apply to tramadol. This includes specific rules relating to storage, recordkeeping, inventory, disposal and prescribing. Every DEA registrant who possesses any quantity of tramadol on August 18 must take an inventory of all stocks of tramadol on hand. In order to prescribe tramadol on or after August 18, 2014, prescribers will have to be registered with the DEA to prescribe Schedule IV substances. Any unfilled prescriptions/refills for tramadol after August 18 will have to follow Controlled Substances Act rules governing Schedule IV substances, and some patients may need new prescriptions Click here to read the final rule. July 15, 2014 General Drug Prescribing, Prescription Drugs, Drug Dispensing, Quality of Care 0 0 Comment Read More »
