Health Bills In Congress Won’t Fix Doctor Shortage
By Phil Galewitz, KHN Staff Writer
OCT 12, 2009
Even as Congress moves to expand health insurance coverage to millions of Americans, it’s doing little to ensure there will be enough primary care doctors to meet the expected surge in demand for treatment, experts say.
“I don’t see anything in the legislation that will greatly increase the primary care pipeline,” said Dr. Russell
“We can’t bend the cost curve without increasing primary care providers,” said Robertson, who is also chair of family and community medicine at Northwestern University’s Feinberg School of Medicine in Chicago.
Add More Residents? ‘Dead on Arrival’
Almost everyone agrees on how to build up the supply of primary care physicians: create more residency positions at teaching hospitals for family doctors and internists to complete their training and significantly increase how much primary care doctors get paid by Medicare and other insurers. But there’s resistance to these steps because of their costs.
Source: Dill, Michael J. and Edward S. Salsberg. 2008. The Complexities of Physician Supply and Demand: Projections Through 2025. Association of American Medical Colleges: Washington, D.C.
A proposal backed by Senate
Instead, the House and Senate overhaul bills would redistribute about 1,000 unfilled residency positions to teaching hospitals that commit to creating more primary care residencies. The Senate Finance Committee bill would give 15 mostly southern and western states preference for those positions because they have a high proportion of doctor shortages or a low percentage of medical residents. Ten of these states have representatives on the Finance Committee.
Proposals to significantly increase Medicare payments for primary care doctors have gone nowhere in part because the money would come from payments to higher-paid specialists — who, not surprisingly, oppose a pay cut.
As they now stand, the House and Senate overhaul bills call for a 10 percent bonus for primary care doctors for five years, an increase in Medicare payment rates that most experts say would have only a slight impact on encouraging new doctors to go into primary care careers. Family doctors on average make about $173,000, less than half of what specialists such as cardiologists earn, according to physician recruiters Merritt Hawkins & Associates.
Dr. Darrell Kirch, CEO of the Association of American Medical Colleges, said the extra training slots emanating from the redistribution of unfilled residency position would amount to a “drop in the bucket.” Kirch noted that after
Money Goes To Specialist Training
Dr. Ted Epperly, a Boise,
Some medical workforce experts applaud Congress for trying to target how it spends billions in medical education funds to help states with the biggest needs and to promote primary care over specialty care. “It’s good to see Congress for the first time step to the plate to work on rebalancing the physician supply,” said Dr. Mark Kelley, executive vice president of the Henry Ford Health System in
The number of residency training positions for all doctors has been flat for years. That’s because in a budget-cutting move in 1997, Congress froze the number of Medicare-funded medical residency positions. Since then, the U.S. population has increased by more than 30 million – making the need for additional medical residents particularly acute, according to the Association of American Medical Colleges. While some teaching hospitals have added residency positions using their own money, those slots have largely gone to train specialists who can improve the facilities’ bottom line.
The bills would also increase funding to the
Whatever the impact of those measures, they don’t address the main issue raised by experts such as Ken Raske, president of the Greater New York Hospital Association. Giving millions of Americans health insurance, while not increasing the doctor supply is a recipe for trouble in his view. “Providing a benefit that you can’t deliver the product on will be a real problem,” he said. “Without expanding the number of residency slots you are not increasing the pipeline.”
Health Bills In Congress Won’t Fix Doctor Shortage
My husband ask me why do you need to pay for professional insurance? My response to him was as follows: there are many advantages to having one's own policy which include:
1. The NP will have her/his own legal counsel with expenses covered.
2. The NP may be covered for incidents that occur out of the employment setting (depending on the terms of the policy).
3. The NP can purchase limits that may be higher than the employer's.
4. If the NP purchases an occurrence policy, the NP will be covered if he/she leaves the employer's practice, and need not purchase a tail.
The disadvantages of having one's own policy may include:
1. The plaintiff may draw the NP into the lawsuit, or attempt to keep the NP in a lawsuit longer than justified, in hopes of drawing on the NP's insurance. However, this may happen whether or not an NP has his or her own policy, as a plaintiff will not know until the discovery part of the litigation process whether or not the NP has an individual policy.
2. It is an significant expenditure.
A key complicating factor in obtaining malpractice coverage is that insurance companies are unfamiliar with the individual state rules and regulations for NPs.
Other problems include misunderstandings about scope-of-practice variations, prescribing issues and even nurse practitioner business entity.
Upon further explanation to my husband I told him that there are several ways to prevent malpractice suits and if one arises to make sure there is no merit to the lawsuit, here is a short list of preventative measures using the example of prescribing medications:
In a medical malpractice lawsuit, the defendant provider’s actions and decisions will be judged by looking at the information available to the provider at the time the medical decision occurred. Staying current and up-to-date about medications is critical to avoiding and minimizing risk.
It is more challenging than ever to stay current about prescription drugs due to the amount of information being produced, the speed at which it develops, and because sometimes there is conflicting and/or incomplete information.
There are various resources that should be consulted to stay current, including, but not limited to:
• Professional literature, journals
• Published research
• Continuing education programs
• Information from professional organizations
• Information from government agencies
• Knowledgeable colleagues/professionals with expertise
Resources for Providers
With the hectic schedules today of providers, may curtail the time available for reading, researching and continuing education about all the topics they wish to follow. It is important to find resources that are reputable and readily available when information is needed. Here are some accessible, online resources to consider:
• FDA Patient Information Sheets for more than 200 medications that provide basic facts about the medication, warnings, precautions and safety information. There are also healthcare professional information sheets and various other resources available on the website. http://www.fda.gov/cder/drug/DrugSafety/DrugIndex.htm
FDA MedWatch Program – You can sign up to receive e-mails from the FDA Safety Information and Adverse Reporting Program, MedWatch, for clinically important safety alerts. The e-mail also provides hyperlinks to obtain more detailed information. www.fda.gov/medwatch/index.html
• FDA Center for Drug Evaluation and Research has a variety of resources including, consumer information, drug safety podcasts, etc. http://www.fda.gov/cder/index.html
• National Institutes of Mental Health website has variety of resources and information available for physicians and patients. http://www.nimh.nih.gov/
• National Institute on Drug Abuse. http://www.nida.nih.gov/
• National Library of Medicine. http://www.nlm.nih.gov/
Medication monitoring guidelines
Another important part of collecting information about medications is to be knowledgeable about medication monitoring guidelines.
Put a medication monitoring system in place to keep track of and evaluate the effectiveness of medications prescribed. Such a system is a powerful tool that helps provide ongoing information about the patient that is essential in adjusting the treatment plan.
There are two principle benefits of effective communication:
• Improved quality of care
• Decreased professional liability litigation
Effective communication leads to improved:
• Diagnostic accuracy
• Patient involvement in the decision-making process
• Information retention
• Patient compliance with the treatment plan
• Patient satisfaction
• Patient retention
Ideally, documentation should accomplish the following:
• It should substantiate clinical judgment and choices
• It should demonstrate the knowledge and skill exercised during treatment
• It should provide contemporaneous assessment of the patient’s needs and behaviors
• It should document explanations of the treatment decisions, significant events, and revisions to the treatment plan
• Provide the most important defense in a medical malpractice lawsuit or an administrative action against your license
Poor documentation can result in:
• Mistakes or delays in treatment due to missing or inaccurate information
• Loss in malpractice litigation
• Loss of licensure
• Loss of accreditation status
• Loss of eligibility for reimbursement by payers
It is helpful to think about documentation in terms of “why” instead of just “what”. Thinking about why certain information is documented will naturally lead to the relevant information being included.
Basically, providers should document so that another professional could review the record and understand what happened in treatment and why. Remember the primary purpose of the record is for clinical care; this documentation approach is consistent with the goal of providing and supporting appropriate patient care.
Consider including in the record:
• Information about what actions were taken and why, AND
• Information about what actions were considered but rejected and why
The Standard of Care
If documentation is questioned how is it evaluated? What factors determine whether a record meets an acceptable standard?
There are many factors that could be used as evidence of the applicable standard of care for a particular patient care issue. Factors that could be relied upon as evidence of the appropriate standard of care include, but are not limited to, the following:
• Statutes (federal and state) – such as prescribing laws addressing items to be documented
• Regulations (federal and state) – such as regulations from a state medical board, the FDA, and the DEA about patient records
• Other materials from federal and state regulatory agencies – such as
o Policy statements
• Authoritative clinical guidelines
• Policies and guidelines from professional organizations
• Learned treatises
• Journal articles
• Research reports
• Accreditation standards – such as JCAHO standards
• Facility’s own guidelines, protocols, policies and procedures
Just finished by Advanced Pharmacology final and made a 100 ended up with a 91 (B) in the class, there goes my 4.0 GPA. Made an A in my Advanced Role Development class. Much needed 3 week break here I come!!!!!
Nurse Practitioner’s Clinical Pocket Guide
Waterproof and Reusable
by Ruth McCaffrey & Ellis Quinn Youngkin
Publisher F. A. Davis Company
ISBN 10: 0-8036-2167-1
ISBN 13: 978-0-8036-2167-1
Published Date: 2010
Review by: Terry L. South, RN, FNP-S
After much anticipation I finally received NP Notes which is a very nice clinical pocket guide. It is compact and will easily fit into your lab coat pocket, this little gem will be my pocket companion for years to come. They have produced a remarkable waterproof and reusable guide that allows you to write on the pages with a pen and then if you want to remove any of the written information or notes you made, simply take an alcohol pad and wipe the page clean. They have also provided on the third page a place to add sticky notes of 2 7/8 x 2 7/8. The tabs at the bottom are wonderful and allow easy access to the sections you need to find in a hurry. The tabbed sections include Screening, Assess, Labs, Differential Diagnosis which is abbreviated Diff Dx, they also have a Billing & Coding section, Meds, Complementary and Alternative Therapies also abbreviated as CAM, and a Tools section. The guide has a total of 260 pages that is packed with so much information that is pertinent to the field of nurse practitioners. This is one of the best purchases I have made and will use this on a daily basis throughout school and my career. This is a must for every nurse practitioner student as well as the practicing nurse practitioner. Highly recommend, I LOVE this pocket guide!
The back of the guide states:
The vital information you need!
HIPPA-compliant, write-on/wipe-off pages
Portable, indispensable, and pocket-sized.
Comprehensive guidance at your fingertips!
Quickly access the information most commonly needed in clinical practice, including an emphasis on prescribing and using tests to diagnose disorders.
Screening tools, including DHHS Health Screening Guidelines for Men & Women
Medicare Preventative Services
Guidelines for Cholesterol Management
RAFFT Questionnaire, and more!
Differential diagnosis charts for most common disorders seen in clinical practice
Complementary and alternative therapies
Billing and coding information, including CPT codes, ICD-9 codes, and more!
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