The physician quality reporting initiative--a gateway to pay for performance: what every health care professional should know

The Physician Quality Reporting Initiative (PQRI) is a pay-for-reporting (P4R) program sponsored by the Centers for Medicare & Medicaid Services open to all health care providers that treat Medicare patients. This P4R initiative provides financial incentives for participation and unlike most pay-for-performance (P4P) programs, there are no penalties for poor performance. PQRI therefore offers Medicare providers nationwide a low-risk opportunity to gain experience with reporting procedures likely to be incorporated into P4P reimbursement schemes. The 74 measures used during the first reporting period are applicable to both generalist and specialist providers and open participation in PQRI to a much broader audience compared with previous federal initiatives. Also in contrast to programs that measure hospital or group quality and reimburse for services at the health system level, measurement and reimbursement in PQRI directly affects individual Medicare providers. The combination of provider-level measurement and reimbursement and efforts to assess care delivered by both generalist and specialist Medicare providers highlights how this P4R initiative is truly a gateway to a P4P reimbursement system. Participation in the PQRI program provides useful experience to Medicare providers and their staff in preparing for future initiatives that try to tie quality to reimbursement.     

What every physician needs to know about disability insurance

Physicians and their patients rely on disability insurance to provide economic protection against unforeseen illness or injury. This article discusses various types of disability coverage and issues that arise in disability claims both from the perspective of the physician as treater as well as consumer.     

What every teacher needs to know about clinical reasoning

CONTEXT: One of the core tasks assigned to clinical teachers is to enable students to sort through a cluster of features presented by a patient and accurately assign a diagnostic label, with the development of an appropriate treatment strategy being the end goal. Over the last 30 years there has been considerable debate within the health sciences education literature regarding the model that best describes how expert clinicians generate diagnostic decisions. PURPOSE: The purpose of this essay is to provide a review of the research literature on clinical reasoning for frontline clinical teachers. The strengths and weaknesses of different approaches to clinical reasoning will be examined using one of the core divides between various models (that of analytic (i.e. conscious/controlled) versus non-analytic (i.e. unconscious/automatic) reasoning strategies) as an orienting framework. DISCUSSION: Recent work suggests that clinical teachers should stress the importance of both forms of reasoning, thereby enabling students to marshal reasoning processes in a flexible and context-specific manner. Specific implications are drawn from this overview for clinical teachers.     

Disciplining physicians: what every physician and health care administrator needs to know about the Health Care Quality Improvement Act

This article highlights the critical provisions of the Health Care Quality Improvement Act that must be considered by physicians and health care entities in conjunction with disciplinary actions. These include: when professional review actions are covered by the Act's immunity; what constitutes adequate notice and a fair hearing for affected physicians; when professional review actions should be reported to the National Practitioner Data Bank; and what must be reported.     

Childhood diabetes: what the case manager needs to know

An 8-year-old girl arrives in the emergency room with a 10-day history of excessive thirst, frequent urination, and weight loss. Her blood sugar is 1000 mg/dL, with urine positive for glucose and ketones. A 14-year-old obese teenager also arrives with dark, thickened skin over his neck and a blood sugar level at 800 mg/dL, with normal urine. The first child has type 1 diabetes and the second type 2 diabetes. As case manager, it is your job to inform the patients and their families that the children have diabetes, see that they are taught basic management skills, and facilitate discharge from the hospital.     

Sexual and gender minority health: what we know and what needs to be done

We describe the emergence of lesbian, gay, bisexual, and transgender (LGBT) health as a key area of study and practice for clinicians and public health professionals. We discuss the specific needs of LGBT populations on the basis of the most recent epidemiological and clinical investigations, methods for defining and measuring LGBT populations, and the barriers they face in obtaining appropriate care and services. We then discuss how clinicians and public health professionals can improve research methods, clinical outcomes, and service delivery for lesbian, gay, bisexual, and transgender people.     

Web 2.0: what a health care manager needs to know

Web 2.0 is one of the latest buzzwords for an assortment of emerging technologies on the Web. Health care managers need to know the benefits and drawbacks of these technologies before integrating them into organizational operations. In this article, we first illustrate the differences in health care management style and workflow between the Web 1.0 and Web 2.0 technologies. After defining and explaining some of the representative technologies, we discuss the benefits of Web 2.0 in general and the reasons why a health care manager should know these trends. And lastly, we list some caveats that a health care manager should know before fully embracing the technologies. The keys are to align the technologies with the culture and workflow of the organization and have a clear policy on their usages.     

Employment agreement: what every doctor (junior and senior) needs to know--Part 3

The final article in a three-part series, this article covers what should and should not be included in an employment agreement. For new recruits and hiring physicians alike, it provides a step-by-step guide to the key issues involved in contract negotiations. Four main topics are addressed: compensation, working conditions, termination provisions, and buy-in provisions. Contractual compensation issues include, among others, salary, bonus, insurance premiums, pension, moving costs, and loans. Contractual working condition issues include the term of the contract, vacation policy, call coverage, governance, CME policy, permissible outside activities, office hours, degree of physician autonomy, physical and human resources, and sick leave. Contractual termination provision issues include rights to termination, covenants not to compete, medical record ownership, and assignment. Contractual buy-in provision issues include probationary periods, the assets being purchased, valuation formula and financing.     

Safety and underwater birth—what every risk manager should know

Underwater birthing has become a popular birth practice in some areas of the country. Although many of these deliveries occur in a home birth setting, the practice has also been implemented in hospitals and birthing centers. There is continued controversy about the risks and benefits of underwater birthing (as opposed to hydrotherapy during labor), and many risk managers are unaware of these potential risks and benefits. The purpose of this article is to review the significant risks and benefits of underwater birthing, to review relevant literature and several Professional Organizations' Position Statements regarding underwater birthing, and to provide a safety checklist for hospital risk managers who wish to consider adding underwater birthing to their current scope of perinatal care.     

The Employment Agreement: what every doctor (junior and senior) needs to know--Part 2

The second of a three-part series examining the physician's Employment Contract, this article describes critical areas of operational due diligence and fundamental elements in the negotiation process. The initial article addressed the critical importance of value and cultural compatibility in group settings, plus financial due diligence details. The final piece will deal exclusively with the terms of the Employment Contract.     

MDS 3.0 section M: Skin Conditions: what the medical director needs to know

The Centers for Medicare and Medicaid Services has released the new Resident Assessment Instrument version 3.0, which went into effect October 1, 2010. The intention of the revised Resident Assessment Instrument is to improve health-related quality of life and care planning, and incorporate evolving standards of terminology, assessment, and technology. To reach this goal, Section M: Skin Conditions has been greatly expanded and will alter the process of pressure ulcer assessment in all long-term care facilities across America. Details of this assessment instrument include upgraded criteria for risk factors, staging, identification, tracking, and evolution of pressure ulcers. The medical director can and should assume a leadership role in education and collaboration with primary care physicians and wound clinicians to accommodate changes in revised Section M. Integrating the medical director into the facility's wound care program will improve the quality of care for residents of long-term care facilities.