Coverage wars. As reform takes effect, insurers drop child-only policies and threaten more cuts

As the first provisions of the healthcare reform law kick in, insurers are signaling they'll simply abandon business lines that are troublesome, such as child-only policies. America's Health Insurance Plans defends the moves as necessary in the wake of additional, mandated benefits. AHIP's "math doesn't make sense," says J. James Rohack, left, immediate past president of the American Medical Association.     

Tracking sexual contacts of HIV patients: a study of physician practices.

Notification of sexual partners of HIV-infected individuals has become a focus of debate at local, state, and national levels. Issues of confidentiality and ethical concerns continue to pose challenges to state and local health departments addressing this issue. We conducted a telephone survey with physicians in Syracuse, New York to ascertain opinions about HIV partner notification and the role of public health agencies in that notification process. In general, physicians mostly relied upon the HIV-infected individuals to notify their own partners but were supportive of enhanced efforts regarding partner notification.     

Multispecialty physician practices: fixed and variable costs,and economies of scale

Medical Group Management Association survey data from 1955 to 1999 was to assess fixed compared to variable cost and the existence of economies of scale among single- and multispecialty groups. During these intervening 44 years, physician operating costs were estimated to increase roughly three times the consumer price index. Among the multispecialty groups in 1999 at least 85% of total medical revenues were considered fixed costs when including a physician's compensation and fringe benefits. On the basis of relative value units (RVUs), 10 practitioners provided the maximum economies of scale. However, for multispecialty groups, based on a physician's total compensation, optimal efficiency occurred between 26 and 50 doctors. Those multispecialty practices with 51 or more MDs are thought to be "less efficient" for several reasons: they deliver care on multisites, experience a higher percentage of managed care patients, and are less effective in controlling their peers' use of time and resources.     

Physician's assistants in primary care practices: delegation of tasks and physician supervision.

Little information is available on factors influencing physicians (MDs) to delegate health care tasks to physician''s assistants (PAs). Information about assignment of tasks to PAs was sought from 19 MDs engaged in practice in primary care settings in Iowa. These MDs employed 28 PAs. Tasks assigned to PAs appeared to be those that MDs judged to require little or no supervision. Tasks that could be performed efficiently by other non-MD personnel were not asigned to PAs. However, PAs were observed at the practice sites to perform tasks which the MDs had indicated could be appropriately assigned to PAs, as well as some tasks that could be performed by other non-MD personnel. The MDs provided health care to 126 (13.6 percent) of the 925 patients seen by PAs for whom the sequences of patient-provider contact were recorded. In these settings, the PAs functioned with a high degree of autonomy in providing health care. These findings have implications for educators and potential employers of PAs.     

Responding to psychosocial needs: physician perceptions of their referral practices for hospitalized patients

Physicians play a critical gatekeeping function related to psychosocial problem identification and subsequent referral to appropriate hospital or community services. Thirty physicians on staff at a moderate-size, multiservice medical facility were interviewed to determine their perceptions regarding identification of and referral rates for psychosocial problems of their hospitalized patients. In addition to raising questions for further investigation, this article provides a useful structure for gathering data for use by hospital social work departments in developing strategies to enhance physicians' collaboration with hospital social workers.     

Increasing physician involvement In cholesterol-lowering practices: The role of knowledge,attitudes and perceptions

The study evaluated a multifaceted educational intervention systematically designed to increase physician involvement in cholesterol-lowering practices. We hypothesized that knowledge, perceptions and behaviours would be enhanced in participating physicians, compared with controls. Method: Fifty-one family physicians were assigned randomly to three groups; the two experimental groups attended a training workshop, received physician and patient education materials and ongoing consultant support. One experimental group also received a “cuing” intervention. The control group received no interventions. Outcome measures included knowledge and attitude scores, self-efficacy perceptions, and physician dietary counselling behaviour. Measures were taken at pretest, 6 weeks and 15 months later. Results: Intervention group physicians achieved significantly higher knowledge scores than the control group at the six-week test; the differences disappeared at 15 months. Attitudes, self-reported practices and overall self-efficacy scores were similar across groups. Within group variation was highly significant. Physician dietary counselling scores were significantly higher in the intervention groups (p = 0.0001). Some associations were seen among knowledge, attitude, self-efficacy and dietary counselling scores. Conclusion: Physician behaviour change in cholesterol reduction may not depend entirely upon knowledge, attitudes and perceptions. This revised version was published online in June 2006 with corrections to the Cover Date.     

Precautionary practices for administering anesthetic gases: A survey of physician anesthesiologists,nurse anesthetists and anesthesiologist assistants

Scavenging systems and administrative and work practice controls for minimizing occupational exposure to waste anesthetic gases have been recommended for many years. Anesthetic gases and vapors that are released or leak out during medical procedures are considered waste anesthetic gases. To better understand the extent recommended practices are used, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted in 2011 among members of professional practice organizations representing anesthesia care providers including physician anesthesiologists, nurse anesthetists, and anesthesiologist assistants. This national survey is the first to examine self-reported use of controls to minimize exposure to waste anesthetic gases among anesthesia care providers. The survey was completed by 1,783 nurse anesthetists, 1,104 physician anesthesiologists, and 100 anesthesiologist assistants who administered inhaled anesthetics in the seven days prior to the survey. Working in hospitals and outpatient surgical centers, respondents most often administered sevoflurane and, to a lesser extent desflurane and isoflurane, in combination with nitrous oxide. Use of scavenging systems was nearly universal, reported by 97% of respondents. However, adherence to other recommended practices was lacking to varying degrees and differed among those administering anesthetics to pediatric (P) or adult (A) patients. Examples of practices which increase exposure risk, expressed as percent of respondents, included: using high (fresh gas) flow anesthesia only (17% P, 6% A), starting anesthetic gas flow before delivery mask or airway mask was applied to patient (35% P; 14% A); not routinely checking anesthesia equipment for leaks (4% P, 5% A), and using a funnel-fill system to fill vaporizers (16%). Respondents also reported that facilities lacked safe handling procedures (19%) and hazard awareness training (18%). Adherence to precautionary work practices was generally highest among nurse anesthetists compared to the other anesthesia care providers. Successful management of waste anesthetic gases should include scavenging systems, hazard awareness training, availability of standard procedures to minimize exposure, regular inspection of anesthesia delivery equipment for leaks, prompt attention to spills and leaks, and medical surveillance.