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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_422"
                     title="Nurses Often Silent About Workplace Violence (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/HospitalBasedMedicine/WorkForce/tb/18335?impressionId=1265817890693"
                     
      The physical and verbal abuse nurses face on the job often goes unreported, according to an Australian survey.&lt;br&gt;
&lt;br&gt;Over the prior year, 52% of nurses in one community hospital said they had been physically assaulted and 69% reported being threatened with violence, according to Rose Chapman, PhD, of the University of Western Australia in Perth, and colleagues.&lt;br&gt;
&lt;br&gt;Verbal abuse was almost universal, being reported by 92% of respondents, the researchers wrote in the February issue of the &lt;em&gt;Journal of Clinical Nursing&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;However, only half mentioned the incidents to senior staff or co-workers, and just 16% filed an official report.&lt;br&gt;
&lt;br&gt;&quot;The reasons for not reporting are many and may include lack of time and management support and the belief that being attacked is &apos;just part of the job,&apos;&quot; they wrote.&lt;br&gt;
&lt;br&gt;The same is true in the U.S., where assaults and under-reporting appear just as common as suggested in the Australian survey, commented Kathleen M. McPhaul, PhD, RN, MPH, of the University of Maryland School of Nursing in Baltimore, who has been involved in such research in the U.S.&lt;br&gt;
&lt;br&gt;A culture change would likely be needed to make a real difference for nurses, Chapman&apos;s group suggested.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Hospitals would have to ensure that nurses have necessary support, education, encouragement, and time to complete official reports. Nurses who report abuse should get positive feedback from all levels of nursing, they said.&lt;/p&gt;
&lt;p&gt;&quot;If administrators and governments are serious in their intention to reduce workplace violence and provide staff with safe work environments, they should be seen to act on all reported [incidents],&quot; which is rare today, Chapman&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;However, currently there&apos;s no strong lever or incentive to address this kind of workplace abuse since hospitals focus mainly on patient safety as part of accreditation, and national and state workplace safety organizations have little mechanism for monitoring such incidents, McPhaul noted.&lt;/p&gt;
&lt;p&gt;The researchers&apos; survey was intended to reach all 332 nurses working at one nontertiary hospital across all departments  --  emergency, medical, surgical, maternity, pediatric, and mental health.&lt;/p&gt;
&lt;p&gt;The 113 nurses who responded were mainly women in their early 40s who worked part time.&lt;/p&gt;
&lt;p&gt;Among them, about three-quarters reported at least one incident of workplace violence over the preceding 12 months  --  25% said it occurred weekly, 27% said monthly, and for 25% it was rarer, at once every six months. &lt;ul&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Fully 30% of the nurses said they had been involved in an episode involving a weapon  --  often hospital equipment and more rarely a knife or gun.&lt;/p&gt;
&lt;p&gt;The number of total incidents was lowest among nurse midwives, with a mean of 1.67 per year.&lt;/p&gt;
&lt;p&gt;Not surprisingly, the rate was highest among emergency department and mental health staff, who reported an average of 46.43 and 40.39 episodes over 12 months.&lt;/p&gt;
&lt;p&gt;One reason behind the high risk in these two departments may be the &quot;shift to a community-based approach to mental health care and a reduction in mental health beds&quot; such that the same psychiatric patients that assault mental health department nurses are mainstreamed to the emergency department as their point of entry to the hospital, the researchers said.&lt;/p&gt;
&lt;p&gt;However, more years of experience or higher educational qualification didn&apos;t appear to protect nurses. Senior nurse unit managers and clinical nurse specialists actually reported more physical assaults than less senior nurses.&lt;/p&gt;
&lt;p&gt;Age and gender didn&apos;t predict occurrence or type of incident either.&lt;/p&gt;
&lt;p&gt;When nurses did report workplace violence or verbal abuse, it was most often to their immediate manager (29%), other senior nursing staff (14.5%), or to their friends and colleagues (6%).&lt;/p&gt;
&lt;p&gt;Overall, 30% of nurses who responded to the survey gave as their reason for not reporting that workplace violence happens all the time and is simply part of the job.&lt;/p&gt;
&lt;p&gt;Even among those who did make a report of some sort, half said they thought hospital management failed to act on it.&lt;/p&gt;
&lt;p&gt;In fact, when the researchers audited hospital records, they found that 42 official incident reports had been filed by nurses over the prior one year period, nearly always involving injuries.&lt;/p&gt;
&lt;p&gt;In 95% of the cases, the only action taken by the hospital was making staff in the area aware of the incident. No other actions had been documented.&lt;/p&gt;
&lt;p&gt;The researchers cautioned that the voluntary nature and limited scope of the study may have limited generalizability, although the occurrence of violence against nurses is likely similar across developed countries.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers provided no information on conflicts of interest.&lt;/p&gt;&lt;p&gt;McPhaul reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_228"
                     title="Nurses Should Have a Bigger Leadership Role in Healthcare"
                     score="-0.001"
                     href="http://www.medpagetoday.com/PracticeManagement/StaffingScheduling/tb/18080?impressionId=1265817890693"
                     
      &lt;p&gt;Opinion leaders across a wide variety of groups think nurses should have more influence in health policy, planning, and management, according to a new Gallup survey.&lt;/p&gt;
&lt;p&gt;Although nurses are viewed as being the most valued source of health information behind physicians, survey respondents rank them as the least likely of healthcare stakeholders  --  including patients  --  to have a great deal of influence in healthcare reform over the next 10 years.&lt;/p&gt;
&lt;p&gt;This despite the fact that among the 1,504 thought leaders in academia, insurance, health services, government, industry, and the corporate world polled, 51% said nurses are very important in reducing medical errors and improving patient safety, and 50% said they are very influential in improving the quality of patient care.&lt;/p&gt;
&lt;p&gt;The major barriers to increased nurse influence, nearly 70% of respondents said, are perceptions that they are lower on the totem pole than physicians when it comes to decision-making and revenue generation.&lt;/p&gt;
&lt;p&gt;When asked what could be done to ensure that nurses take on more leadership responsibility, the first priority, respondents said, was that they make their voices heard  --  56% had said that nursing lacks a single voice in speaking on national issues. More than half of respondents also noted that there was a lack of opportunities for nurses to advance into leadership positions.&lt;/p&gt;
&lt;p&gt;The survey, conducted by Gallup for the Robert Wood Johnson Foundation, examined professional views of nursing, nursing leadership, the future of the industry, and potential barriers to leadership roles for nurses among various healthcare-related groups. It included responses from opinion leaders in academia (276), health services (253), government (253), industry (253), insurance (237), and the corporate world (232).&lt;/p&gt;
&lt;p&gt;Nine out of 10 said nurses should have more influence in increasing the quality of care and reducing medical errors.&lt;/p&gt;
&lt;p&gt;About 85% said they wanted nurses to have more influence in promoting wellness and preventive care, improving efficiency and cost, coordinating care through the healthcare system, and adjusting care to meet an aging population.&lt;/p&gt;
&lt;p&gt;Additionally, 72% thought increased nurse influence would help the healthcare system adapt to the growing change in ethnic, racial, and cultural diversity in patient populations.&lt;/p&gt;
&lt;p&gt;The opinion leaders were also asked whether they feel there is a nursing shortage in the U.S. Just over 80% said Yes and of those, only 2% said it was not a serious problem.&lt;/p&gt;
&lt;p&gt;To blame for the shortage? Respondents cited a stressful/poor work environment (44% see that as a very important reason), not enough openings in nursing schools (40%), and too many nurses leaving the profession (37%). Only 22% cited low pay as very instrumental in causing the shortage.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_19_849"
                     title="Is Cash-Only Medicine the Next Big Thing?"
                     score="-0.005"
                     href="http://www.medpagetoday.com/PracticeManagement/PracticeManagement/tb/13347?impressionId=1265817890693"
                     
       As increasing numbers of physicians work longer and harder to maintain income levels in the face of declining third-party reimbursements, some have opted out. Not out of medicine, but out of managed-care contracts.
              &lt;p&gt; 
              &lt;p&gt;They&apos;re running cash-only practices.
              &lt;p&gt; 
              &lt;p&gt;And, instead of losing patients because they no longer take insurance, the recent job market has actually boosted the patient base for some cash-only doctors. Patients who have lost jobs -- and the health insurance that went with those jobs -- seek out cash-only practices, which typically charge less. 
              &lt;p&gt; 
              &lt;p&gt;Even patients who are still employed have seen deductibles soar, so that some insured patients essentially pay out of pocket for routine care. They, too, have been seeking out cash-only practices.
              &lt;p&gt; 
              &lt;p&gt;Will the current economic climate continue to increase the number of physician who go cash-only?
              &lt;p&gt; 
              &lt;p&gt;Seven out of 10 respondents to a &lt;em&gt;MedPage Today&lt;/em&gt; online spotcheck think so.
              &lt;p&gt; 
              &lt;p&gt;And so do a handful of new services -- such as &lt;a href=&quot;http://www.simplecare.com&quot; target=&quot;blank&quot;&gt;SimpleCare&lt;/a&gt; and &lt;a href=&quot;http://www.pricedoc.com&quot; target=&quot;blank&quot;&gt;PriceDoc&lt;/a&gt; -- aimed at bringing cash-only patients together with cash-only doctors.
              &lt;p&gt; 
              &lt;p&gt;&lt;strong&gt;Benefits and risks&lt;/strong&gt;
              &lt;p&gt;
              &lt;p&gt;Statistics on the number of cash-only physicians are hard to come by, but, according to the CDC, in 2005-06, 11% of physicians had no managed care contracts.
              &lt;p&gt; 
              &lt;p&gt;These cash-only physicians are earning less than they used to, but that&apos;s a trade-off that few regret.
              &lt;p&gt; 
              &lt;p&gt;Rick Baxley, M.D., a family physician in Orlando, Fla., retained only a third of his 4,900 patients when he decided to break ties with insurers in 2001. Now, however, Baxley has about 4,000 people on his patient roster and sees just 20 to 22 patients a day, down from 40 to 60 in his third-party-payer days.
              &lt;p&gt; 
              &lt;p&gt;His overhead has dropped significantly, however, so he still makes a decent living. &quot;I&apos;m not getting wealthy,&quot; he said, &quot;but my quality of life is off the charts.&quot;
              &lt;p&gt; 
              &lt;p&gt;Cash-only physicians don&apos;t operate like concierge practices, said Jeffrey J. Denning, a practice management consultant in La Jolla, Calif. &quot;Concierge practices charge an annual membership fee of $1,000 or so for increased access to the physician in an upscale office environment, then bill insurance companies or Medicare for services. Nothing much changes in a cash-only practice except getting out of the insurance billing business.&quot;
              &lt;p&gt; 
              &lt;p&gt;That means less paperwork and third-party interference, as well as reduced staffing needs and the ability to run the practice in smaller quarters. 
              &lt;p&gt; 
              &lt;p&gt;Internist and emergency medicine physician Robert Berry, M.D., who launched his urgent care/internal medicine cash-only practice in Greenville, N.C., in 2001, estimated that his annual overhead is $200,000 less than that of physicians who collect from insurance companies. 
              &lt;p&gt; 
              &lt;p&gt;As in most cash-only practices, Dr. Berry&apos;s patients pay at time of service, so there&apos;s no need to employ billing staff. 
              &lt;p&gt; 
              &lt;p&gt;Dr. Baxley&apos;s former practice had a staff of 22 for three physicians; he now has four employees, and has ditched a $12,000-per-year accounting software package in favor of QuickBooks, which costs him about $200 a month.
              &lt;p&gt; 
              &lt;p&gt;Because cash-only physicians have lighter workloads than their peers, noted Judy Capko, a consultant in Thousand Oaks, Calif., they&apos;re better able to build strong healthcare partnerships with patients. 
              &lt;p&gt; 
              &lt;p&gt;Patients, in turn, have easier access to care and are less likely to experience the rushed appointments that result when physicians see large numbers of patients to compensate for managed care&apos;s low reimbursement rates.
              &lt;p&gt; 
              &lt;p&gt;The flip side of this, of course, is that cash-only patients must dig deeper into their pockets than patients who only need to fork over a copayment.
              &lt;p&gt; 
              &lt;p&gt;For physicians, the downside of the cash-only model includes the need to rebuild a practice. There&apos;s also no telling how practices that aren&apos;t set up to process insurance payments will be affected if healthcare reform results in a universal or single-payer medical system. 
              &lt;p&gt; 
              &lt;p&gt;Among the other things a physician needs to consider before switching to cash-only:
              &lt;p&gt; 
              &lt;p&gt;&lt;strong&gt;&lt;em&gt;Is there an increased risk of embezzlement?&lt;/em&gt;&lt;/strong&gt; Not necessarily, say consultants, because &quot;cash only&quot; rarely means a drawer brimming with currency; most physicians with this practice model accept checks and credit cards. But it doesn&apos;t hurt to have strict accounting policies and controls in place. And staffers who handle money should be bonded. 
              &lt;p&gt; 
              &lt;p&gt;&lt;strong&gt;&lt;em&gt;How are fees determined?&lt;/em&gt;&lt;/strong&gt; Like most small-business operators, cash-only physicians look at what competitors are charging, calculate the cost of doing business, then tack on enough to make a profit. Dr. Berry said he strives to keep fees &quot;between the cost of an oil change and a brake job.&quot; 
              &lt;p&gt; 
              &lt;p&gt;The fees, which are posted on his website, &lt;a href=&quot;http://www.patmosemergiclinic.com&quot; target=&quot;blank&quot;&gt;PATMOS EmergiClinic&lt;/a&gt;, include $10 for a rapid strep test, $60 for an intermediate office visit, and $80 for a complex visit.
              &lt;p&gt; 
              &lt;p&gt;&lt;strong&gt;&lt;em&gt;What about Medicare patients?&lt;/em&gt;&lt;/strong&gt; Consultant Judy Capko suggests that Medicare is one carrier physicians might want to stay connected with. A halfway tack -- becoming a nonparticipating Medicare provider -- is also a possibility. That&apos;s what Dr. Baxley did. 
              &lt;p&gt; 
              &lt;p&gt;That enabled him to keep his Medicare patients when he transitioned to a cash-only practice, and he can continue to treat existing patients as they age into Medicare.
              &lt;p&gt; 
              &lt;p&gt;Nonparticipating Medicare providers do not accept assignment and are reimbursed at slightly lower levels than participating providers. For cash-only physicians, this is an attractive option because the patient pays the doctor for services rendered; Medicare, in turn, reimburses the patient. 
              &lt;p&gt; 
              &lt;p&gt;If you choose not to participate in Medicare, you must sign an &quot;opt out&quot; affidavit. In many states, that means you can&apos;t re-up as a Medicare provider for two years.
              &lt;p&gt; 
              &lt;p&gt;&lt;strong&gt;&lt;em&gt;What about promoting the practice?&lt;/em&gt;&lt;/strong&gt; Physicians who drop third-party contracts typically have to advertise their practices until word-of-mouth kicks in. 
              &lt;p&gt; 
              &lt;p&gt;At first, Dr. Berry ran the gamut from fliers to billboards to television. But, he said, &quot;we currently have 8,700 patient charts and don&apos;t need to advertise anymore.&quot;
              &lt;p&gt; 
              &lt;p&gt;For those physicians without the resources to launch an advertising campaign, special services are cropping up to steer patients to cash-only physicians. 
              &lt;p&gt; 
              &lt;p&gt;Renton, Wash., family physician Vern Cherewatenko, M.D., who launched his cash-only practice in 1997, also heads &lt;a href=&quot;http://www.simplecare.com&quot; target=&quot;blank&quot;&gt;SimpleCare&lt;/a&gt;, which for a small fee -- $125 for the first year and $50 annually after that -- puts physicians&apos; names on its website and sends them information about how to create a cash-based practice.
              &lt;p&gt; 
              &lt;p&gt;Patients, who pay $29 a year for an individual and $39 for a family, can use the site to locate physicians in their area.
              &lt;p&gt; 
              &lt;p&gt;Another website, &lt;a href=&quot;http://www.pricedoc.com&quot; target=&quot;blank&quot;&gt;PriceDoc&lt;/a&gt;, will enable cash-paying patients to &quot;comparison shop&quot; online for medical, dental, vision, cosmetic, and other healthcare services and procedures. The site is a work in progress; it currently lists only clinicians in the state of Washington.
              &lt;p&gt; 
              &lt;p&gt;&lt;strong&gt;Transitioning to cash only&lt;/strong&gt;
              &lt;p&gt;
              &lt;p&gt;Consultants recommend establishing a cash-only practice in stages. 
              &lt;p&gt; 
              &lt;p&gt;Physicians should cut ties with their worst-paying payers first, and offer to see patients with that coverage on a cash-only basis, said Jeff Denning. Let those patients know you&apos;ll provide them with a superbill to submit claims on their own.
              &lt;p&gt; 
              &lt;p&gt;Then, one at a time, resign the remaining contracts, allowing time for the practice to stabilize after each cut. This strategy allows you to reverse course if sufficient patients don&apos;t stay on board.
              &lt;p&gt; 
              &lt;p&gt;Send letters to patients at least 30 days before you stop accepting their health insurance, although in some instances you may need to provide contracted care for a longer period, said Steven Kern, a healthcare attorney in Bridgewater, N.J. 
              &lt;p&gt; 
              &lt;p&gt;You&apos;ll be on safer legal ground if you continue to see pregnant women until labor and delivery, and if you stick with a patient undergoing a specific course of treatment until the treatment is completed, especially if the patient can&apos;t readily be transferred.
              &lt;p&gt; 
              &lt;p&gt;Bear in mind, too, that in some states you&apos;re required to copy and transfer medical records of patients you &quot;terminate&quot; -- a costly process if you don&apos;t have an EMR.
              &lt;p&gt; 
              &lt;p&gt;Even cash-only doctors acknowledge the need for patients to have some medical insurance, though. Dr. Cherewatenko advises his patients to purchase catastrophic policies. &quot;I have one myself that costs $150 a month with a $3,000 deductible,&quot; he said. 
              &lt;p&gt; 
              &lt;p&gt;Cherewatenko added, however, that because most medical problems can be handled at affordable prices, cash-only is a good bet for all concerned. 
              &lt;p&gt; 
              &lt;p&gt;&quot;It offers freedom of choice to patients and freedom from billing hassles for physicians,&quot; he said. &quot;I want to return medicine to patients and doctors. Patients come to see me because they know I&apos;m working for them, not the insurance company.&quot;
             
    </recommendedItem>
    <recommendedItem id="20090101_19_1635"
                     title="Retail Clinics Leave Underserved Behind"
                     score="-0.005"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/tb/14387?impressionId=1265817890693"
                     
      WHEELING, W.Va., May 27 -- Although proponents saw retail medical clinics as a way to reach underserved populations, the clinics tend to be in relatively affluent communities, researchers have found.
              &lt;p&gt; 
              &lt;p&gt;The clinics, located in larger stores such as CVS and Walgreen pharmacies, are typically operated either by these chains or by local hospitals.
              &lt;p&gt; 
              &lt;p&gt;Two University of Pennsylvania researchers who mapped 930 of these clinics found them located in census tracts that were wealthier than nearby tracts with stores that didn&apos;t have clinics.
              &lt;p&gt; 
              &lt;p&gt;The clinic tracts had higher median household incomes and were less likely to be classed as medically underserved, they reported in the May 25 issue of &lt;em&gt;Archives of Internal Medicine&lt;/em&gt;.
              &lt;p&gt; 
              &lt;p&gt;&quot;Retail clinics tend to be preferentially located in more advantaged neighborhoods,&quot; wrote Craig Evan Pollack, M.D., and Katrina Armstrong, M.D. &quot;To the extent that location correlates with accessibility, this distribution may undermine efforts to promote access for underserved populations.&quot;
              &lt;p&gt; 
              &lt;p&gt;They also noted that one-third of chain stores are located in areas designated as medically underserved, suggesting that expansion of clinics into these stores &quot;could potentially improve access for underserved populations.&quot;
              &lt;p&gt; 
              &lt;p&gt;Retail clinics first appeared in 2000, according to the Convenient Care Association, a trade group representing such facilities. The group estimated that about 1,200 are now in operation.
              &lt;p&gt; 
              &lt;p&gt;Clinics are typically staffed by nurse practitioners or physician assistants, with off-site supervision by a licensed physician.
              &lt;p&gt; 
              &lt;p&gt;Most provide care for uncomplicated acute ailments such as skin rashes, upper respiratory infections, cuts, and sprains, along with immunizations and health screening.
              &lt;p&gt; 
              &lt;p&gt;Drs. Pollack and Armstrong noted that the clinics&apos; sponsors and other advocates say that such facilities can be a point of access for patients without regular providers or insurance -- or without timely access to healthcare facilities.
              &lt;p&gt; 
              &lt;p&gt;The researchers did not directly dispute such claims, but their findings undercut any suggestion that the underserved are these operations&apos; main clientele.
              &lt;p&gt; 
              &lt;p&gt;They reported the following characteristics for 908 census tracts with retail clinics (some tracts had more than one), compared with 28,631 control tracts without such clinics:
              &lt;p&gt; 
              &lt;ul&gt;
                &lt;li&gt;Medically underserved areas or populations: 13.6% of tracts with clinics, 25.0% of control tracts (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001)
                &lt;li&gt;Nonwhite population: 18.5% in tracts with clinics, 31.4% in control tracts (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001)
                &lt;li&gt;Owner-occupied housing rate: 65.9% in tracts with clinics, 59.7% in control tracts (&lt;em&gt;P&lt;/em&gt;=0.03)
                &lt;li&gt;Median income: $58,544 in tracts with clinics, $50,559 in control tracts (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001)
                &lt;li&gt;Poverty rate: 7.0% in tracts with clinics, 12.4% in control tracts (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001)
              &lt;/ul&gt;
              &lt;p&gt; 
              &lt;p&gt;The researchers found almost identical results when they confined their analysis to the six counties with the largest number of retail clinics.
              &lt;p&gt; 
              &lt;p&gt;These counties -- which contain the cities of Los Angeles, San Diego, Chicago, and Houston, and also include Orange County in California and Florida&apos;s Palm Beach County -- had 135 stores with retail clinics and 1,293 stores without.
              &lt;p&gt; 
              &lt;p&gt;Some 15.6% of clinics in these counties were located in medically underserved areas, while 31.6% of other stores in the same chains were underserved areas (&lt;em&gt;P&lt;/em&gt;=0.008)
              &lt;p&gt; 
              &lt;p&gt;The same demographic and economic gaps seen in the national data for nonwhite populations, owner-occupied housing, and income and poverty rates were reflected in these six counties.
              &lt;p&gt; 
              &lt;p&gt;&quot;These results raise important questions about the ability of retail clinics to increase healthcare access for the underserved or uninsured,&quot; Drs. Pollack and Armstrong said.
              &lt;p&gt; 
              &lt;p&gt;They noted that such conveniences as evening hours and instant appointments may not help disadvantaged patients if the clinics are located across town.
              &lt;p&gt; 
              &lt;p&gt;But the researchers acknowledged earlier studies showing that significant numbers of retail clinic patients are in fact uninsured and do not have a regular source of medical care.
              &lt;p&gt; 
              &lt;p&gt;&quot;This high level of use occurs despite a relatively unfavorable distribution of retail clinics within particular counties,&quot; they said, perhaps because disadvantaged patients are willing to travel to reach them.
              &lt;p&gt; 
              &lt;p&gt;In two separate invited commentaries, other public health scholars found the results plausible but interpreted them differently.
              &lt;p&gt; 
              &lt;p&gt;Mark Smith, M.D., M.B.A., and Margaret Laws, M.P.P., of the California Healthcare Foundation in Oakland, Calif., said the findings were as expected, given the rollout strategy of retail clinics so far.
              &lt;p&gt; 
              &lt;p&gt;&quot;The major operators have positioned their offerings as meeting mainstream consumer needs for convenient, timely access to basic care for a subset of needs rather than as an alternative to comprehensive primary care,&quot; they noted.
              &lt;p&gt; 
              &lt;p&gt;But Dr. Smith and Laws argued that the pattern seen to date could change in the future, and already may be doing so in some locations.
              &lt;p&gt; 
              &lt;p&gt;They pointed to two operators, Take Care Health and Minute Clinic, which have begun contracting with Medicaid authorities in some states.
              &lt;p&gt; 
              &lt;p&gt;Wal-Mart has also begun opening retail clinics, which should improve accessibility for many low-income and medically underserved populations, Dr. Smith and Laws added.
              &lt;p&gt; 
              &lt;p&gt;&quot;[We should] allow ourselves to let the cheap, simple things be cheap and simple,&quot; they said.
              &lt;p&gt; 
              &lt;p&gt;But Barbara Starfield, M.D., M.P.H., a health policy researcher at Johns Hopkins University, used the Penn researchers&apos; study as ammunition to attack the retail clinic concept.
              &lt;p&gt; 
              &lt;p&gt;As now implemented, she said, the model &quot;is a misguided attempt to solve the problems of the health system. It is an approach consistent with market principles in a world that is moving toward conceptualizing health services as social systems.&quot;
              &lt;p&gt; 
              &lt;p&gt;She added that retail clinics most resemble &quot;health posts&quot; that provide basic care in rural areas of developing countries, and are &quot;therefore an odd solution for a highly industrialized and wealthy country.&quot;
              &lt;p&gt; 
              &lt;p&gt;The authors cited  several limitations of the study.
              &lt;p&gt; 
              &lt;p&gt;&quot;It is an area-level analysis, which does not examine the particular clients of a retail clinic and does not measure other important aspects of accessibility such as hours of operation, public transportation, and commuting patterns,&quot; they noted. &quot;Census tracts were used, which do not necessarily correspond with where people receive their goods and services.&quot;
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The study was funded by the Robert Wood Johnson Foundation.
              &lt;p&gt; 
              &lt;p&gt;No potential conflicts of interest were reported.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
             
    </recommendedItem>
    <recommendedItem id="20090101_19_3084"
                     title="Finance Committee Focuses on Physician Payment"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Washington-Watch/Washington-Watch/tb/16214?impressionId=1265817890693"
                     
      &lt;p&gt;WASHINGTON  --  A GOP amendment that would pay rural doctors more money passed by unanimous consent during Tuesday evening&apos;s Senate Finance Committee markup.&lt;/p&gt;
&lt;p&gt;The amendment, sponsored by ranking Republican Sen. Chuck Grassley of Iowa, would adjust the Geographic Practice Cost Index, or GPCI, helping to level the current payment differential between physicians in rural and urban areas for the same procedures.&lt;/p&gt;
&lt;p&gt;The GPCI is part of the formula used by CMS to determine physician payments and reflects regional differences in practice costs, such as rent and employee wages.&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s getting harder and harder for seniors to find doctors serving in rural areas,&quot; Grassley said in a prepared statement. &quot;Part of the problem is Medicare payment policies that shortchange rural states. It&apos;s a question of fairness and accuracy to fix the problem of rural physicians getting paid less for performing the same procedures than doctors in other areas.&quot;&lt;/p&gt;
&lt;p&gt;The amendment would not take money away from physicians practicing in urban areas.&lt;/p&gt;
&lt;p&gt;Rather, it directs the Department of Health and Human Services to examine the current way that practice expenses are determined to make sure that the formula accurately reflects the cost of operating a medical practice in a rural community.&lt;/p&gt;
&lt;p&gt;The current formula uses inaccurate proxies to determine payment, Grassley said in a press release. For instance, the cost of physician office rent is estimated using apartment rental data that &quot;doesn&apos;t have any connection with the cost of office space. Rural states including Iowa and North Dakota are especially penalized by this formula,&quot; Grassley said.&lt;/p&gt;
&lt;p&gt;Another physician payment issue also had bipartisan support Tuesday night, although no definitive action was agreed upon.&lt;/p&gt;
&lt;p&gt;Sen. John Kyl (R-Ariz.), introduced an amendment to nix a provision in the bill that would have penalized doctors who use a disproportionate share of medical resources.&lt;/p&gt;
&lt;p&gt;As written, the &lt;a href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/Washington-Watch/15878&quot; mce_href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/Washington-Watch/15878&quot; target=&quot;_blank&quot; title=&quot;Baucus&amp;#8200;Hoping&amp;#8200;for&amp;#8200;Bipartisan&amp;#8200;Agreement&amp;#8200;Before&amp;#8200;Obama&apos;s&amp;#8200;Speech&quot;&gt;Finance Committee&apos;s bill&lt;/a&gt; would require all eligible healthcare professionals to participate in the Physician Quality Reporting Initiative (PQRI) program by 2011. Using PQRI data, physicians would be able to see how their utilization of medical services compares with that of other physicians, so they would know if they are utilizing more services  --  and costing the healthcare system more money  --  than their colleagues.&lt;/p&gt;
&lt;p&gt;Then, starting in 2015, payment would be reduced by 5% for any physician whose resource use is at or above the 90th percentile nationwide, with the goal of reining in unnecessary medical and surgical procedures.&lt;/p&gt;
&lt;p&gt;In other words, beginning in 2015, physicians who do the most tests and procedures would get a 5% pay cut, regardless of whether the tests and procedures are warranted.&lt;/p&gt;
&lt;p&gt;Once a Senate Finance Committee aide clarified the provision, no one on the panel, Republican or Democrat, much liked the sound of it.&lt;/p&gt;
&lt;p&gt;&quot;I could see a lot of physicians saying, &apos;Whoa, you&apos;re going to reduce my payment by 5%?&apos;&quot; Baucus said.&lt;/p&gt;
&lt;p&gt; &lt;/p&gt;
&lt;p&gt;&quot;The most pernicious thing is to say 10% of physicians are going to take a 5% cut,&quot; said Kyl. &quot;You can&apos;t just have an arbitrary penalty like this.&quot;&lt;/p&gt;
&lt;p&gt;Sen. Kent Conrad (D-N.D.) agreed.&lt;/p&gt;
&lt;p&gt;&quot;I do think that Sen. Kyl has a point here,&quot; Conrad said. &quot;This is an area that could have unintended consequences. It&apos;s one thing to have the feedback. But this thing about putting in a penalty leaves me cold,&quot; he said, adding that it would be difficult to determine whether a certain doctor is utilizing more resources because he or she treats a sicker patient population.&lt;/p&gt;
&lt;p&gt;Cutting the planned 5% penalty for doctors who use the most medical services would mean the government won&apos;t collect those fees, which adds to the total cost of the bill.&lt;/p&gt;
&lt;p&gt;Democrats weren&apos;t about to accept the proposed &quot;offset,&quot; or method of paying for the amendment that Kyl proposed  --  to scrap all federal funding for the proposed &lt;a href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/Washington-Watch/14669&quot; mce_href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/Washington-Watch/14669&quot; target=&quot;_blank&quot; title=&quot;State-Run&amp;#8200;Insurance&amp;#8200;Cooperative&amp;#8200;Plan&amp;#8200;Reshaping&amp;#8200;Debate&amp;#8200;on&amp;#8200;the&amp;#8200;Hill&quot;&gt;insurance cooperatives&lt;/a&gt;, which is Conrad&apos;s brainchild.&lt;/p&gt;
&lt;p&gt;So Kyl agreed to withdraw the amendment, but Democrats assured him they&apos;d work together to agree on language that would likely strike the penalty for &quot;overutilizing&quot; physicians.&lt;/p&gt;

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