Healthcare Industry News and Ideas for Medical Conference Organizers

ASSOCIATION NOTES Hang on to your hats-we have a scoop for you, courtesy of the February 1997 issue of Management Review, the journal of the American Management Association. In "Prescription for a Powerful Lobby," author/consultant David A. Andelman blasts the American Medical Association (AMA). Did you know that physicians, as a group, are very well paid? And that there are physicians in every state of the Union? And that a little less than half of their number are members of the AMA? And that the AMA has a powerful lobbying operation in Washington that works on behalf of its members' interests? Amazing but true.

Actually, it's wrong to mock this story. Andelman gives an excellent quick take on the problems that are dividing the AMA now, in particular the generational conflict between the old-line specialists who depend on a wide referral base for the maintenance of their lucrative practices and the newer physicians who are happy with the steady income and job security their relationships with managed care organizations provide. He points out that the AMA-like many other medical associations-is dealing for the first time with a real split in the interests of its members, and that it will become clear in the next few years whether the organization comes down on the side of those members who are most powerful or those that represent its future.

MEDICAL NOTES The AMA's Socioeconomic Monitoring System recently released the following new statistics on physician work settings: Fifty-seven percent of physicians say they are self-employed. Forty-three percent are employees of some organization. Group practices or freestanding centers are where 32.5 percent of physicians work; eight percent are with HMOs; 20.8 percent work for state or local governments; 20.4 percent are ensconced at medical schools or other academic institutions; and 18.3 percent work at private hospitals.

Whether self-employed or employees, 75 percent of all U.S. physicians work in groups of fewer than ten, according to a news item appearing in the March 3, 1997, issue of Fortune. The article goes on to suggest that physician practice management companies (PPMs) are proving to be an alternative for doctors who would prefer to remain independent but belong to small practices that lack an HMO's cost-cutting clout. PPMs act as liaisons between physicians and insurers and other payors. Small groups sell their practices to a PPM, which in turn uses its scale economies to help physicians present themselves as cost-effective alternatives to HMOs. Since the basis of the relationship is purely an economic one, no PPM seems likely to have any interest in funding CME-at least no CME program than cannot demonstrate improvements to the physician's bottom line.

CME for the bottom line: The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the group that accredits hospitals, will soon start considering a facility's success rate in curing patients, and not just the quality of its staff and equipment, when deciding which hospitals to approve. Previously, the organization considered whether good medical practices were followed, not what outcomes resulted. Hospitals don't have to be accredited, but the JCAHO's okay gives healthcare consumers an indication that an institution gives good care. CME programs that can demonstrate their ability to improve physician outcomes at hospitals that are up for accreditation or reaccreditation will surely gain status and funding.

What kind of CME produces measurable results? The kind that helps physicians become better communicators with patients. A new study by Wendy Levinson, MD, an academic physician based in Portland, OR, finds that primary care doctors who explained what they were doing during the course of an office visit, asked patients what they thought, and showed a sense of humor were less likely than other primary care doctors to have had two or more malpractice claims filed against them. The study of 124 physicians in Colorado and Oregon, published in the Journal of the American Medical Association, said primary care doctors who spent more time with patients during routine office visits were 57 percent less likely to have had lawsuits filed against them.

This study should provide a shot in the arm to CME providers who have been trying to convince managed care organizations that physician/patient communications CME programs are worth their financial support.

For an unusual perspective on physician communication, pick up a copy of The Poetry of Healing: A Doctor's Education in Empathy, Identity, and Desire, by Rafael Campo, MD (Norton, $23). Campo-an internist at Boston's Beth Israel Hospital-warns that many HMOs actually encourage physicians to be distant from their patients, and that this practice is "diabolical" in its effectiveness at reducing costs.