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Issue Date: November 2006

Health Systems Will Focus on Chronic Care
Health care managers know that some 20% or less of patients account for 80% or more of total health care spending, according to an article by Gregg Lehman, “When It Makes Cents to Back Into the 80/20 Rule,” published by HealthLeaders.com in March 2004. These percentages follow Pareto’s Law. In the late 1800s, Vilfredo Pareto, an Italian economist, established that 20% of the population of Italy owned 80% of the land.
Chronic kidney disease is one of the Pareto Group of diseases, so called because patients with these conditions account for a disproportionate share of costs. Not everyone agrees that the split is 80-20. The UnitedHealth Group, the large managed care organization in Minneapolis, estimates that 7% of chronically ill patients generate 70% of all costs.
Whatever the percentages and conditions, the federal Centers for Disease Control and Prevention in Atlanta says that the medical care costs of people with chronic diseases account for more than 75% of the nation’s $1.4 trillion medical care costs. Those conditions include cardiovascular disease, diabetes, cancer, and other diseases.

CAP Vendor Says Company Is Committed to Safety, Service
The specialty pharmacy company chosen to manage the federal Competitive Acquisition Program (CAP) has extensive experience in prescription order fulfillment, company officials say. Before the federal Centers for Medicare & Medicaid services named BioScrip, Inc., as the sole national pharmacy vendor for the program in May, the company was not widely known.

Hospitalists Enhance Care Quality
Hospitalist care has gained widespread recognition among primary care physicians and specialists such as cardiologists, orthopedists and gastroenterologists. Now, a growing number of nephrologists also are working with hospitalists to co-manage their inpatients. Also, nephrologists are touting hospitalist care as a valued strategy for both improving quality and enhancing practice efficiency.
“Certain specialties very quickly welcomed hospitalist involvement in patient care,” says Ronald Greeno, MD. For nephrologists, the strategy holds some untapped potential.

Groups Boost Efficiency With EMRs
Recognizing that EMRs help increase efficiency and improve the quality of care they deliver to patients, nephrology practices are investing in electronic medical record (EMR) systems. Southwest Kidney Institute, a 23-physician kidney disease management company with six locations in the Phoenix metropolitan area, provides high-quality kidney disease care through a model built on providing a continuum of care. To enhance its ability to improve clinical quality and the efficiency of its research efforts, Southwest Kidney Institute adopted the GE Centricity EMR (from GE Healthcare in Hillsboro, Ore.) in the spring of 2005. “An EMR can be hugely valuable to any nephrology practice,” says Jeff Weintraub, the CEO of Southwest Kidney Institute. “It allows the nephrologists to access patient records anywhere at any time, enhancing both physician efficiency and quality of care. An EMR also enables the practice to track outcomes, allowing for the formation of evidence-based protocols for care.”

What a Chart Audit Will Tell You
Coding claims correctly in a nephrology practice is a continual learning process that involves developing an expertise with all the fine points of coding and then adjusting to changes in coding rules as they are made. That’s why coders and billers in nephrology practices do routine internal audits. Regular audits can help a practice assess coding accuracy and help physicians and administrators identify ways to improve coding.
Practices that routinely audit their claims will likely see an overall rise in their billing for evaluation and management codes (E&M), says Mary McCloskey, the billing manager at Nephrology Associates, a practice of 10 nephrologists in Wynnewood, Pa., that routinely does self audits.

Patient Volume Stretches Resources
A recent study showed that a high percentage of patients with early kidney disease are not getting the care they need. The result is that many of the 20 million Americans with chronic kidney disease are at risk for developing preventable complications such as kidney failure and heart disease, the researchers said. The research was presented at a conference this spring that was sponsored by the National Kidney Foundation. Given that there are so many patients with kidney disease and not enough nephrologists, the health system will need to find ways to help primary care physicians get more involved in the treatment of these patients, says James Weiss, MD, one of 16 physicians at Renal Endocrine Associates in Pittsburgh.

Retail Clinics Challenge Primary Care Physicians
Primary care physicians are beginning to see the marketplace advantages of consumer-driven health care. In August, ProHealth Physicians, a large group practice in Middletown, Conn., with 200 physicians, opened a retail clinic in Putnam, Conn. In a partnership with Price Chopper, a supermarket chain, ProHealth will offer accessible medical care at supermarkets in Connecticut. The program is called MedAccess, in which the partners will offer the first chain of retail clinics in the state. The partners aim to provide quality medical care to patients when they need it.

Expert Says Groups Need IT Strategy
Many cardiologists have made the implementation of an electronic medical record (EMR) system the focal point of their information technology strategy. But many industry experts and physician practice managers believe that medical groups should consider EMR adoption only after maximizing the efficiency of their billing and collections efforts. Accordingly, these experts assert, an up-to-date practice management system should be the first priority for any practice’s investment in information technology.
Some physicians may not fully realize how important a practice management system is, says Ajit Kumar, PhD, general manager of Henry Schein Medical Systems (formerly, Microsys Computing, Inc.). Based in Boardman, Ohio, Henry Schein Medical Systems produces MicroMD PM, a practice management system, and MicroMD EMR, an EMR.

Some Retirement Options to Consider
Even physicians in the same specialty who have similar levels of income throughout their careers can have different income levels in retirement. There are three main reasons for this discrepancy. First, one of the physicians may have had a devastating incident such as a lawsuit or divorce. Second, he or she may have made poor investments in a failed limited partnership, medical center, or real estate endeavor, for instance. Or, third, the physician may not have paid attention to tax issues.
For a physician in one of these three situations, certain tax planning strategies can help. Unfortunately, most physicians use only traditional qualified retirement options, such as pensions and 401(k) plans. These restrictive and burdensome mechanisms ignore the more flexible non-qualified deferred compensation (NQDC) plans and the non-traditional benefit plans. More doctors should take advantage of NQDC or non-traditional plans because they offer certain benefits that qualified plans do not.