As it turns out, it’s the result of several unrelated issues — none of them easily fixed.

While multiple sites, such as RateMDs and HealthGrades, have been set up to collect patient reviews of doctors, they tend to have relatively little data for individual doctors. It’s not uncommon to find a doctor who has treated hundreds of patients but only has two or three reviews on any given site.

And anyone who has used Web-based reviews knows that just one or two outliers can severely skew the results of the company (or doctor) being reviewed to the point that the reviews are no longer useful to anyone shopping around for a new provider.

In its coverage of this issue, the New York Times uncovered several issues:

• Those in professional fields, such as doctors and lawyers, are far more likely to threaten, and sometimes take, legal action against negative reviewers and the sites that host the information.
• The personal nature of the doctor/patient relationship may make some patients hesitant to share information about the doctor or the treatment they received, and
• Some patients put their doctors on such a high pedestal that they’re simply unable or unwilling to publicly share even relatively benign, constructive criticism (such as the need to work on reducing wait times).

Those issues are understandable, but they don’t change the fact that the lack of effective review sites leaves patients short of a useful tool to help choose a new provider.

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For those who can afford it, privately paid, virtually made-to-order medical care isn’t a luxury, it’s a necessity. But it’s out of reach of most people: Membership fees alone to get access to a concierge practice can start at $1,500. With additional services such as round-the-clock access to doctors, house calls, overseas care, top-of-the-line equipment (at the practice and in the patient’s home if treating chronic illness) can easily bring the cost to $30,000 or more per year.

All of it out of pocket.

Expensive as it is, its growing quickly, as those with the means to pay for it say it’s worth the cost to know that they have quick and easy access to the best medical care possible. And some admit to enjoying the feeling of exclusivity. Patients at a concierge practice don’t have to worry about long ER waits for less-urgent problems or trying to hound an office for test results.

That exclusivity does create other problems though. Because of the intense level of time and attention provided to these patients, doctors in concierge practices by necessity have to limit the number of patients they can take on — hence the steep fees. But we’re already in the grips of a physician shortage — one that shows no sign of improving any time soon.

When concierge practices limit the number of patients they can see, less deep-pocketed patients have to scramble to be seen by already busy doctors in more accessible practices.

Do you think concierge care benefits those who can afford it at the expense of everyone else? Or is it just a basic market response to a need for more personalized attention? Share your thoughts in the comments.

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It’s not official yet, but the House and Senate have reached a compromise agreement. The bill is expected to be voted on before President’s Day.

A nearly 28% cut to physicians’ Medicare payments was scheduled to take effect March 1. Under the proposed plan, physicians will get a 0% “payment update,” essentially leaving them at the same payment level. It’s good news, although certainly most doctors would have preferred even a slight increase in payments.

Of course, Congress now has to make up that money somewhere. So the proposal includes other cuts such as:

• inpatient acute care hospitals will see Medicare bad debt payments reduced to 65% beginning in 2013
• critical access hospitals will see  payments reduced to 65% over the next three years
• a reduction in Medicaid Disproportionate Share Hospital payments in 2021.

What the proposal doesn’t change are payments for evaluation and management services provided in hospital outpatient departments or rules regarding physician self-referral.

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The need for outpatient facilities in particular is expected to increase as the industry adapts to the ongoing health reform and a move toward accountable care organizations. Outpatient facilities generally provide more access at the local level, and at a lower-cost care overall.

Another driver behind that activity is an expected increase in mergers and acquisitions. The company said that the anticipated activity — of both hospital mergers and the acquisition of physician practices — will create real estate dilemmas for the organizations involved.

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More young people are entering the profession thanks to a efforts to make nursing a more appealing career option. According to a new study published in Health Affairs, there’s been an 62% increase in the amount of people aged 23-26 who started careers in the field between 2002-2009.

Now, the number of registered nurses is expected to keep pace with population growth through 2030. Previously, the number of nurses was expected to decline over the next 20 years.

The problem isn’t totally resolved though. Several independent reports suggest that key specialties, most notably geriatrics, may not have adequate numbers of well-trained nurses to meet patient needs.

To keep the workforce growing, experts recommended finding ways to make nursing a more mobile career. Right now, more than 52% of nurses work within 40 miles of where they went to high school. In the long-term, that could create regional pockets where there aren’t enough nurses to fill the required positions. To meet long-term needs of those areas, the researchers recommended:

• Expanding the number of educational programs in under-served areas, such as off-campus “registered nurse to bachelor’s degree in nursing” programs or increased use of distance learning
• Targeting educational support such as scholarships and loan forgiveness programs to local students, to encourage them to not only be nurses but also to serve their local area
• Urging state and university leaders to review admission policies for nursing programs and the financial aid they offer, and
• Funding programs and policies such as the National Health Services Corps that offer financial incentives to attract nurses to under-served areas.

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Overall, measures of factors, such as wait time and one-on-one time with doctors, show that most patients are satisfied with the care they receive.

A recent study looked at doctor rankings at Dr.Score.com. The data, from nearly 15,000 patients, ranked six years worth of their doctor visits. Doctors were ranked on a 1-10 scale, with 10 being the highest rating.

The verdict: Health care pros are doing a good job of leaving patients satisfied.

The average overall satisfaction rating was an excellent 9.28. About 85% of ratings were a 9 or higher. Less than 2% of ratings were below a 1.

That may seem at odds with common public perception that a doctor’s appointment is little more than a date with frustration. The researchers said that perception is driven mainly by things that are out of doctors’ hands, such as opaque insurance company policies, and bad-news headlines. But most patients realize that their doctors are doing a good job of taking care of them.

The study appeared in Health Outcomes Research and Medicine.

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What kind of discipline do doctors face when they commit serious violations of patient safety? In many cases, nothing at all.

That’s what Public Citizen discovered after analyzing records from the National Practitioner Data Bank Public Use File for 1990-2009. The research found that of more than 10,000 physicians in the file who had at least one revocation or restriction of their clinical privileges, 45% also had one or more state licensing actions — which means 55% of the docs didn’t.

In one of the states least likely to take disciplinary action, California, the group found that the state medical board had failed to discipline about half of the doctors who had been disciplined by their own hospitals or health organizations between September 1990 and December 2009. That’s more than 700 doctors — most disturbingly, 102 of those doctors had been deemed by their peers as an “immediate threat” to patient health or safety.

Typical actions that landed physicians in the database were alcohol and substance abuse, providing substandard care, wrong diagnoses and leaving equipment in surgical patients.

Yet the state medical board didn’t act.

Since the initial report this spring, the state medical board hasn’t picked up the pace, and Public Citizen sent a letter to the governor outlining both the slow action against potentially dangerous docs and the state’s alarming recent decline in enforcing medical standards.

While these complaints are specific to California, it’s hardly the only state where malpractice is dealt with something less than haste. The real question is why some states seem to make it a practice to do little more than wink at physicians’ serious missteps.

Do physicians get a free pass when it comes to unprofessional behavior? Or is it merely that the process moves slowly? Share your thoughts in the comments.

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So far, more than 30,000 doctors have signed up for the Doximity network since its launch seven months ago — that’s twice the number of physicians on LinkedIn, according to Doximity.

The services is a HIPAA-secure communication platform for doctors that lets them connect and collaborate with their professional peers.
Unlike other popular social media sites, Doximity membership is reserved for medical professionals, such as  physicians, nurse practitioners and physician assistants. Members sign up with their real names and verified credentials. The general public can’t access any information on the site, so health care pros can have true — and private — peer-to-peer communication.

Click here for more information on HIPAA.

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According to the report, hospital outpatient department visits attended only by PAs or APNs increased by 50% between 2000 and 2009. But not all areas are seeing the same level of growth. More urban hospitals are less likely to have PAs and APNs handle patient visits on their own.

Some specialties rely more on PAs and APNs, as well. More visits with only a PA or APN were made to general medicine (21%) and OB/GYN (19%) practices. The specialties least-likely to rely on PAs and APNs for these visits were pediatrics (8%) and surgical (5%).

The types of visits most likely to be handled solely by a PA or APN were visits where a patient was coming in to discuss a new issue (22%). Other types of patient visits included treatment for a flare-up of a chronic condition (14%), routine treatment of a chronic condition (11%) and pre- or post-op care (6%).

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Primarily, systems that protect anonymous reporting and don’t emphasize assigning blame for the error get more reports than more traditional reporting systems. That’s the takeaway from a recent report in the journal Pediatrics.

After instituting a new system at a pediatric clinic in North Carolina, the number of mistakes reported increased from an average of five per year to 86.

Under the clinic’s old system, reports weren’t anonymous and frequently led to punishment of some sort for those involved in the error. With the new system, employees were able to report anonymously, and punishments weren’t attached to the error reports. Employees from all areas of the practice were put on a safety team to review reports once a month and find solutions to the reduce the likelihood of a similar mistake happening again.

The most common mistake by far was incorrect data being entered into a patient record, followed by delayed or forgotten lab work and medication errors. About 75% of the mistake reports were addressed by the team with simple procedural changes and staff training.

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