Published 11/1/2013

Second Look—Advocacy

Self-employed physicians
According to a report released by the American Medical Association (AMA), about 60 percent of physicians still work in physician-owned practices, and 53.2 percent of physicians were self-employed during 2012. The report notes a trend toward more hospital employment during the last 5 years, with 29 percent of physicians either working directly for a hospital or for a practice at least partially owned by a hospital compared to 16.3 percent of physicians in 2007/2008. The percentage of physicians in solo practice during 2012 dropped 6 points from the 2007/2008 report.

Hospital recruitment of physicians rising
A report released by search firm Merritt Hawkins & Associates finds that 64 percent of physician search assignments from April 1, 2012, to March 31, 2013, came from hospitals. In 2004, hospitals generated just 11 percent of physician searches. Demand for primary care and emergency physicians has increased, while demand for radiologists and anesthesiologists has decreased. Most (75 percent) search assignments featured a salary with production bonus, and a growing number of production formulas featured quality-based metrics.

ER/LA opioid analgesics label changes
The U.S. Food and Drug Administration (FDA) has announced plans to initiate class-wide safety labeling changes and new postmarket study requirements for all extended-release and long-acting (ER/LA) opioid analgesics intended to treat pain. An updated indication states that ER/LA opioids are indicated for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate, and further clarifies that, because of the risks of addiction, abuse and misuse, overdose, and death, such drugs should be reserved for use in patients for whom alternative treatment options are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain. ER/LA opioid analgesics are not indicated for as-needed pain relief. The agency will begin requiring a new boxed warning on ER/LA opioid analgesics to caution that chronic maternal use of these products during pregnancy can result in life-threatening neonatal opioid withdrawal syndrome.

Repealing SGR would cost $175 billion
According to a cost estimate from the U.S. Congressional Budget Office (CBO), passage of the Medicare Patient Access and Quality Improvement Act of 2013 (H.R. 2810) would increase federal spending by $175 billion by 2023. If enacted, the act would replace the Medicare Sustainable Growth Rate (SGR) formula with an alternative system that would give providers reimbursement increases of 0.5 percent each year from 2014 through 2018. In 2019, physicians could choose to report certain quality measures and have traditional fee-for-service payments adjusted based on how they compare with their peers on those measures or opt out of that model if they participate in an alternative payment system such as a patient-centered medical home, accountable care organization, or other yet-to-be-determined system. Current congressional rules require lawmakers to balance any new spending through spending cuts or increased revenues.

Preventable deaths at epidemic level
A study in the Journal of Patient Safety claims that more than 400,000 premature deaths per year in the United States are associated with preventable hospital errors. Previous estimates of U.S. deaths due to hospital medical errors were 98,000, based on 1984 data compiled by the Institute of Medicine. The updated estimate was based on a literature review of studies published from 2008 to 2011.

Use of ASCs increasing
According to HealthLeaders Media, a report from Moody’s Investors Service projects that the use of ambulatory surgery centers (ASCs) will continue to grow as hospital inpatient surgery volumes shrink. Insurers are increasingly directing patients to ASCs, which are reimbursed on average at about 57 percent of the hospital rate for similar procedures. However, growth in the use of ASCs could be balanced by factors such as reductions in reimbursement, a shift toward bundled payments and value-based care, and hospital acquisition of ASCs.

COI policies at medical schools
A national survey of medical schools published in the Journal of General Internal Medicine (August) finds that many medical trainees continue to receive gifts from pharmaceutical companies, despite the implementation of school policies concerning conflicts of interest (COI) and interactions with industry. The cross-sectional survey of 1,610 medical students and 739 PGY-3 residents found that 33.0 percent of first-year students, 56.8 percent of fourth-year students, and 54 percent of residents had received industry-sponsored gifts, including meals outside the hospital (reported by 5 percent of first-year students, 13.4 percent of fourth-year students, and 27.5 percent of residents) and free drug samples (reported by 7.4 percent of first-year students, 14.1 percent of fourth-year students, and 14.3 percent of residents). Overall, students in schools receiving more funding from the National Institutes of Health reported industry gifts less often, but strength of institutional COI policies was not associated with the likelihood of reporting industry-sponsored gifts.

These items originally appeared in AAOS Headline News Now, a thrice-weekly enewsletter that keeps AAOS members up to date on clinical, socioeconomic, and political issues, with links to more detailed information. Subscribe at www.aaos.org/news/news.asp (member login required)