The Estimated Cost of Maintenance of Certification.

BACKGROUND: Maintenance of Certification (MOC) is a controversial topic in medicine for many different reasons. Studies have suggested that there may be associations between fewer negative outcomes and participation in MOC. However, MOC still remains controversial because of its cost. We sought to determine the estimated cost of MOC to the average orthopaedic surgeon, including fees and time cost, defined as the market value of the physician's time. METHODS: We calculated the total cost of MOC to be the sum of the fees required for applications, examinations, and other miscellaneous fees as well as the time cost to the physician and staff. Costs were calculated for the oral, written, and American Board of Orthopaedic Surgery Web-based Longitudinal Assessment (ABOS WLA) MOC pathways based on the responses of 33 orthopaedic surgeons to a survey sent to a state orthopaedic society. RESULTS: We calculated the average orthopaedic surgeon's total cost in time and fees over the decade-long period to be $71,440.61 ($7,144.06 per year) for the oral examination MOC pathway and $80,391.55 ($8,039.16 per year) for the written examination pathway. We calculated the cost of the American Board of Orthopaedic Surgery web-based examination pathway to be $69,721.04 ($6,972.10 per year). CONCLUSIONS: The actual cost of MOC is much higher than just the fees paid to organizations providing services. The majority of the cost comes in the form of time cost to the physician. The ABOS WLA was implemented to alleviate the anxiety of a high-stakes examination and to encourage efficient longitudinal learning. We found that the ABOS WLA pathway does save time and money when compared with the written examination pathway when review courses and study periods are taken. We believe that future policy changes should focus on decreasing physician time spent completing MOC requirements, and decreasing the cost of these requirements, while preserving the model of continued evidence-based medical education.

The clinical pharmacist's role in a high-cost medicine pharmacy: Patient-centered care

Abstract In Brazil, medicine dispensing is a pharmacy service provided within the national health system that allows the pharmacist to interact directly with the patient in order to prevent, detect and solve problems related to pharmacotherapy and health needs. However, it is known that most dispensing services provided in the country are still limited to supplying medications and, at their finest, offering advice on medication utilization. Attempts to change this scenario present new challenges the area of pharmacy, which involve the need for a patient-centered pharmaceutical service model. This paper describes the patient-centered pharmaceutical service of high-cost medicine dispensing performed at a pharmacy linked to the Brazilian Unified Health System. In the model described here, the medicine-dispensing activity is the pharmacist's main field of practice, which consists of identifying patient needs related to health care itself and medication utilization. It also aims to introduce the instrument developed (a Pharmaceutical Care Protocol) that contributed to implementing this clinical service provided by the pharmacist. The protocols guide and qualify the service by providing information that helps in evaluating the effectiveness and safety of treatments and in the preparation of the care plan and can be used as a basis for other services that intend to adopt clinical pharmacy practices.

The triple option choice: self-selection bias in traditional coverage, HMOs, and PPOs.

Health care costs and utilization by salaried employees and their dependents at a large self-insured midwestern industrial manufacturing corporation were analyzed for the year before employees were first offered a triple option choice. Members had the option of retaining traditional Blue Cross and Blue Shield of Michigan (BCBSM) coverage or switching to either a number of health maintenance organizations (HMOs) or a number of preferred provider organizations (PPOs). Members who switched to HMOs or PPOs were generally younger and had lower average expenses and utilization rates than those who retained the traditional BCBSM plan. The results suggest that a selection bias does occur in this population, as lower cost members were more attracted to the HMOs and PPOs than were more expensive members. Implications for the corporation as well as for the drive toward managed care alternatives are discussed.

Improving group practice performance with benchmarking.

Group practices can use benchmarking to improve physician productivity to best-practice levels. The benchmarking process can be broken down into two phases. In the first phase, the problem is identified. This phase involves identifying critical drivers, choosing an external benchmark, gathering internal data, identifying variances, and establishing targets. In the second phase, action is taken. This phase involves identifying actions to take, defining responsibilities, implementing the changes, and monitoring performance. Group practices that use benchmarking need to understand the tool's limitations. Benchmarks serve as roadmaps, but any action plan should be tailored to the practice and take a variety of factors into consideration.

The cost of turnover in a home care agency.

An agency experiencing an over-50% turnover rate of home care aides in one year took a hard look at what this meant in financial terms.

Medicare+Choice--cost and funding issues for Medicare risk plans.

The Balanced Budget Act of 1997 contained the most important changes in Medicare since its inception in 1965. The most notable changes include Medicare+Choice, which includes existing Medicare risk programs. The author offers a brief summary of the history of Medicare and the changes that will impact employer/union service providers. Areas of discussion include typical Medicare risk benefit packages, a financial analysis of Medicare risk contractors and changes to risk contracting under the new law.

New issues in long-term care.

Employer sponsorship of long-term care programs is a growing trend, one that is likely to continue, no matter what direction national health care reform takes.

Physician office-based information systems for managed care plans.

Three problems must be overcome before an ideal information system can be implemented. First, such setups are costly. For a group of 7 to 10 physicians, the price will be upwards of $100,000. Physicians must therefore weigh this cost against the direct economic benefit of personnel savings and the indirect benefit of enhanced information accuracy. Second, the culture of the organization must be assessed and found to be supportive before implementing any of these recommendations. If the information system is to function optimally, physicians must be willing to participate in the data entry. Some entry functions are no more onerous than filling out a superbill. Other tasks, such as completion of referrals, may require use of a keyboard--an activity that is foreign and distasteful to many practitioners. It is axiomatic, but necessary, to state that if the physicians will not use the system, it should not be purchased. Third, most sophisticated businesses have an administrator who understands the structure of information flows and the functions of the data system. The system described here requires the attention of such a person, who will manage the information and troubleshoot problems. If a group is small, the administrator may be able to accomplish this task; if it is large, the function may need to be assigned to a full-time manager with backup support staff. Three future developments may mitigate these problems. First, with increasing competition among hardware and software vendors, the price of these systems may decrease to a more affordable level. For the setup described, however, such pricing may be several years away.(ABSTRACT TRUNCATED AT 250 WORDS)

Employee lawsuit insurance covers possible liability under new laws.

Employers faced with increased liability under recently enacted federal legislation can now turn to insurance companies for protection against suits involving personnel practices. At least two insurance companies are now offering policies that protect companies against litigation for wrongful dismissal, sexual harassment, and/or discriminatory employment practices and procedures.