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Issue Date: January 2007

Study Shows Value of Integrated Medical Groups
Physician Practice Options has often reported on how organizational structure of physician groups influences results. Now, as we enter our 12th year of publishing the newsletter, it is interesting to note that a new study supports this contention. The study shows that the structure of physician groups influences the quality of care groups deliver. The study was supported by a grant from the Commonwealth Fund (at www.cmwf.org), a foundation in New York that promotes a high-performing health care system.
In an article, “Do Integrated Medical Groups Provide Higher-Quality Medical Care than Individual Practice Associations?” in the Annals of Internal Medicine, Dec. 5, researchers reported that integrated medical groups (IMGs) provided higher-quality care compared with individual practice associations (IPAs).

System Delivers Outcomes Feedback
A national registry that amasses comparative treatment and outcomes data on patients with rheumatic diseases is helping rheumatologists improve their quality of care. The registry, called the Consortium of Rheumatology Researchers of North America (CORRONA), collects data on 14,000 patients at 92 sites around the country, making it the largest registry in rheumatology that collects data from both rheumatologists and patients. Particular aspects of the rheumatology specialty, such as the need to treat patients with complex conditions and use a variety of treatment options, make a national database such as CORRONA particularly important. The CORRONA database is a good example of the kind of system that physicians in various specialties could use to manage the vast amounts of disparate data needed to provide quality care over time to patients with chronic disease.
The development of CORRONA offers many lessons for other specialists interested in creating a registry. “In a few months, the federal Agency for Healthcare Research and Quality in Rockville, Md., will post a how-to‚ white paper on its Web site (at www.ahrq.gov) that will have full information about how to develop a registry,” says Joel Kremer, MD, a rheumatologist with the Center for Rheumatology in Albany, N.Y., and president of CORRONA. Kremer also offered some general suggestions for other specialists regarding lessons learned in developing CORRONA: include as much information as possible in the registry; expect, but don't be discouraged by, setbacks during development; and don’t expect instant success, he says. “It’s a marathon, not a sprint,” he comments.

Web Presence Builds Patient Loyalty
As more patients become comfortable with the Internet, physicians have considered options for using the Web to help them build and maintain a loyal patient base. Two of the most common methods currently in use are e-mail communication and Web site development. The article also discusses the value of having an effective Web site. E-mail communication, which is so commonly used personally and professionally, is still not widespread between physicians and patients. “Physician-patient e-mail is not very well entrenched. Fewer than 25% of physicians are using e-mail to communicate with patients regularly,” says Daniel Z. Sands, MD, MPH, senior medical informatics director of Cisco Systems, in San Jose, Calif. “However, e-mail is growing in popularity. As physicians overcome their reluctance to try it, they are enjoying the benefits of e-mail while finding that their initial concerns are largely unfounded.”

Physician and Pharmacist Collaboration Boosts Quality
Coordination of care by physicians and pharmacists can improve the quality of patient care, according to pharmacists and physicians. Each profession brings specialized training and skills to medicine, and working collaboratively enhances the value of individual experience. Physicians are beginning to realize that pharmacists can provide the expertise needed to improve drug therapy and patient self-care skills. Quality and safety in patient care depend on a conscious collaborative effort among health care providers, says Barbara Muller, MD, a professor of clinical medicine in the Depart-ment of Internal Medicine at the University of Iowa Hospitals and Clinics in Iowa City. “Using the clinical expertise of all frontline professionals is critical to ensuring quality,” she adds. “The role of the pharmacist at the point of care has evolved from a dispensing-based role to that of being an integral member of the health care team.”

Here’s Help for Patients in Part D
More than 20 million Medicare beneficiaries are enrolled in prescription drug plans, either freestanding plans or one that is part of a Medicare managed care plan. Most of these plans have a coverage gap, the so-called doughnut hole, during which an enrollee must pay for the full cost of their prescription drugs. Inevitably, patients who fall into this coverage gap have questions for their physicians and office staff. While it’s impossible to answer every question satisfactorily, there are steps physicians can take to ease the burden of having to explain the intricacies of a complex federal law. These strategies involve being prepared for the questions you’ll get, identifying a staff member to answer most of them, and preparing material that patients can read at home.

Liability Risks in General Partnerships
Physicians should never operate any business or practice as a general partnership. Such an arrangement could be a creditor or plaintiff’s dream and a partner’s liability nightmare. Instead of a general partnership, physicians should consider a limited partnership, a C or S corporation, or a limited liability company. These entities have limited liability provisions for owners. If a physician does use a general partnership, each physician should set up a corporation and the corporations should become the partners in the general partnership. Many medical professionals and attorneys using professional corporations (PCs) follow this advice. Each doctor or lawyer sets up a PC and the PC is the official partner in the partnership, thereby protecting the professionals personally. By structuring the partnership in this way, the underlying corporate owner’s personal assets remain protected from claims against the partnership. As with any corporation, however, the partners must follow rules and regulations governing the corporation in order to protect their assets.

Multidisciplinary Approach to Care
Coordination among medical disciplines is critical when treating patients with diabetes and other chronic conditions, health experts say. Appropriate triaging, proper referrals, and patient education about their conditions form the basis of effective multidisciplinary care, they say. “The management of comorbidities for chronically ill patients is the foundation of quality treatment,” says Michael Mustille, MD, associate executive director of The Perman-ente Federation, which coordinates the quality improvement efforts of the Permanente Medical Groups, including the 8,500 physicians associated with Kaiser Permanente, an 8.5-million member HMO in Oakland, Calif.