The Doctors Company, the nation’s leading physician-owned medical malpractice insurance carrier, today announced it will aid physician members whose medical practices have been disrupted by the wildfires and their aftermath by temporarily suspending their policies, without cost, for the period that their practices are not operational, and by working with them as they reestablish their practices. Additionally, for those impacted members who are continuing to practice, the company will grant up to a 60-day grace period for premium payments.

“In the wake of the devastating wildfires, The Doctors Company would like to offer its support and commitment in assisting physician members with their rebuilding and restoration efforts,” said Richard E. Anderson, MD, FACP, chairman and CEO of The Doctors Company. “As a physician-owned company, we are committed to advancing, protecting and rewarding the practice of good medicine, and today that takes the form of strong and flexible assistance for our affected members.”

Members of The Doctors Company who need assistance because of the wildfires are encouraged to contact their agent or the Member Service Unit at (800)421-2368. If telephone service is not available, an e-mail can be sent to memberservices@thedoctors.com.

A yearly exam may not be the best way to assure patients get proper care

The patient’s ear was throbbing. You have an infection, Dr. Beth Averbeck told 37-year-old Diane Shannon. And that’s where the trip to the doctor’s office might very well have ended.

But Averbeck wasn’t finished. With Shannon at her elbow, the primary care physician scanned the woman’s medical record to make sure she was current on all her routine care.

Breast exam? Check. Cholesterol screening? Check. Tetanus booster? Check. Pap smear? Check. Flu shot? We can give it to you right now.

It was, in a sense, two medical visits in one: treatment for an acute ailment combined with a snapshot of the woman’s overall health, the kind of review that historically has been the domain of the annual physical exam. “It saves them having to do two visits,” Averbeck said last week from her practice in St. Paul, Minn. “And from the standpoint of my schedule, it gives time for more patients to be seen.”

For decades, the yearly physical for adults has stood as an iconic fixture on the healthcare landscape, right next to tongue depressors and stethoscopes. Abraham Lincoln was in the White House when a doctor was first recorded suggesting that patients have a regular visit to detect and prevent illness.

And annual exams are still phenomenally popular: A study released last month found that 64 million Americans a year get a physical or gynecological exam, costing $7.8 billion and outpacing visits for respiratory conditions or high blood pressure.

But researchers and some health plans increasingly voice deep skepticism about the value of scheduling a separate annual exam for a healthy person. There’s little scientific evidence, they maintain, to justify the time, money, and expertise being invested in a ritual that consumes appointment slots, especially when patients with immediate aches and pains can’t squeeze into a doctor’s frenzied schedule.

“If I’m spending 20 minutes or half an hour with you on an exam that’s not necessary, that’s 20 minutes I could be spending with one or two other patients who are ill and want to come in that day,” said Dr. Robert Goldszer, associate chief medical officer at Brigham and Women’s Hospital in Boston. “If we’re doing visits that we bill for and someone pays for and we’re doing tests that someone pays for and it’s not necessary, that’s waste.” (more…)

Some Say Fee System Cuts Costs, Boosts Care;
Dr. Wood’s Legal Battle

Vic Wood’s walk-in clinic here sees patients six days a week and logs roughly 15,000 visits a year. Its sparsely furnished waiting room is packed much of the 11-hour day with people seeking care for conditions ranging from sore throats to chest pains.

The Situation: Some doctors are testing a new approach to health care — charging patients a flat rate in advance for medical services.
The Players: Physicians like Vic Wood, who began offering a prepaid plan at his West Virginia clinic in 2003 as a way to cut administrative costs and help uninsured patients.
The Hurdles: Rules for prepaid plans vary from state to state, and some critics have questioned whether the approach provides enough care for patients.

Despite the booming business, Dr. Wood and his staff — another doctor and four physician assistants — have battled strong head winds to keep the clinic going. Rising administrative costs and flat insurance-reimbursement rates make it tough to cover basic expenses. One in five patients lacks insurance; others are saddled with sky-high deductibles. Last year, Dr. Wood even cut his annual salary by half to help keep the clinic afloat.

In an attempt to turn the tide, Dr. Wood is trying a new approach — one that he hopes will one day sustain his practice.

For a monthly fee of $83 per individual or $125 for a family, the clinic provides unlimited primary and urgent care. Those who enroll in the prepaid plan get office visits, lab work, X-rays and as many generic drugs as the clinic can provide.

Dr. Wood is one of several hundred doctors across the country offering flat-rate, pay-in-advance plans. Though still experimental, proponents argue that the approach tackles two crises in U.S. health care: the rapid decline of doctors practicing primary-care medicine and the growing number of Americans who are either uninsured or underinsured.

“I’ll sign up one patient at a time if I have to,” says Dr. Wood, who has so far enrolled 100 people in his plan. The streamlined system, he says, cuts down on administrative hassles and costs, compels more office visits — and delivers better profits than one that relies on insurance dollars. “I can’t see my practice surviving for the next 10 years without this model,” he says.

Prepaid plans — and the opposition they face from various industry and regulatory factions — show how the medical establishment remains at odds over the delivery of basic care. Insurers say that high medical and drug fees force them to police doctors’ treatments and rates. Physicians argue that the hassles of processing insurance claims and referrals means less time with patients. At the conflict’s root, say health experts, is a medical payment system that tends to reward expensive, procedure-based care over routine, family-doctor visits.

“We all talk about how we’d like primary care to change, but we don’t pay for those activities,” says Paul Ginsburg, president of the Center for Studying Health System Change, a Washington, D.C., health-policy research group. “That’s why you have doctors trying to fund these services in a new way.”
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WASHINGTON, Oct. 17 — With little expectation of overriding President Bush’s veto, Democrats in Congress said Wednesday that they would pass a new bill to provide health insurance for 10 million children, but were willing to tweak it to address some White House concerns.

Mr. Bush predicted that on Thursday the House would uphold his veto of a bill to renew and expand the State Children’s Health Insurance Program. He named three administration officials to “seek common ground” with Congress.

But Democratic leaders, believing they have public support for expanding the program, said they saw no urgent need to negotiate the central elements of the bill.

Speaker Nancy Pelosi of California said Democrats in Congress would not compromise on their goal of providing health insurance for 10 million children — 6.6 million already on the rolls and nearly 4 million who are uninsured.

Many Republicans argue that the vetoed bill would allow coverage of children from middle- and upper-income families and of adults and some illegal immigrants. Democrats reject such criticism, but say they will consider revising the bill to make its restrictions and prohibitions clearer.

“We will type it in bigger, bolder letters, but we will not compromise on the goal of insuring 10 million children,” said Representative Rahm Emanuel of Illinois, chairman of the House Democratic Caucus.

If Mr. Bush vetoes a second version of the bill, Democrats say they will send him a third version just before Election Day 2008.

Supporters of the bill said they had not decided exactly how to proceed after the House voted Thursday on whether to override Mr. Bush’s veto.
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Two Dallas doctors fined for publishing misleading advertisements. A Garland doctor fined for inadequately monitoring a patient. Two people ordered to stop practicing medicine in Texas without a license.

These are among dozens of disciplinary cases announced by the Texas Medical Board in August for problems ranging from failing to file paperwork to endangering patients’ lives. Twenty-one of those disciplined were in the Dallas-Fort Worth area.

While most of the state’s more than 44,000 physicians provide patient care without incident, it’s worth checking out your doctor. The medical board, which is responsible for licensing and disciplining doctors, physician assistants and other medical professionals, provides tools for consumers to review their backgrounds on its Web site.

The Texas Medical Board search allows you to look for a doctor by name, license number, ZIP code, city and specialty. The results page indicates what information the agency has verified. The rest is reported by the physician.

The information verified includes license status and license history, the doctor’s medical school and any action or closed investigations the medical board has conducted.

Information reported by doctors, but not verified by the agency, includes board certification, malpractice claims, criminal records and basic information about their practices, such as office location and the hospitals where they work.

While the medical board does not verify board certification, you can check individual certifying boards’ Web sites or the American Board of Medical Specialties’ Web site. The search is free but requires registration. You also can call 866-275-2267 to verify a certification.

Investigations by the Texas Medical Board are prompted by complaints, which come to the agency in a variety of ways.
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