Class
of 1995-96
Abstracts of Policy Papers
Submitted for Completion of Certificate Requirements
Mark
S. Cantieri, D.O.
Inpatient Osteopathic Manipulative Treatment: Impact on Length of
Stay
Purpose/Background: Osteopathic manipulative treatment (OMT) for the hospitalized patient is a long standing practice. There are various claims regarding the efficacy and cost effectiveness of the utilization of OMT. While there is general recognition of the efficacy of OMT in the treatment of musculoskeletal pain, there is much less support for it as a technique to complement the care of the hospitalized patient.
Methods: All hospitals approved by the American Osteopathic Association (133) were surveyed requesting information regarding the utilization of OMT in their institution for the 1994 calendar year. The data contributed from the 18 responding hospitals was then analyzed.
Results: Data was analyzed on those cases where at least ten patients for that particular diagnostic related group (DRG) received OMT. Those DRGs where there was noted to be a decreased length of stay (LOS) greater than one day associated with the utilization of OMT included: psychosis; peripheral vascular disorder to age 70; septicemia age 18+; noncancerous disorder of the pancreas; stomach, esophagus and/or duodenum procedures; intestinal obstruction up to age 70; transient ischemic attack; circulatory disorder with acute myocardial infarction discharged alive, with cardiovascular complications; circulatory disorder without acute myocardial infarction, with cardiac catheterization, with complex diagnosis; operative vascular procedure, with major reconstruction, with age 70; and other digestive system diagnosis, age 18 to 70.
Conclusion: There is a need for double blind studies to further evaluate the impact of OMT in the hospitalized patient population. Several questions are raised from this study. Does severity of illness affect consultation patterns? Does OMT impact other parameters other than LOS, for example patient satisfaction and/or the overall cost and utilization of hospital resources? This paper helps to provide direction towards these ends.
James
J. Dearing, D.O.
A Survival Strategy in the Changing Healthcare Environment
Many physicians are not prepared to practice in a managed care environment. A dynamic, changing environment in medicine exists and persistent change is a likely constant for several years. The healthcare system's evolution to managed care will lead to its ultimate expression in managing populations' health care instead of individual patient's care. Physicians in practice must manage this transition and the medical education infrastructure must be reformed to prepare new physicians to be effective in the new systems. This paper processes new directions for our medical education system which should result in an appropriate supply of education providers needed to meet the changing health care market. The proposed model integrates appropriate educational change into the highly managed care environment.
Dawn
A. Fairley, D.O.
Osteopathic Dysfunction: Life or Death of Our Profession
An organization representative of it's entire membership must be sure it's members have a working knowledge of the structure and function of that organization. A recent study sampling the knowledge of interns and residents of Osteopathic medicine concerning the structure and function of the American Osteopathic Association revealed poor comprehension of both the framework and function of the various representative associations speaking for and making policy decisions for the AOA. The author explored the same knowledge base of currently practicing physicians. Results of the study mirror the previous mentioned study of interns and residents revealing a general lack of understanding of the structure and function of the organization that spans our entire membership. The author recommends a push toward education of our members concerning the structure of our organization to ensure not only more effective policy decisions but to guarantee the very life of our profession.
Gail
Feinberg, D.O.
Rural America: "I Still Don't Have a Physician"
In spite of a National concern with physician oversupply, there are still areas of physician shortage. The lack of primary care physicians in rural areas needs to be addressed. Past efforts to rectify the situation have not been fully effective. The assumption in the 1960s and 1970s that opening more medical schools would allow market forces to cause physicians to "trickle down" into areas of medical need didn't work. Federally funded programs which place physicians into rural areas have been found to work primarily on a temporary basis. Utilization of foreign medical graduates has also been unsuccessful.
Several medical schools have initiated early exposure of their students into rural practices throughout their training and have been successful in encouraging them to select rural primary care practices. A survey of physicians in practice in rural manpower shortage areas was performed and found that early exposure to rural practice played a role in their eventual selection of and satisfaction in a rural site.
Early exposure to medical practice in rural areas appears to increase the number of physician permanently practicing in these areas. To prepare physicians to serve in areas of need and be satisfied both personally and professionally in those areas, medical schools and postgraduate programs must focus on incorporation of rural practice exposure throughout medical training.
David
D. Goldberg, D.O.
Treatment of Substance Abuse: Well Worth the Price
A review of the literature reveals that substance abuse costs society in excess of $150 billion annually. The major substance contributing to this cost is alcohol. Most of these costs come from health care services, various expenses related to the criminal justice system, and increased insurance settlements for property losses and damages. Health care benefits specifically allotted for substance abuse are frequently nonexistent or not sufficient. A positive cost benefit is possible if appropriate treatment is available at the proper level of care and in a timely manner. Studies at the state level have shown a savings of between $5 and $11 relative to individuals treated early over individuals treated late for substance abuse. Patients completing treatment save between 30% and 55% of health care cost compared to non-completers. Insurance reforms need to be directed by legislation to make benefits available for prevention and early detection. Education of the primary care provider is key toward the early detection and referral for treatment. Producing treatment guidelines is vital for taking the patient through a continuum of care. This allows for the development of outcomes studies that reconfirm the cost effectiveness of treatment. The author combines these factors to recommend a multi-step policy initiative.
Kirk
L. Hilliard, D.O., FACOI
The Intern Registration Program: A Time to Revisit
The American Osteopathic Association (AOA) requires new graduates of osteopathic medical schools to participate in the Intern Registration Program (IRP) to obtain an AOA-approved internship. Completing an AOA-approved internship is essential for the continuation of postdoctoral training and future credentialing in the osteopathic profession. In the current health care climate, competition for osteopathic medical graduates has increased. According to W. Douglas Ward, the AOA instituted the intern matching process in 1963 and administered the matching process until 1994 (personal communication). The Intern Registration Program (IRP), the "osteopathic intern match," has been conducted by the National Matching Service since 1994. The National Matching Service was contracted by the AOA and completed its first match in January of 1995.
The National Matching Service is also directly involved with the National Resident Matching Program (NRMP), the "allopathic resident match." This organization provided the NRMP with the computer software and mathematical format to accomplish the match, although the National Matching Service is not involved with the administration of the resident match. The algorithm, a term used to describe the mathematical paring of applicant to program, is for all practical purposes the same for the IRP and the NRMP.
The purpose of this study was to investigate the perceptions of the Osteopathic Directors of Medical Education (DMEs) toward the IRP and to explore their knowledge base. Specific areas of interest included the following: contractual obligations of the osteopathic "Match", present policies of the IRP, and the interaction that exists between the osteopathic and allopathic matching process. Does the IRP meet the needs of the osteopathic DMEs as they struggle to retain more of the osteopathic graduate medical pool in AOA-approved training sites?
Paul
E. LaCasse, D.O., M.P.H., FACOEP
Physician Workforce Issues and Policy Options
Physician workforce supply will exceed projected demand early in the next century. Several policy options have been recommended to correct supply and demand mismatches and improve specialty mix characteristics of the physician workforce. These policy options are analyzed using key objectives of the osteopathic profession and educational community which include: 1) retain the autonomy and unique characteristics of the osteopathic profession, 2) match physician workforce with projected demand, and 3) establish an osteopathic training continuum for graduates of osteopathic medical schools. Policy options that limit and allocate aggregate GME positions jeopardize the autonomy of the osteopathic profession and fail to acknowledge the unique and beneficial characteristics of the osteopathic physician workforce. Policy options that satisfy the key objectives and should be supported by the profession include regulation that limits GME positions available to International Medical Graduates and reform of the accreditation process for new schools of osteopathic medicine that would include a physician workforce needs assessment. Market forces will continue to slowly affect geographic and specialty distribution of physicians in a favorable direction. Due to the dynamic and complex nature of physician workforce planning, an AOA health policy initiative should be established to analyze projections and recommend a strategic plan that incorporates the impact of the osteopathic workforce on national requirements.
Edward
K. Lee, D.O., M.P.H.
Joint Physician Ventures: The Antitrust Issue
Physicians in private practice are under considerable pressure by health care insurers and medical delivery systems to hold down costs. According to health care providers, mergers and joint ventures will lead to lower costs and lower consumer prices, while also allowing them to negotiate effectively with consumer purchasing groups. The wave of consolidation will be directed to reversing the effects of years of inefficient, cost-based reimbursement. Physicians are considering mergers or joint ventures as a way to survive. The Consumer Federation of America has estimated that approximately 20% of physicians have entered into joint venture partnerships. The existence of physician controlled plans is viewed as necessary in order to create competition for plans controlled by insurance companies and hospitals. Antitrust liability is a major concern when forming physician joint ventures. Unfortunately, guidelines which may point out antitrust liability are often unclear or non-existent. This potential liability has created much discussion and confusion. When forming a physician joint venture, the health care provider must ask themselves what is the purpose of the merger? When the purpose of the joint venture has been determined, one must analyze the merger for its potential antitrust liability. Antitrust reforms may help to allow physicians to facilitate physician joint ventures and participate on a level playing field with health care insurers and large health care plans. This paper will review major antitrust considerations when planning physician joint ventures.
Gary
L. Moorman, D.O.
The Education Crisis in Osteopathic Medicine
Purpose: This study attempts to identify those aspects of perceived program quality which may influence student, intern and resident choice of training programs.
Method: Separate focus groups consisting of 6 to 9 participants involving segregated students, interns and residents in osteopathic training programs at a large AOA/JCAHO institution were conducted by an experienced group facilitator. The question asked was "what factors are important to you in choosing a medical education program?" Responses were recorded for each session.
Results: The results from each group were recorded and categorized into the following headings: 1) Administrative/institutional support; 2) Programming--content and faculty; 3) Quality of life factors.
Most of the issues identified were consistent among each group. Factors such as appropriate patient volume, faculty support, didactic programming and institutional commitment were identified as very important. Administration function and user friendliness, prestige of the program and institution, as well as paid faculty and learning resource availability were among many other factors identified.
Conclusion: Osteopathic institutions must reform their approach to medical education with attention to administrative function, programming and quality of life issues to assure future viability of the profession.
Karen
J. Nichols, D.O., FACOI
Death and The Reimbursement System
Purpose: The purpose of this study was to determine if the type of reimbursement method influences the amount of charges for patients who die in the hospital.
Methods: This is a retrospective study using analysis of hospital financial records for all Medicare patients over age 65 who were admitted to Mesa General Hospital, a 140 bed community general hospital in Mesa, Arizona from August 1, 1995 through January 31, 1996. The two types of reimbursement were Medicare fee-for-service (FFS) and a Medicare capitated managed care (MC) plan (FHP).
Results: The number of patients admitted under both plans was similar (610 FFS vs. 656 MC). The number of decedent patients in both plans was similar (20 FFS vs. 14 MC). The charges/ admission for survivors in both plans was similar ($14,231.18 FFS vs. $14,494.40 MC). The charges for decedents in both plans was significantly different ($23,209.40 FFS vs. $48,776.50 MC). After age-adjusting the data, the MC survivors had 2.4% higher charges than FFS survivors. The MC decedents had 544% higher charges than FFS decedents.
Conclusion: The survivor patients under both reimbursement methods had similar charges. The decedent patients under a fee-for-service reimbursement method had lower charges than those under a managed care reimbursement method.