August 27, 2007

Brought to you by Thomas Jefferson University’s Department of Health Policy

Volume II, Number 32

Drugstores Now Offer Medical Care

Are you getting frustrated waiting to get an appointment with your physician? A concept
that is being called urgent care “lite” is or will soon be available at your local drugstore. Many
questions have been raised about the quality of care delivered at such clinics and health care
goliaths such as the American Medical Association have vocalized their concerns. There is no
doubt that the convenience of these clinics is their appeal, but state officials are concerned about
medical care being delivered in a business such as a pharmacy. Frank Munoz, associate
commissioner of the State Education Department’s Office of the Professions stated, “If we
determine the business corporations are practicing medicine, then they are illegally practicing the
profession and we have the authority to investigate.” Regulations differ between states for
convenient care clinics. Some require the presence of a physician at all times, while others have
nurse practitioners running the clinics. The American Medical Association recently proposed a
series of guidelines for the clinics and urged federal and state officials to investigate how these
clinics operate. (NY Times, 8/23/07)
Keeping Score of P4P Programs
PricewaterhouseCoopers released a report on the nation’s commercial health insurers’
Pay for Performance (P4P) programs, which stated that P4P has only served to temporarily
conceal a fundamentally flawed payment system. The report, “Keeping Score,” compares P4P
programs among commercial health insurers and includes interviews with executives from 10 of
the nation’s largest commercial payers.
Key findings from the report include a tremendous variation among commercial P4P
plans. Nearly 60 indicators of physician performance are being used by the plans surveyed;
however, none was being used by all plans. Commonalities among the programs included:
ƒ P4P is viewed as a necessary component of a quality-driven healthcare system, and eight of
the commercial insurers had plans to expand their P4P programs
ƒ Health plans believe that they must tailor their P4P scorecards for specific needs, leading to a
cornucopia of metrics in the market
ƒ In the commercial sector, physician P4P programs have evolved more fully than hospital
programs. Of the plans surveyed for the report, eight have P4P programs for physicians and
four have P4P programs for hospitals
ƒ Transparency of physician performance remains in its infancy because payers are cautious of
publishing names of physicians with poor quality performance
ƒ P4P payments ranging from 1% to 8% of total base physician reimbursement is considered
too low to significantly change provider behavior
Results from P4P are varied and few plans have set up tracking methods to chart progress. P4P
programs had little or no impact on costs according to the plans interviewed for the report, but
seven of the ten plans said they had seen some quality improvement. A full copy of the report is
available at www.pwc.com/hri. ( Health Imaging and PRWeb, 8/22/07)
AMA Campaign to Cover the Uninsured
The American Medical Association (AMA) launched a three-year, multi-million dollar
media campaign to promote its proposal for helping uninsured Americans get health insurance.
The campaign, called ”Voice For The Uninsured”, includes a website
(www.VoiceForTheUninsured.org ), newspaper and television ads. In the next two years the
campaign will focus on the presidential election and lobbying Congress to pass legislation to
cover all Americans. AMA President-elect Nancy Nielsen, M.D., said the campaign “is grounded
in the sad fact that one in seven Americans is uninsured. That’s not just a statistic, it’s a tragedy.”
(AMA and AHA News Now, 8/23/07)

Any questions regarding this newsletter can be directed

to Valerie Pracilio at valerie.pracilio@jefferson.edu or
Bettina Berman bettina.berman@jefferson.edu.