Research Roundup: Primary care doc pay and satisfaction; fixes to Medicare reimbursements; free vaccines?

American Journal of Public Health: Recruiting And Retaining Primary Care Physicians In Urban Underserved Communities: The Importance Of Having A Mission To Serve - "A critical element of improving population health in underserved areas is the adequacy and distribution of the primary care physician supply," write the authors of this study, who interviewed 42 primary care physicians from both underserved and non-underserved areas in Los Angeles County, California. "Three major themes emerged in relation to selecting geographic- and population-based practice decisions: (1) personal motivators, (2) career motivators, and (3) clinic support ... personal motivators (e.g., personal mission and self-identity) for choosing a practice were more common in responses among physicians who worked in underserved areas than among those who did not. By contrast, physicians in nonunderserved areas were more likely to cite work hours and lifestyle as reasons for selecting their current practice location or for leaving an underserved area" (Walker et al., November 2010).

Archives of Internal Medicine: Physician Wages Across Specialties - "Considerable debate surrounds the disparity in pay among different physician specialties, particularly between primary care physicians and specialists," according to this study examining some categories of doctor pay. Based on a "cross-sectional analysis of data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study," the authors report, "the wages of physician specialists were approximately 36% to 48% higher than were those of primary care physicians.   Wages varied substantially across physician specialties and were lowest for primary care specialties. ... The primary care wage gap was likely conservative owing to exclusion of radiologists, anesthesiologists, and pathologists. In light of low and declining medical student interest in primary care, these findings suggest the need for payment reform aimed at increasing incomes or reducing work hours for primary care physicians" Even internal medicine and pediatric specialists had significantly higher wages than primary care doctors" (Leigh et al., 10/25).

Archives of Internal Medicine: Physicians' Opinions About Reforming Reimbursement - This study describes the results of a national survey of 1,222 physicians between June 25 and Oct. 31, 2009: "Four of 5 physicians (78.4%) indicated that under Medicare, some procedures are compensated too highly and others are compensated at rates insufficient to cover costs. Incentives were the most frequently supported reform option (49.1%), followed by shifting payments (41.6%) and bundling (17.2%). Shifting payments and bundling were more commonly supported by generalists than by other specialists. There was broad support for increasing pay for generalists (79.8%), but a proposal to offset the increase with a 3% reduction in specialist reimbursement was supported by only 39.1% of physicians. ... Physicians are dissatisfied with Medicare reimbursement and show little consensus for major proposals to reform reimbursement" (Federman, Woodward and Keyhani, 10/25).

Health Affairs: Fixing Flaws In Medicare Drug Coverage That Prompt Insurers To Avoid Low-Income Patients - "Since 2006 numerous insurers have stopped serving the low-income segment of the Medicare Part D program, forcing millions of beneficiaries to change prescription drug plans. Using data from participating plans, we found that Medicare payments do not sufficiently reimburse insurers for the relatively high medication use among this population, creating perverse incentives for plans to avoid this part of the Part D market. Plans can accomplish this by increasing their premiums for all beneficiaries to an amount above regional benchmarks. We demonstrate that improving the accuracy of Medicare's risk and subsidy adjustments could mitigate these perverse incentives" (Hsu et al., 10/28).

UCLA Center for Health Policy Research: Profiling California's Health Plan Enrollees: Findings From The 2007 California Health Interview Survey - "This report provides a detailed profile of demographic characteristics, disease conditions, health status, health care use, and barriers to care among California residents. The report provides a pre-reform snapshot of health status and characteristics of health care use by Californians who were either enrolled in commercial or public managed care plans or who were uninsured in 2007," the authors write (Roby, Nicholson and Kominski, October 2010). A UCLA press release summarized the findings: "Three million Californians are enrolled in high-deductible health plans, insurance policies that offer consumers a lower monthly premium in return for higher out-of-pocket spending for health care services ... High out-of-pocket costs are associated with a reluctance to seek care.  For example, commercial PPO enrollees with high deductible plans were significantly more likely to delay care (20 percent) than those without high deductibles (17 percent)" (10/28).

Kaiser Family Foundation: Coordinating Coverage And Care In Medicaid And Health Insurance Exchanges - "Along with increasing affordability of coverage, the ACA [Patient Protection and Affordable Care Act] includes provisions to make it easy for individuals to enroll in coverage by requiring states to create a coordinated, simple, and technology-supported process through which individuals may obtain coverage through Medicaid, CHIP, and the new Exchanges," according to this brief from a roundtable event.

"There was consensus among participants that utilizing existing databases to support eligibility determination and automate enrollment would go a long way in simplifying the enrollment process," the brief notes. "With regard to income, it was noted that although eligibility for Medicaid and subsidized Exchange coverage will be based on Modified Adjusted Gross Income (MAGI)—which is captured when individuals file taxes and available through the Internal Revenue Service—there will need to be processes to collect more current income to assure individuals are enrolled in the correct program and receive the correct amount of financial assistance" (Artiga, Rudowitz and Lyons, 10/26).

Urban Institute: Universal Purchasing Of Childhood Vaccines In New York State: A Feasibility Assessment -  Researchers interviewed "key stakeholders and independent experts including physicians, vaccine manufacturers, health plans, regulatory officials, and staff in other states that have pursued this course," of providing free vaccines to children and adolescents in the state. They write that "initial estimates suggest that purchasing vaccines would cost the state approximately $160 million at the low end of the range and $224 million at the high end," with administrative costs to the state of about one percent. Based on "our assessment that many providers are financially strained to provide vaccines to their patients, and the state is risking a possible erosion of immunization rates (especially for higher priced vaccines) that can be avoided by a modest per-person investment of public funds," the authors advise New York State to "consider purchasing vaccines for all privately insured children in the state."

"[H]owever, … the state must recognize the limitations of a universal vaccine purchasing program: it will eliminate the opportunity for some providers to generate revenue from vaccine purchasing; it may not do enough to stabilize or raise immunization rates; and it will not address concerns about inadequacies in administration fee reimbursement" (Benatar, Howell, Bovbjerg, 10/1).

National Minority Quality Forum: National MRSA Atlas - The National Minority Quality Forum on Wednesday launched the National MRSA Atlas, which "graphically depicts the prevalence" of Methicillin-resistant Staphylococcus aureus (MRSA), a bacteria that is resistant to antibiotics. MRSA "causes significant infections throughout the U.S. with mortality rates of up to 20 percent in certain settings ... 'Mapping the spread of MRSA is an important step in localizing MRSA, raising awareness in high impact areas and tailoring prevention and treatment efforts to that particular locale,' Gary Doern, CEO of the National Minority Quality Forum said. 'Now that we know where the problem is, we can improve early diagnosis and treatment in the hardest hit communities,' he added" (10/27).