The Chosen Profession
“Be a physician” is the most common career advice that Americans give young adults, according to a Gallup poll of 1,003 adults aged 18 years and older. Of those who responded to the survey, 20% recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, only 11% and 8% suggested that women and men choose careers in computers, respectively. Nursing continues to be viewed as a women's profession: 13% thought women should choose nursing, but that choice did not even make the top five careers for men. Medicine has always been cited as a top career choice for men, although the percentages have been rising steadily over the years for women, as more pursue careers as physicians. “These poll results offer great encouragement for a profession facing a diversity gap and a workforce deficit,” said Jordan Cohen, M.D., president of the Association of American Medical Colleges.
Pay-for-Performance Shortfalls
The “pay-for-performance” style of reimbursement system is still largely untested and is not designed to reap cost savings, “particularly since most of the quality measures it targets are measures of underuse,” Meredith B. Rosenthal, Ph.D., of Harvard School of Public Health, Boston, said during testimony before a subcommittee of the House Committee on Education and the Workforce. Also, there is little guidance in the literature for purchasers and health plans to reference when they set out to design pay-for-performance programs. Coordination among payers in using these measures is needed, she said. “If only a few of the many payers that a provider contracts with are paying for performance, or if each payer focuses on a different measure set, the effects of pay for performance may be dulled.” She suggested that Congress fund more research by the Agency for Healthcare Research and Quality to identify approaches that would improve this method's cost-effectiveness and increase the likely gains in quality of care.
Monitoring Health Fraud
The Federal Bureau of Investigation is not monitoring its spending on health care fraud investigations as carefully as it should, according to a report from the Government Accountability Office. The report, requested by the chairman of the Senate Finance Committee, Chuck Grassley (R-Iowa), found that some agents who previously were assigned to work on health care fraud had been shifted to counterterrorism activities. The GAO said it had been told by the FBI that the bureau wasn't too concerned about not spending enough because most of the time such spending was “historically far in excess” of the budgeted amount. “However, once FBI began to shift agent resources away from health care fraud investigations, agent[s] … charged to health care fraud investigations fell below the budgeted amounts.” The GAO recommended that the FBI improve its monitoring capability and establish better reporting procedures. The bureau said it already has taken steps in that direction.
Illinois Malpractice Bill
Another state has taken steps to curb rising malpractice costs. In May, the Illinois General Assembly approved legislation to place caps of $500,000 per physician and $1 million per hospital on noneconomic damages. The legislation also calls for increased physician scrutiny by posting disciplinary actions and malpractice lawsuit outcomes on the Internet, and requires insurers to release actuarial data during public hearings called to review rate increases. Steve Schneider, vice president of the American Insurance Association, Midwest Region, took issue with this last provision, indicating it would “send the wrong message to insurers who may be considering entering the market.” At press time, Gov. Rod Blagojevich (D) was expected to sign the bill into law.
Medicaid Commission Formed
To strengthen Medicaid, the Department of Health and Human Services established an advisory commission to identify reforms necessary to stabilize the program. The commission must submit two reports to HHS Secretary Mike Leavitt. The first, due Sept. 1, will outline recommendations for Medicaid to save $10 billion over the next 5 years, targeting potential long-term enhancements and performance goals. The second, due Dec. 31, 2006, will make recommendations to help ensure Medicaid's long-term sustainability, addressing issues such as expanding coverage while still being fiscally responsible, and providing long-term care to those in need. Secretary Leavitt plans to appoint up to 15 voting members to the commission with expertise in health care policy, finance, or administration.
Gender-Difference Research Stalled
Research into gender differences is receiving limited funding at the National Institutes of Health, according to the Society for Women's Health Research (SWHR). Grants awarded to study gender differences make up a small percentage of the total number of NIH grants, and none of the NIH institutes had devoted more than 8% of its funded grants to research on gender differences from 2000 to 2003, according to a report from SWHR. “We looked at NIH research grants awarded between 2000 and 2003 and found that across all institutes, an average of just 3% of grants focused on sex differences,” Sherry Marts, Ph.D., SWHR vice president for scientific affairs and the study author, said in a statement. SWHR officials said they had hoped to see increasing levels of funding for gender-related research, but they are encouraged that some NIH institutes have established mechanisms to foster such research.