71 results match your criteria Consultant[Journal]


Asthma Control During Pregnancy: Avoiding Frequent Pitfalls.

Consultant 2017 Nov;57(11):662-665

Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, and director of the ROAD Center at UC Davis Medical Center in Sacramento, California.

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November 2017
10 Reads

Risk for HIV infection among health care workers. Nine questions physicians often ask.

Authors:
J R Schwebke

Consultant 1991 Sep;31(9):29-30

Northwestern University Medical School, Chicago, IL.

Consideration is given to the risk from needlestick injury and other accidental exposure to blood and bodily fluids infected with HIV. Recommendations are made for postexposure prophylaxis with zidovudine: how soon to start administering the drug, optimal dosages, and subsequent monitoring of the person who has been exposed. Also discussed is the possibility of additional risks incurred by pregnant health care workers. Read More

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September 1991
5 Reads

Practical methods to improve fee collections.

Authors:
J J Aluise

Consultant 1990 Jan;30(1):93-4, 99-100, 103

Chapel Hill School of Medicine, University of North Carolina.

A medical practice's financial policies should be frankly discussed with patients and explained at the initial visit. At that time, health insurance coverage should also be discussed. This candid conversation not only opens the door to further communication regarding a once-sensitive subject but also facilitates collection of fees--especially important when high-priced procedures are contemplated. Read More

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January 1990
5 Reads

Appropriate health care. Setting the limits.

Authors:
W L Kissick

Consultant 1989 Oct;29(10):73-4, 76, 79

Appropriate is defined by Webster as "especially suitable or compatible". Historically, health care has been appropriate in the eyes of physicians. Now we recognize that health care, like beauty, is in the eyes of the beholder, and the beholders include the consumer and society as well. Read More

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October 1989
6 Reads

How to benefit from the coming RBRVS changes.

Consultant 1989 Sep;29(9):66-7, 71-2

The Physician Payment Review Commission's endorsement of the Resource-Based Relative Value Scale (RBRVS) represents a major step in reform of the Medicare payment system. Under this plan, cognitive services finally would be reimbursed at the same level for the work involved. The authors present a closer look at the commission's recommendations and discuss how these might substantially improve payment of primary care physicians. Read More

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September 1989
4 Reads

Health care for the elderly. Who will pay for it and how?

Authors:
P D Mott

Consultant 1989 Aug;29(8):81-2, 84-5

Given adequate resources and an effective reimbursement system, an individual physician can properly diagnose an elderly patient's illness and can plan and provide a continuum of immediate and long-term care. Why, then, is the larger system failing our older patients? What have diagnosis related groups done for them? Have health maintenance organizations (HMOs) helped at all? Do social HMOs or the Medicare Catastrophic Coverage Act offer any promise? Does Canada's long-term care system offer physicians more support than ours are given? Each of these questions is explored, and the challenge to US medicine is made clear. Read More

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August 1989
4 Reads

Geriatric health care. Older patients and medical consumerism.

Authors:
C A Harvey

Consultant 1989 Aug;29(8):86-8, 91

Aging of the "baby-boom" generation and increased life expectancy will mean a projected population increase of persons 65 and older from 39 to 65 million between 2010 and 2030. Surveys conducted among members of the American Association of Retired Persons (AARP) reflect their wish to establish a more equal part in the physician-patient relationship and to participate in local and federal health care monitoring and reform. Accordingly, many are asking for health information and are prepared to change heretofore ineffectual communication with the health care system--whether in their personal physician's office or at the federal level. Read More

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August 1989
4 Reads

Cost-containment incentives in HMOs. What's known, what's not known.

Authors:
A L Hillman

Consultant 1989 Jul;29(7):84-5, 88, 91

HMOs use various incentives to control utilization of health care resources, and physicians who are thinking of joining these organizations should understand how these factors will influence their practice. Financial incentives include withheld funds, penalties against those at risk, and bonuses for physicians with good practice habits. Nonfinancial incentives include education concerning efficient use of health care resources, feedback mechanisms, participation in planning cost-containment programs, and administrative constraints. Read More

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July 1989
4 Reads

Stemming the AIDS epidemic. Drawing on past experience with VD control.

Authors:
J C Cutler

Consultant 1989 Jun;29(6):56-7, 60, 62-3

In view of the increasing concerns about AIDS, confidentiality, and reactions to risk factors such as homosexuality and drug abuse, our patients and communities should be familiarized with medicine's past successes in control of sexually transmitted diseases. The system of contact tracing and patient notification has been highly productive and can be done in a caring and effective manner to minimize emotional trauma and maximize protection of sexual partners, family, and the community. By building on the experiences of past programs, we can do much to slow the spread of human immunodeficiency virus infection and to counter the panic and irrational fears that are so prevalent. Read More

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June 1989
4 Reads

Followup in HIV testing. Partner notification: the Colorado Department of Health approach.

Authors:
T M Vernon

Consultant 1989 Jun;29(6):43-6

The Colorado Department of Health finds that partner notification, a procedure that has been beneficial in stemming epidemics of communicable diseases (most notably of syphilis), has proved useful and cost beneficial when applied to the current human immunodeficiency virus (HIV) epidemic. Of key importance is the extremely high level of confidentiality maintained by the department. Highly trained disease intervention specialists search for contacts, advise them to seek HIV testing, and counsel them on safer sex and I. Read More

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June 1989
5 Reads

AIDS and health care workers. Safety measures that prevent transmission.

Consultant 1989 Jun;29(6):29-32, 39, 42

Despite the fears of health care professionals that they might contract AIDS from their patients, they actually run a low risk. By identifying existing situations that routinely expose them to body substances and by taking reasonable preventive measures when caring for all patients, these workers can institute habits that will afford them excellent protection against not only AIDS but all infectious diseases. Needlesticks and other puncture or cutting accidents are the prime cause for seroconversion among such personnel. Read More

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June 1989
5 Reads

A cost-effective approach to managing infectious disease.

Authors:
R A Wright

Consultant 1989 May;29(5):143-6, 150, 155

Outpatient intravenous therapy (OIT) offers a safe, practical, and cost-effective means for long-term antimicrobial treatment of certain infectious diseases. The author compares the efficacy, frequency of administration, and cost of the most suitable parenteral agents and cites criteria for patient selection. An efficient and safe OIT program requires a multidisciplinary approach that integrates support from the physician, nurse-educator, social services, and pharmacy. Read More

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May 1989
6 Reads

What HMOs should tell their subscribers, and what you can do about it.

Authors:
D F Levinson

Consultant 1989 May;29(5):118-20, 123-5

All health maintenance organization (HMO) plans try to control costs by restricting choice of physicians and regulating utilization of service. Have some plans gone too far? Patient and physician can become caught in a complex web of gatekeepers and capitation arrangements, withholds, bonuses, and penalties. Patients are almost always unaware of the details of these pressures on the physician. Read More

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May 1989
4 Reads

Mandatory assignment. What hath it wrought in Massachusetts?

Authors:
W M McDermott

Consultant 1989 Apr;29(4):84-6, 88

The national precedent set in 1986--when Chapter 475, mandating Medicare assignment in Massachusetts, became law--has spread across the United States as other states seek to control physicians' incomes under the Medicare program. While some form of mandatory assignment is the law in at least a dozen states, the Bay State's law currently remains the most restrictive in the country. The effects of Chapter 475 continue to ripple through the health care system and are sure to intensify as the national debate heats up over the future of the Medicare program. Read More

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April 1989
5 Reads

DRG "creep". Pitfalls and sanctions to avoid.

Consultant 1989 Mar;29(3):93-5, 98-9

In 1983, with the advent of the Medicare prospective payment system, the physician's role became crucial in determining a hospital's reimbursement for treatment of a Medicare patient. The correct diagnosis-related group assignment depends upon the physician's accurate designation of the primary and secondary discharge diagnoses. Manipulation of this information can result in an inaccurate payment, and the physician is ultimately responsible for the misrepresentation. Read More

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March 1989
4 Reads

HMO update. Where are they headed?

Authors:
P D Fox

Consultant 1989 Mar;29(3):109-12

Health maintenance organizations (HMOs) are undergoing major changes, among them the following: Enrollee growth will continue to be strong, although the rate of growth will diminish. HMOs will develop new product lines, such as offering preferred provider organizations and various cost management services. The competitive environment has become tougher. Read More

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March 1989
4 Reads

Underinsured and uninsured patients. Who are they, and how can they be covered?

Authors:
G R Wilensky

Consultant 1989 Feb;29(2):59-62, 67, 70

Whether 31 million or 37 million, the number of Americans who are either partially or completely without medical insurance is far too high, and may well be growing. Explanations include the recession of the early 1980s, the change from a manufacturing to a service-related US economy, and health care cost-containment pressures. The total uninsured population comprises three main groups: the indigent (around 25%), the medically uninsurable (0. Read More

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February 1989
4 Reads

Underinsured and uninsured patients. Basic health care: the Washington State experiment.

Authors:
E W Gray

Consultant 1989 Feb;29(2):71-2, 74, 77-9

During the early 1980s in the state of Washington, a change in access to health care became apparent. This was due to a change in the basic method of financing. Within the state, a shift to a service-dominated economy resulted in minimum wage earning with no fringe benefit for health, and a severe recession resulted in unemployment and under-employment. Read More

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February 1989
4 Reads

How they've changed and how they're changing medicine.

Authors:
J G Freymann

Consultant 1989 Jan;29(1):69-70, 75-6

Most Americans have, until recently favored a health care system preoccupied with treatment of disease, oriented around hospitals, and dominated by specialists. But this concept is being changed by economic, demographic, and technologic stresses. The public's new perception of how health care should be delivered is reflected by community-based medical services that emphasize health maintenance and that are dominated by primary physicians. Read More

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January 1989
6 Reads

The Chrysler experience, and forecasts.

Authors:
J A Califano

Consultant 1989 Jan;29(1):58-60, 63, 66

Using his experience with Chrysler Motors as an example, the author tells how waste, inefficiency, and greed shaped a corporate health care system that, if it continued, could have blocked the corporation's recovery. An intense investigation of the use and abuse of this plan resulted in savings of about $100 million over an initial two-year period, with an additional $250 million savings projected over the following five years. In considering future changes in the country's health care system, he comments on the need for hospital cutbacks; reduction in unwarranted variations in medical practice; dissemination of necessary information to both individual and corporate purchasers of health care; increasing utilization of nurses in the medical arts; changes in the medical malpractice system; an increase in corporation case management systems; and competition among providers, which, by reducing costs, will most likely result in an efficient health care system for all people. Read More

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January 1989
5 Reads

Competition in health care. Where it has failed and why.

Authors:
B S Mittler

Consultant 1988 Dec;28(12):74-6, 78, 80 passim

During the 1980s, it was expected that competition and deregulation would render health care more efficient and less expensive, but these measures have not worked. Rather, hospitals have become more expensive, HMO costs are increasing as fast as those for fee-for-service practices, access to care has deteriorated, cost-containment policies have reduced quality of care, and government regulation has increased instead of decreased. Examined in detail is the failure of supermeds (giant hospital corporations), HMOs, and marketing and advertising to lower costs and increase efficiency. Read More

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December 1988
5 Reads

Competition among physicians. Avoiding anticompetitive activities.

Authors:
D Oliver

Consultant 1988 Dec;28(12):60-1, 68, 73

Increases in both the cost of medical care and the numbers of providers have generated strong pressure for competition in the medical profession. The Federal Trade Commission strives to maintain such competition free from public and private restraints in order to maximize consumer welfare. The author describes the advantages of these types of competitive practices and discusses the competitive restraints that most concern the FTC: restrictions on ethical advertising, exclusion of competitors, restraints on dispensing drugs, and restrictions on commercial practice locations. Read More

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December 1988
4 Reads

Managed care contracts. A primer on how to analyze contracts and avoid the traps: Part 2.

Authors:
R Robinson

Consultant 1988 Nov;28(11):92-3, 96-7

Because many business entities are attempting to increase their control over medical practice, physicians must take extreme care in reading proposed amendments to managed care contracts. Beware of vague language concerning utilization review; contracts that require you to passively accept future contract modifications; innocuous language that may endow the medical director with excessive authority; and unacceptable regulations concerning medical, financial, and administrative records. The author suggests counterproposals that are fair to both business entities and participating physicians. Read More

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November 1988
6 Reads

Current status of AIDS. An overview of statistics, reporting, and at-risk populations.

Authors:
P W Mansell

Consultant 1988 Nov;28(11):23-7, 30, 32

The acquired immunodeficiency syndrome (AIDS) was first described in 1981. It is estimated that there have now been more than 250,000 cases worldwide, with more than 69,000 in the United States. Probably there are between 5 and 10 million people infected with the causative organism--the human immunodeficiency virus--globally. Read More

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November 1988
4 Reads

Presidential health care priorities. Health care access; AIDS; and drugs.

Authors:
G H Bush

Consultant 1988 Oct;28(10):87, 89, 91 passim

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October 1988
4 Reads

Home health care. What's happening and what to look for.

Authors:
P Rogatz

Consultant 1988 Sep;28(9):68-9, 72-3

Home health care services have undergone tremendous growth in recent years thanks to increased need, Medicare reimbursement, improved technology, and preference for care at home rather than in the hospital. Criteria are listed for choosing the best agency for your patients' needs, in terms both of accreditation and certification factors and of specific services provided. Services may include home use of such sophisticated technologies as intravenous chemotherapy, total parenteral nutrition, and peritoneal dialysis; long-term assistance with daily needs for clinically stable patients; and home hospice care. Read More

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September 1988
4 Reads

Peer review organizations. Practical steps in dealing with them.

Authors:
M B Shook

Consultant 1988 Aug;28(8):72-4, 76-7

Peer review organizations exist to maintain high standards of medical care, not to intimidate physicians or hamper their style of practice. The author traces the history of these organizations and stresses their decentralized nature. Physicians are instructed on the optimal response to a peer review notice. Read More

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August 1988
4 Reads

Your stake in hospital-based strategies for liability control.

Authors:
D W Johnston

Consultant 1988 Aug;28(8):83-90

Tort reform, regrettably, offers only limited hope for reducing the professional liability of physicians and hospitals. Formalized risk management programs soon may be demanded by state agencies, accrediting organizations, and liability carriers. Liability-related losses can be held to a minimum by adoption of a formal risk management program, aimed at preventing or minimizing untoward incidents and adverse patient outcomes and integrated with ongoing quality-of-care assessments and utilization-review programs. Read More

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August 1988
6 Reads

A primer on how to analyze contracts and avoid the traps.

Authors:
R Robinson

Consultant 1988 Jul;28(7):74-7

Contracts from preferred provider organizations, health maintenance organizations, independent practice associations, and managed health plans present numerous problems for primary care physicians. The ability to understand the terms and conditions is an essential part of the practice of medicine today. Additionally, physicians need to involve experts in the preparation of counterproposals that will render contracts fair and equitable for physicians. Read More

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July 1988
4 Reads

A look at ASIM's program.

Authors:
A Fawley

Consultant 1988 Jul;28(7):91-3

The American Society of Internal Medicine's Medical Advocacy Services, Inc, (MASI) provides contract analysis and negotiation assistance by letter, telephone, or in person. Within MASI's purview are employment relationships, advice on mergers and buy-sell arrangements, contract development for various group arrangements, and negotiation seminars. Its services are available to individual physicians nationwide as well as, on a retainer basis, to groups. Read More

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July 1988
5 Reads

Contracting assistance, California-style.

Authors:
E A Snelson

Consultant 1988 Jul;28(7):83-5

The California Medical Association's Division of Physician Contracting and Medical Staff Affairs serves as a clearinghouse of data on the numerous and varied entities offering contracts to physicians in California and in other states. In addition to disseminating this information, it offers specific analysis on a contract-by-contract basis to members of the association and to other physicians and groups, and it presents seminars on contractual agreements and negotiation. Read More

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July 1988
4 Reads

Working toward a more rational pattern of fees.

Authors:
P B Ginsburg

Consultant 1988 Jun;28(6):82-5

Following its congressional mandate to reform physician payment, the Physician Payment Review Commission has been examining the concept of a fee schedule. The commission, which operates almost entirely in public, has extensive contact with physician groups and beneficiary organizations, and provides extensive opportunities for formal testimony at public meetings and for frequent informal interactions at the staff level. By sending various organizations a draft outline of issues it hopes to take up in its next report to Congress, it is soliciting suggestions from them long before any decisions are made. Read More

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June 1988
5 Reads

Enhanced reimbursement is becoming a reality.

Consultant 1988 Jun;28(6):89-90, 93-5

Physicians' cognitive services, historically underpaid in comparison to specific procedures, are finally beginning to earn deservedly higher fees. To a great extent, this increased reimbursement is the result of action by the American Society of Internal Medicine. The authors note how some HMOs and insurers are already implementing payments for cognitive services, and a Table outlines congressional action in this direction from late 1983 to the present. Read More

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June 1988
5 Reads

Foreign experiences relevant to Medicare.

Authors:
W A Glaser

Consultant 1988 May;28(5):104-7, 111

The method of paying doctors under Medicare has never been workable; it creates disputes and confusion for physicians and everyone else and will soon be replaced. The problem is the need to develop a simple and predictable method that will avoid both government dictation and financial bankruptcy. Every other developed country has had structured methods of paying doctors; the United States can use these methods as the starting point for reform. Read More

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May 1988
5 Reads

Women in medicine: past, present, and future.

Authors:
S R Wynn

Consultant 1988 May;28(5):117-9, 123

Women now constitute 14% of all physicians in practice and are concentrated in the primary care specialties. Thirty-five percent of all medical students are female, and their numbers are increasing yearly. Female physicians frequently combine career and family, and the average woman physician has one child during residency and one child in the early years of practice. Read More

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May 1988
5 Reads

Health care delivery update: Part 2. Banking on quality: the call for a quality reserve system.

Authors:
P M Ellwood

Consultant 1988 Apr;28(4):92-3, 99-100

In the health policy arena, policy-makers listen when physicians use quality as their battle cry in promoting or opposing health care innovations. Physician-managers are being challenged to measure quality and determine whether it is appropriate to deviate from community standards or expert opinion in providing care. Their responsibility extends to shaping their organization's culture and values, strategic planning, technology acquisition, and clinical performance. Read More

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April 1988
4 Reads

Managing managed care. Grouping together is the answer.

Authors:
F J Wenzel

Consultant 1988 Apr;28(4):105-7, 110-2, 114

Working through an organization is the only way to manage in a managed care system. To be successful we need sophisticated management information systems, outstanding leadership and management, and a discretionary income distribution system. We must be willing to accept venture risk even though we will not win all the time. Read More

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April 1988
5 Reads

The hard choices that we must make.

Consultant 1988 Mar;28(3):82-3, 87-8, 91

The cost of caring for patients with cardiovascular disease has increased more than 50% in the past five years. Much of this increase is due to the dissemination of new technologies that have proved effective for specific patient populations. Molecular biology, immunology, magnetic resonance imaging, and second generation cardiovascular drugs all promise more effective, noninvasive diagnostic and treatment methods--and continued higher costs. Read More

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March 1988
7 Reads

How Washington State doctors battled it and won.

Authors:
D M Keith

Consultant 1988 Mar;28(3):92-4, 97

Mandatory medical assignment bills have been presented to the legislatures of 16 states since 1985, when a bill passed in Massachusetts tied acceptance of assignment to medical licensure, In November 1987, an initiative appeared on the Washington State voter's ballot asking that it be considered a consumer protection violation for physicians to charge more than Medicare's "reasonable" fee. This was the first time that the issue was presented to the registered voters of any state. This article details the way in which the Washington State Medical Association combatted the initiative and turned around an electorate that was 68% in favor, in August, to a final ballot of 63. Read More

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March 1988
6 Reads

The physician-executive: Part 2. The mature physician. Retooling for management roles.

Authors:
F A Riddick

Consultant 1988 Feb;28(2):120, 125-7

Many physician-managers enter the field of management in mid-career. There are ample opportunities for learning the principles of management through societies such as the American Academy of Medical Directors, through graduate degree and shorter programs targeted to mature physicians, and through institutionally developed programs of continuing education. Mastery of these principles requires application in practice. Read More

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February 1988
5 Reads

Changes in hospital-doctor relations.

Authors:
S E Berki

Consultant 1988 Feb;28(2):114-6, 119

Recent trends in the health care system are changing relationships between physicians and hospitals. Excess hospital capacity, DRGs, and prospective payment impel managers to be more cost conscious. By introducing protocols, practice monitoring, and incentives for conservative styles, they are eroding traditional physician autonomy. Read More

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February 1988
6 Reads

Health care delivery update: Part 1. Trends: less and more integration, bundled services, rethinking IPAs.

Authors:
P M Ellwood

Consultant 1988 Jan;28(1):86-8, 91-2, 95

Vertical integration of national medical firms that contract with physicians has slowed dramatically. At the same time, several top-level group practices, taking advantage of reputations for excellence, are integrating vertically on a national or regional scale. A shift from buying well to actually managing medical care will separate the "prospective supermeds" that learned to collaborate with physicians from those that are attempting to manipulate them. Read More

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January 1988
4 Reads

Blood glucose self-monitoring. An evaluation of five systems.

Consultant 1988 Jan;28(1):99-103, 106-7, 110 passim

Self-monitoring of capillary blood glucose has proved to be of great value to diabetic patients. Primary care physicians should therefore become familiar with the various models of reflectance meters so that they can advise each patient on the most appropriate type, and on its use. Accordingly, the authors reviewed five of the major self-monitoring blood glucose systems: Glucometer II, Accu-Chek II, Diascan-S, Glucochek SC, and Trends-Meter. Read More

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January 1988
5 Reads

Medicare HMOs. The new kid on the block.

Authors:
M R Gillick

Consultant 1987 Dec;27(12):97-100

Medicare HMOs may not be the ultimate answer to geriatric care, but they continue to grow in number and are becoming increasingly popular among the elderly. Independent practice association (IPA) groups are the fastest growing type. Problems concerning quality of care and cost, exemplified in the extreme by the recent case of the International Medical Centers HMO in Florida, have illustrated the need for greater regulation of Medicare HMOs by the Health Care Financing Administration. Read More

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December 1987
4 Reads

Physician profiling. How it can be misleading and what to do.

Authors:
S D Horn

Consultant 1987 Dec;27(12):86-8, 93-4

Hospitals want to identify physicians whose practice patterns are more costly or less costly than their colleagues', because of cost containment pressures from government, employers, and insurers. But whether a given physician is high cost or low cost depends strongly on the classification system used to define case types. Since diagnosis related groups (DRGs) are used by the Health Care Financing Administration for payment of Medicare beneficiaries, hospitals often use DRGs to compare physicians' use of resources. Read More

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December 1987
4 Reads

The physician-executive: Part 1. The younger doctor. Growing demand for an emergency subspecialty.

Authors:
D B Nash

Consultant 1987 Nov;27(11):97-8, 101-2, 106 passim

Changes in the health care system have fostered the need for a new, evolving specialty: the physician-executive. The author, who foresees medical administration as a board-certified subspecialty within five years, describes this position as a liaison between the administrative and the clinical personnel of a hospital or prepaid health plan. It is particularly suitable for young physicians who are newly certified in internal medicine. Read More

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November 1987
4 Reads

Today's young physicians. Factors that shape their professional lives.

Authors:
M F Collins

Consultant 1987 Nov;27(11):86-8, 91, 95

Young physicians represent a sizeable constituency of the medical professions, but they are facing increased socioeconomic pressures. The large number of women physicians continues to increase, thus changing the demographics of the young physician population. Rising economic pressures have become harsh realities for all of them. Read More

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November 1987
4 Reads