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USC practice study report criticized by ACEP Committee
USC Practice Study Report Criticized by ACEP Committee The Emergency Physician Practice Study Report, produced by t h e Medical A c t i v i t i e s a n d M a n p o w e r Projects Division of Research in Medical Education a t the U n i v e r s i t y of Southern California School of Medicine, has been reviewed by the A C E P Research Committee and found to be "disappointing," according to Committee C h a i r m a n Ronald L. Krome, MD. Despite the e v i d e n t a m o u n t of effort t h a t was expended in the study of 24 medical and s u r g i c a l specialties and s u b s p e c i a l t i e s , t h e R e s e a r c h Committee listed a n u m b e r of problems with the USC report. A major concern is the fact t h a t the M e d i c a l A c t i v i t i e s a n d M a n power Projects Division used a physician s a m p l e d r a w n from t h e A M A master list of emergency physicians, rather t h a n from the A C E P m e m b e r ship list. Research C o m m i t t e e members a g r e e d t h a t t h e A M A m a s t e r file does not r e p r e s e n t an a p p r o p r i a t e universe of physicians practicing in hospital emergency d e p a r t m e n t s , b u t only those d e c l a r i n g an i n t e r e s t in emergency medicine. The Report refers to the A M A m a s t e r file as "the 0nly c o m p r e h e n s i v e n a t i o n a l d a t a base c u r r e n t l y in e x i s t e n c e , " e v e n though it lists only 2,992 e m e r g e n c y physicians. The USC s t u d y developed a relatively low response r a t e . Of the 592 physicians asked to p a r t i c i p a t e in t h e study, only 46% r e s p o n d e d a n d no mention is m a d e of a v a l i d a t i o n study of the d a t a collected. The R e s e a r c h C o m m i t t e e a l s o found fault with t h e p a t i e n t load statistics presented in theReport. The USC d a t a showed t h a t ' t h e h i g h e s t median p a t i e n t load was 16 p a t i e n t s per day, with most r e s p o n d i n g physicians i n d i c a t i n g a p a t i e n t load of less than two p a t i e n t s seen per'hour. This is contrasted to a n A C E P m e m b e r ship survey of 600 r a n d o m l y selected members with a s t a t i s t i c a l l y significant 66% response r a t e t h a t showed an average of more t h a n 19 p a t i e n t s seen per day. This r e s u l t e d in an average p a t i e n t load of more t h a n two patients per hour seen by the physicians p a r t i c i p a t i n g in t h e A C E P study. Still another study conducted' at T r i - C i t y H o s p i t a l in S a n Diego County showed almost t h r e e p a t i e n t s seen per hour b y t h e a v e r a g e emergency physician. The discrepancy between USC's statistics a n d other reports can p a r t i a l l y be explained by the fact t h a t no p a t i e n t s s e e n on
9:4 (April) 1980
S a t u r d a y or Sunday, a time u s u a l l y b u s i e r t h a n t h e r e s t of t h e w e e k , were included as p a r t of t h e study's m e d i a n data. The Research Committee h a s expressed concern t h a t t h e d a t a r e s u l t i n g from the USC s t u d y will be used to d e t e r m i n e manpower n e e d s in e m e r g e n c y h e a l t h c a r e planning. Because it is probable t h a t all or p o r t i o n s of t h e U S C d a t a m a y be
u s e d by the G r a d u a t e Medical Education N a t i o n a l Advisory C o m m i t t e e (GMENAC) and others to assess man~ p o w e r n e e d s in e m e r g e n c y m e d i cine, it is i m p o r t a n t t h a t A C E P cont i n u e s to offer critiques of such m a n p o w e r studies, and to c o m m u n i c a t e t h e C o l l e g e ' s p o s i t i o n on m a n p o w er p l a n n i n g a n d t r a i n i n g needs to G M E N A C a n d others.
Rural Health Conference Set for April in Boston A c r y s t a l b a l l v i e w of r u r a l h e a l t h care in the 1980s will open t h e 3 3 r d N a t i o n a l C o n f e r e n c e on R u r a l H e a l t h at the Sheraton-Boston A p r i l 17-18. The keynote session of the twod a y c o n f e r e n c e will f e a t u r e J a c o b K o o m e n , MD, of t h e U n i v e r s i t y of N o r t h C a r o l i n a , who will e x a m i n e t h e p r o b l e m s to b e faced in r u r a l h e a l t h delivery in the coming decade a n d discuss p r o g r a m s to deal w i t h those problems. S e m i n a r s d u r i n g the conference will deal with emergency medical services; extrication from farm e q u i p m e n t ; self-care, h o m e h e a l t h , a n d hospice care; m e n t a l h e a l t h care in r u r a l settings; t h e i n c r e a s i n g dem a n d s on r u r a l h o s p i t a l s ; h e a l t h planningi a n d other m a t t e r s of conc e r n to t h o s e i n v o l v e d in r u r a l health. A series of c o n t i n u i n g medical - education courses designed for physicians trea~ing r u r a l populations will
be presented d u r i n g both days of t h e conference. P r o g r a m topics i n c l u d e wound closure, p r i m a r y m a n a g e m e n t of head t r a u m a , poisoning, zoonosis, replantation mlcrosurgery, and sports medicine for r u r a l schools. " C o s p o n s o r s of t h e c o n f e r e n c e , with the A m e r i c a n Medical Association, a r e t h e A m e r i c a n Hospital Association's C e n t e r for Small or Rural Hospitals, the A m e r i c a n Nurses' Association, the A m e r i c a n P h a r m a c e u tical Association, the Cooperative E x t e n s i o n S e r v i c e of t h e U n i t e d S t a t e s D e p a r t m e n t of A g r i c u l t u r e , the F a r m Foundation, the Massachus e t t s Medical Society, a n d t h e Nat i o n a l Safety Council. F o r a d d i t i o n a l i n f o r m a t i o n on t h e conference, contact the Departm e n t of C o m m u n i t y Health Systems, A m e r i c a n Medical Association, 535 N o r t h Dearborn Street, Chicago, Illinois 60610; 312/751-5997 or 312/ 751-6604.
"Reasonable" Fees Allowed Physicians in Teaching Hospitals Under Proposed Amendment P h y s i c i a n s in t e a c h i n g hospitals will Continue to be p a i d "reasonab] e a n d c u s t o m a r y " fees for t h e i r services under Medicare r e i m b u r s e m e n t schedules if a measure recently a d o p t e d by a H o u s e s u b c o m m i t t e e becomes law, according to an article in t h e F e b r u a r y 13 issue of Health
Planning and Manpower Report. The m e a s u r e is an a m e n d m e n t to t h e Medicare a n d Medicaid reform bill, HR 4000, w h i c h was r e p o r t e d out by t h e House I n t e r s t a t e and Fore i g n Commerce C o m m i t t e e ' s H e a l t h S u b c o m m i t t e e on J a n u a r y 31. I t reverses section 227 of the 1972 Social Security Amendments. T h a t s e c t i o n c a l l e d for p h y s i cians in t e a c h i n g hospitals to be paid on t h e "cost" basis while those practicing in n o n t e a c h i n g facilities were to be p a i d ~'reasonable and customary" fees.
Ann Emerg Med
The l a w w a s n o t e n f o r c e d because D H E W never got beyond prop o s i n g t h e r u l e s for i m p l e m e n t i n g the regulations. The amendment, which was introduced by Rep. D a v i d S a t t e r f i e l d (D-VA), e s s e n t i a l l y means "continuation of t h e s t a t u s quo,'? according to an .aide of t h e congressman. A p r o v i s i o n of t h e .amendmefit allows physicmns in teaching hospit a l s to be p a i d on a "cost" basis if t h e r e is u n a n i m o u s a g r e e m e n t to opt for t h a t method. No d a t e has b e e n set for :conside r a t i o n .of .the bill by the full Inters t a t e a n d F o r e i g n C o m m e r c e Committee. Changes adopted by that c o m m i t t e e will h a v e to be consolid a t e d on t h e House floor w i t h t h e W a y s and Means bill, which w a s reported out last October.
107
9:4 (April) 1980
S a t u r d a y or Sunday, a time u s u a l l y b u s i e r t h a n t h e r e s t of t h e w e e k , were included as p a r t of t h e study's m e d i a n data. The Research Committee h a s expressed concern t h a t t h e d a t a r e s u l t i n g from the USC s t u d y will be used to d e t e r m i n e manpower n e e d s in e m e r g e n c y h e a l t h c a r e planning. Because it is probable t h a t all or p o r t i o n s of t h e U S C d a t a m a y be
u s e d by the G r a d u a t e Medical Education N a t i o n a l Advisory C o m m i t t e e (GMENAC) and others to assess man~ p o w e r n e e d s in e m e r g e n c y m e d i cine, it is i m p o r t a n t t h a t A C E P cont i n u e s to offer critiques of such m a n p o w e r studies, and to c o m m u n i c a t e t h e C o l l e g e ' s p o s i t i o n on m a n p o w er p l a n n i n g a n d t r a i n i n g needs to G M E N A C a n d others.
Rural Health Conference Set for April in Boston A c r y s t a l b a l l v i e w of r u r a l h e a l t h care in the 1980s will open t h e 3 3 r d N a t i o n a l C o n f e r e n c e on R u r a l H e a l t h at the Sheraton-Boston A p r i l 17-18. The keynote session of the twod a y c o n f e r e n c e will f e a t u r e J a c o b K o o m e n , MD, of t h e U n i v e r s i t y of N o r t h C a r o l i n a , who will e x a m i n e t h e p r o b l e m s to b e faced in r u r a l h e a l t h delivery in the coming decade a n d discuss p r o g r a m s to deal w i t h those problems. S e m i n a r s d u r i n g the conference will deal with emergency medical services; extrication from farm e q u i p m e n t ; self-care, h o m e h e a l t h , a n d hospice care; m e n t a l h e a l t h care in r u r a l settings; t h e i n c r e a s i n g dem a n d s on r u r a l h o s p i t a l s ; h e a l t h planningi a n d other m a t t e r s of conc e r n to t h o s e i n v o l v e d in r u r a l health. A series of c o n t i n u i n g medical - education courses designed for physicians trea~ing r u r a l populations will
be presented d u r i n g both days of t h e conference. P r o g r a m topics i n c l u d e wound closure, p r i m a r y m a n a g e m e n t of head t r a u m a , poisoning, zoonosis, replantation mlcrosurgery, and sports medicine for r u r a l schools. " C o s p o n s o r s of t h e c o n f e r e n c e , with the A m e r i c a n Medical Association, a r e t h e A m e r i c a n Hospital Association's C e n t e r for Small or Rural Hospitals, the A m e r i c a n Nurses' Association, the A m e r i c a n P h a r m a c e u tical Association, the Cooperative E x t e n s i o n S e r v i c e of t h e U n i t e d S t a t e s D e p a r t m e n t of A g r i c u l t u r e , the F a r m Foundation, the Massachus e t t s Medical Society, a n d t h e Nat i o n a l Safety Council. F o r a d d i t i o n a l i n f o r m a t i o n on t h e conference, contact the Departm e n t of C o m m u n i t y Health Systems, A m e r i c a n Medical Association, 535 N o r t h Dearborn Street, Chicago, Illinois 60610; 312/751-5997 or 312/ 751-6604.
"Reasonable" Fees Allowed Physicians in Teaching Hospitals Under Proposed Amendment P h y s i c i a n s in t e a c h i n g hospitals will Continue to be p a i d "reasonab] e a n d c u s t o m a r y " fees for t h e i r services under Medicare r e i m b u r s e m e n t schedules if a measure recently a d o p t e d by a H o u s e s u b c o m m i t t e e becomes law, according to an article in t h e F e b r u a r y 13 issue of Health
Planning and Manpower Report. The m e a s u r e is an a m e n d m e n t to t h e Medicare a n d Medicaid reform bill, HR 4000, w h i c h was r e p o r t e d out by t h e House I n t e r s t a t e and Fore i g n Commerce C o m m i t t e e ' s H e a l t h S u b c o m m i t t e e on J a n u a r y 31. I t reverses section 227 of the 1972 Social Security Amendments. T h a t s e c t i o n c a l l e d for p h y s i cians in t e a c h i n g hospitals to be paid on t h e "cost" basis while those practicing in n o n t e a c h i n g facilities were to be p a i d ~'reasonable and customary" fees.
Ann Emerg Med
The l a w w a s n o t e n f o r c e d because D H E W never got beyond prop o s i n g t h e r u l e s for i m p l e m e n t i n g the regulations. The amendment, which was introduced by Rep. D a v i d S a t t e r f i e l d (D-VA), e s s e n t i a l l y means "continuation of t h e s t a t u s quo,'? according to an .aide of t h e congressman. A p r o v i s i o n of t h e .amendmefit allows physicmns in teaching hospit a l s to be p a i d on a "cost" basis if t h e r e is u n a n i m o u s a g r e e m e n t to opt for t h a t method. No d a t e has b e e n set for :conside r a t i o n .of .the bill by the full Inters t a t e a n d F o r e i g n C o m m e r c e Committee. Changes adopted by that c o m m i t t e e will h a v e to be consolid a t e d on t h e House floor w i t h t h e W a y s and Means bill, which w a s reported out last October.
107