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Research Aims to Reduce Over-Practicing Among PCPs

Best practices have always been emphasized by the various medical societies and academies. But under health reform, payers and providers will increasingly have to work together to make best practices the standard so as to meet the rigorous cost and quality dictates coming down the road. Primary and preventive care will demand special attention and researchers are busy compiling the not to dos for PCPs.

The non-profit National Physicians Alliance, through funding by the American Board of Internal Medicine Foundation, has published results of research that aims at telling internists, pediatricians and family practice doctors when they are over practicing, potentially putting member health at risk, lowering the quality of care, and adding to the inefficiencies of our health care system.

A plethora of pressures – government regulation, malpractice litigation, over-the-edge direct to consumer advertising, medical illiteracy on the part of patients, limited time to deal with the incessant complaints from patients, and exceedingly rich benefit packages that offer expensive, tertiary services at low cost – have led even the most well-meaning doctors to give in to poor practices at times.

Some of the don’t on the Alliance’s list:

  • Imaging for low back pain unless red flags are present
  • Don’t prescribe antibiotics for pharyngitis unless positive for strep or for mild or moderate sinusitis unless present for 7 days or more
  • Don’t order blood chemistry and urinalysis in asymptomatic adults
  • Don’t order EKGs and other screenings for low-risk, asymptomatic adults
  • Use only generic statins

Marc Ryan

Marc S. Ryan serves as MedHOK’s Chief Strategy and Compliance Officer. During his career, Marc has served a number of health plans in executive-level regulatory, compliance, business development, and operations roles. He has launched and operated plans with Medicare, Medicaid, Commercial and Exchange lines of business. Marc was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program. Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He also was nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was inducted into Sigma Beta Delta, a national honor society for business, management, and administration.

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