Reimbursement For Clinical Services Research Articles

Petros Levounis, M.D., M.A., named APA president‐elect

The American Psychiatric Association (APA) announced Feb. 15 the election of Petros Levounis, M.D., M.A., as the medical society's next president‐elect. Dr. Levounis is the first openly gay psychiatrist elected to the presidency of the APA. He is a professor and chair of the Department of Psychiatry and associate dean for professional development at Rutgers New Jersey Medical School. He is also the chief of service at University Hospital in Newark, New Jersey. He currently serves on the Psychiatric News Editorial Advisory Board, and he has also served as vice chairperson of the APA Publishing Editorial Board and member and vice chairperson of the Council on Addiction. Among Dr. Levounis' priorities as APA president is to expand the workforce through building more residencies and developing innovative career pathways for young psychiatrists, fight for parity in reimbursement of clinical services on par with other medical specialties and amplify the psychiatrist's voice on critical social issues, such as systemic racism, homophobia and climate change. Dr. Levounis' term as president‐elect of the APA will begin this May at the conclusion of the APA annual meeting, when current President‐Elect Rebecca Brendel, M.D., J.D., begins her one‐year term as president.

Writing New Rules for Insurers — Progress on the Medical Loss Ratio

Few undertakings in the short history of the implementation of health care reform have been as difficult or contentious as the drafting of regulations to define the statute's “medical loss ratio” requirement. Beginning in 2011, health insurers must report annually the percentage of their premium revenue (excluding expenditures for taxes and regulatory fees) that they spend on “reimbursement for clinical services” and on “activities that improve health care quality.” This is their medical loss ratio. If the medical loss ratio of an insurer in the individual or small-group market falls below 80% (or, for large-group insurers, 85%), the insurer must . . .

Reimbursement for clinical services

We commend AJHP for publishing the recent commentary by Dole and Murawski.[1][1] The authors took a tough, but honest, look at clinical pharmacy and the failures associated with trying to receive compensation for the services rendered. The commentary addressed several issues that are multifactorial

Reimbursement for clinical services provided by pharmacists: What are we doing wrong?

Perhaps the most telling measure of pharmacy’s professional inertia is the fact that nearly every-one reading this will have heard the phrase “Pharmacy is at a crossroads.” After a little more dithering and a few more years of introspective analysis, the crossroads will no longer be an issue.

What will it take to bring the internet into the consulting room?

What will it take to bring the internet into the consulting room?

ASHA’s Board of Ethics—Let's Get Acquainted

ASHA’s Board of Ethics—Let's Get Acquainted

Recent advances: ambulatory care and family medicine.

Recent advances in primary care have been and continue to be exciting and innovative. The evolution of pharmaceutical care has the potential to have an immediate impact in the primary care arena. A major focus of primary care research will center on the evaluation of pharmaceutical care and the consequences of implementing pharmaceutical care, such as reimbursement for clinical services, quality of life, and improved clinical outcomes. With an increasing emphasis being placed on the provision of health care through primary care providers, advances in primary care/family medicine pharmacotherapy promise to remain exciting and innovative.

The palliative care consultation service of the Medical College of Wisconsin

Palliative care has not become a routine aspect of US academic medicine due to lack of reimbursement for clinical services, little research funding, and the perception that care for the terminally ill is not important in academic medical centers. This article describes the clinical activities of a new Palliative Care Consultation Service (PCS) for inpatients and outpatients, which was started at the Medical College of Wisconsin in April 1993. The goals of the PCS are to provide symptom control, assist with end-of-life decision making, and serve as a resource for appropriate discharge planning for all dying patients, not only those with cancer. Since its inception, an average of five consultations per week have been seen. Pain and end-of-life decisions were the most frequent reasons for consultation. Thirteen different clinical services consulted the PCS, most commonly internal medicine and oncology. Cancer and acquired immunodeficiency syndrome (AIDS) were the most frequent diagnoses. The PCS has also been used as a resource for assessment of inpatients with chronic nonmalignant pain who were believed to be drug addicts. The PCS has received widespread acceptance by the medical, nursing, and support staffs. The clinical and educational role of a dedicated palliative care service in academic medicine is discussed.

Development of Clinical Standards in Industrial Rehabilitation

Before discussing adjustments in the fees for the clinical services of industrial rehabilitation, the Medical Free Guide Committee of the Maryland Industrial Commission requested a copy of the clinical standards for these services. However, there were no multidisciplinary standards for industrial services that had state-wide approval. Therefore, a committee was formed to write the standards. Following a review of the literature and unpublished work from other associations and state organizations, standards were developed. Constructive criticism was solicited from national and local professionals and organizations with demonstrated interest and experience in providing or using these services or with experience writing standards. Further comment was solicited from individuals in the state of Maryland before final editing. Because of the dearth of outcome studies supporting the efficacy of clinical services in industrial rehabilitation, the standards describing a level of expectation from clinical services have become important for state organizations responsible for making decisions on reimbursement for clinical services. This paper summarizes the process used for the development of clinical standards of industrial rehabilitation services.

Enhancing academic allergy/immunology faculty and training programs

From the chairman’s perspective, the allergy/immunology program can bring a wealth of knowledge to the departments of medicine and surgery. However, it must be recognized that financial stability of departments is paramount and that the quality of academic programs that have a reputation for excellence is a close second in the chairman’s view. It is important that the program director understand the needs and direction of the department and develop a program that speaks to those needs. The field of allergy should be an increasingly attractive subspecialty for individuals interested in both academic and practice-oriented careers. Demographic considerations suggest there will be a marked shortfall in the number of practitioners. Favorable increases in reimbursement for clinical services are likely in the future. Both internal medicine and pediatric health care services are moving toward an outpatient setting. Exciting clinical applications of immunologic discoveries are becoming available. However, a number of major problems have been identified that were discussed at this workshop. It is important to note that the status of the field is difficult to evaluate because of inadequate data collection. Data needed include (1) specific numbers of full-time and part-time faculty with accurate assessment of their time spent in clinical and more academic activities, (2) sources for funding of faculty and trainees, (3) follow-up studies of the career path of both faculty and trainees; we are particularly interested in what happens to academic faculty over time, and (3) data on academic and private-practice salaries. These data should be assembled by our professional organizations and made available. All members perceive a problem in visibility and identity of programs. This finding may be partially explained by the outpatient nature of the specialty. Training program directors must develop opportunities to make allergy-immunology programs more visible. These programs include interactions with medical students and house staff, collaborative research activi-