If you are a sales rep in the pharma market, 6 minutes may be as long as you get with your customer, often while standing on your feet. In a secret-shopper study done by BioPharma Alliance among 200 specialists, undercover former drug reps observed 350 pharmaceutical rep visits. From their observations, nine out of ten calls lasted 6 minutes and almost half were conducted while standing. According to the study, 83% of primary care physicians look for their rep to be an expert when the drug is new compared to 76% when the drug is already established. However, when doctors were asked about their frustrations in dealing with sales reps, topping the list was, “no new information.” Similarly, “pushy” and “aggressive” sales reps are also top annoyances.
According to Mike Luby, of consultancy BioPharma Advisors, “The biggest problem pharma has is admitting they have nothing new and adjusting their approach.” Luby goes onto say, “Consider the doctor who sees the rep waiting for them at the sample closet. They don’t know if it is new information, good science, a valued medical update waiting for them, or someone waiting to tackle them and pretend that they have something new on an old brand that hasn’t had any new information in years. So it burns doctors out. It also drags all reps down, because as a doctor, you don’t know until you are in the conversation, when you’ve invested time you will never get back.”
When patients don’t show up for their scheduled surgery, many costs are incurred that cannot be recouped, including the OR staff, the anesthesiology team, and equipment and medication that have been ordered. Reducing potential “no-shows” is imperative to maximize efficiencies. In addition to “no-shows,” reasons for cancelled surgeries to include scheduling errors, equipment problems, cancellations due to patient medical status, and emergency surgeries bumping medical procedures.
Key predictors of no-shows include prior missed appointments, history of alcoholism or other substance abuse and/or psychiatric issues. Measures can be taken to deter no-shows among patients from low-income background, such as scheduling appointments around public transportation times, educating patients on the benefits of the surgery, and eliminating the fear of uncomfortable procedures that seems to be higher in low-income patients.
It may seem counterintuitive, but runners have a lower risk of knee orthoarthritis than walkers do. A July 2013 study followed more than 75,000 runners and 14,000 walkers and found that runners had a lower overall risk of developing arthritis than walkers. Runners generate greater knee forces than walkers, but due to the longer strides of running, the net result is less overall load on the runners’ knees than on walkers’ knees. Although running doesn’t decrease the cause of ‘wear’ on the knee, it seems better than walking for delaying development of osteoarthritis.
David Glaser, JD, alerts us to proposed changes in the healthcare reimbursement model that would make employing physicians less appealing for hospitals. MedPAC, the Medicare Payment Advisory Commission, issued a report that details a discrepancy between higher reimbursements for services rendered in hospitals relative to those for the same services provided in clinics. Simply put, more Medicare money is available to compensate physicians when they are in a hospital outpatient setting. This MedPAC report proposes an end to the added “facility fee” that drives the discrepancy by leveling reimbursements across the board in all settings. MedPAC recommendations are not binding, and Congress has the final say about Medicare reimbursements. But in Glaser’s opinion, “the days of additional facility fee payments are numbered.”
This past fall, JBJS released the results of its annual survey of orthopaedic surgeons, “The Third Annual Role of the Orthopaedic Surgeon Study 2013.” Surgeons surveyed identified 10 ways that orthopaedic practices are changing. Other reported trends included a growth in services offered and staff employed. For example, respondents said they’ve hired more physician assistants, coding specialists, physical therapists, hospitalists, and nurse practitioners over the past 12 months. Also, more orthopaedic practices are adding x-ray, physical therapy, and MRI to their list of services.
On Oct. 28, the American Association of Orthopaedic Surgeons joined other national and state physician organizations in signing a letter to Health and Human Services Secretary Kathleen Sebelius expressing “serious concerns” about a key part of the Physician Payments Sunshine Act. The more than 70 physician-organization signatories argued that medical textbooks, reprints of peer-reviewed scientific journal articles, and abstracts should be excluded from the restrictions because these items directly benefit patients, although they may not be intended for direct use by patients. The Oct. 28 letter, which was spearheaded by the AMA and the Massachusetts Medical Society, says that the decision by the Centers for Medicare & Medicaid Services to not include these educational materials as exclusions in the regulation is “contrary to both the statute and congressional intent and will potentially harm patient care by impeding ongoing efforts to improve the quality of care through timely medical education.” The letter goes on to say that these items are “essential tools” that doctors use to stay informed of the latest developments. The letter further states that including these items in the Sunshine Act reduces the focus on quality patient care.
BoneStress is a new free app that allows orthopaedic surgeons to look at the effects of action and joint loading for different hip stem designs. One of many factors considered when determining a hip implant is the angle of the neck of the femur. This app shows an interactive model for different hip stem designs and how they affect radial load in the bone. The app is designed specifically for orthopaedic surgeons who have a desire to better understand hip biomechanics and stem length implications, but it cannot be used for operative planning for individual patients.