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Chapter 6 : The Changing Practice of Medicine

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Abstract:

This chapter presents an overview of the major changes that impact the practice of medicine over the first decade of the 21st century. As healthcare costs have risen, there has been pressure to gain control through restructuring, mostly in the form of changes in Medicare and Medicaid regulations as well as the continued growth of managed care. The chapter outlines the major cost-containment and medicolegal issues faced by the healthcare team, including laboratorians. Changing the rules of payment and reimbursement has had vast effects on the clinical laboratory. A description of the recent advances in medicine and information technology is presented. These include computerized information systems, electronic medical record (EMR), meaningful use/value-based purchasing, and advances in diagnostic testing. Describing physician practice and utilization patterns developing in response to societal, reimbursement, and emerging technology, the chapter outlines the emergence of clinical guidelines. Clinical pathways and clinical practice guidelines are also developed by individual institutions, as evidenced by reviews of peer-reviewed publications. The chapter also summarizes the steps required to develop a clinical pathway. We live in a litigious society and the medical community has felt the impact. Increases in medical malpractice awards impact medical care. Changes in the practice of medicine impact medical student and resident training. Finally, the chapter identifies the changes in medical school and residency curricula intended to prepare physicians for medical practice in the 21st century.

Citation: Roseff S, Russell D, Grimes M. 2014. The Changing Practice of Medicine, p 139-163. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch6

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References

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Tables

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Table 6.1

Themes of change

Citation: Roseff S, Russell D, Grimes M. 2014. The Changing Practice of Medicine, p 139-163. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch6
Generic image for table
Table 6.2

Perceived benefits of the medical home

Citation: Roseff S, Russell D, Grimes M. 2014. The Changing Practice of Medicine, p 139-163. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch6
Generic image for table
Table 6.3

Pay for performance

Medicare Modernization Act of 2005: Hospitals are required to report quality measures to CMS.

October 12, 2012: Performance by the hospital will now tie back to Medicare reimbursement.

Citation: Roseff S, Russell D, Grimes M. 2014. The Changing Practice of Medicine, p 139-163. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch6
Generic image for table
Table 6.4

The electronic medical record versus the paper record

Citation: Roseff S, Russell D, Grimes M. 2014. The Changing Practice of Medicine, p 139-163. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch6
Generic image for table
Table 6.5

Pros and cons of clinical practice guidelines and clinical pathways

Citation: Roseff S, Russell D, Grimes M. 2014. The Changing Practice of Medicine, p 139-163. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch6
Generic image for table
Table 6.6

Elements for developing clinical pathways

Citation: Roseff S, Russell D, Grimes M. 2014. The Changing Practice of Medicine, p 139-163. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch6
Generic image for table
Table 6.7

Traditional types of malpractice reform

2 arrows = large change, 1 arrow = moderate change, 0 = none. Some classifications may be theoretical only, with no evidence or certainty classified.

Limits the amount of a malpractice award that a plaintiff 's attorney may take in a contingent-fee arrangement.

Limits the amount of money that a plaintiff can receive as an award for noneconomic losses or “pain and suffering” in a malpractice suit.

Requires a plaintiff to present, at the time of filing the claim or soon thereafter, an affidavit certifying that a qualified medical expert believes there is a reasonable and meritorious cause for the suit.

Requires that if a plaintiff has received reimbursement for injury-related expenses from other sources, such as health insurance, that amount be deducted from the award that a defendant who is found liable for the injury must pay.

Limits the financial liability of each defendant to the percentage of fault that the jury allocates to that defendant.

Allows or requires insurers to pay out malpractice awards over a long period of time, rather than in a lump sum.

Review a malpractice case at an early stage and provide an opinion about whether a claim has sufficient merit to proceed to trial. A negative opinion can be introduced by the defendant as evidence at a trial.

Limits the amount of time a patient has to file a malpractice claim.

Citation: Roseff S, Russell D, Grimes M. 2014. The Changing Practice of Medicine, p 139-163. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch6
Generic image for table
Table 6.8

CMS never events and serious reportable events

Citation: Roseff S, Russell D, Grimes M. 2014. The Changing Practice of Medicine, p 139-163. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch6
Generic image for table
Table 6.9

Essential elements of a legal contract

See reference

Citation: Roseff S, Russell D, Grimes M. 2014. The Changing Practice of Medicine, p 139-163. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch6
Generic image for table
Table 6.10

Ethical principles and moral obligations governing the patient and healthcare organization's relationship

See reference

Citation: Roseff S, Russell D, Grimes M. 2014. The Changing Practice of Medicine, p 139-163. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch6

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