The lede:

Large physician groups have long had a head start on solo and small practices in the medical marketplace because they can negotiate better health plan contracts. Now, a rising tide of evidence indicates that size also confers a quality advantage.

Researchers admit that the medical literature emerging on the relationship between group size and quality is far from a slam dunk. They argue, however, that bigger physician groups can pool capital to pay for electronic medical records systems and other quality initiatives that help them more reliably deliver guideline-based care.

On the opposite end of the spectrum, a small but growing movement of doctors is experimenting with a leaner model of medicine that they say improves the financial viability of solo and small-group practice and, most importantly, improves patient care.

The whole shebang.

The lede:

Toni Cordell’s surgery would be “an easy repair,” her doctor said. Embarrassed at being a slow reader, she signed the informed-consent papers she was given without understanding them.

She said no one, including her doctor, explained the procedure in detail beforehand or uttered the word “hysterectomy.” Cordell didn’t discover the nature of her operation until months after surgery when an office nurse inquired about her recovery.

Cordell’s story of being bewildered by medical-legal jargon is not unique. According to a 2005 National Quality Forum report, between 60% and 70% of patients do not read or understand informed-consent documents and nearly half cannot recall the exact nature of the operation to be performed.

Now a growing number of hospitals and physicians are moving to redesign informed-consent protocols. They are using new computer technology and education techniques to improve safety and ensure that patients understand a surgery’s risks and benefits. Informed consent is a process, they say, not a piece of paper.

The whole shebang.

The lede:

Thirteen states this year have seen legislative proposals aimed at limiting financial relationships between physicians and drugmakers. Most bills failed to pass, due to heavy pressure from pharmaceutical lobbyists, experts said, but new efforts are afoot.

The latest proposals include a Michigan bill that would make that state the second in the nation after Minnesota to place a limit — $100 — on the total value of gifts a drugmaker can give a physician in a year. Michigan and Massachusetts are considering so-called sunshine laws requiring drug companies to publicly disclose any gifts, payments, subsidies or incentives worth more than $25.

The whole shebang.

The lede:

The Robert Wood Johnson Foundation is pouring $15.9 million into a new effort to give doctors and the public a more accurate assessment of physician performance.

The plan is to combine national Medicare and private health plan claims data and then use the data for public reporting of physician performance on quality and cost measures. Reporting in select areas is set for 2010.

The initiative comes on top of criticism that the nation’s dozens of quality measurement and reporting efforts are redundant or rely on widely varying metrics. For example, a 2005 Institute of Medicine report on performance measurement called for a new office in Health and Human Services to coordinate and fund the development of metrics for pay-for-performance and public reporting programs.

The whole shebang.