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Biomedical subjects

D J Shulkin

Publications and source records attributed to D J Shulkin.

At least 19 recordsLinked to original sources
PubMed1992

A privately financed fellowship model for management training of physicians.

This paper describes the ongoing need for physician executives and reviews current opportunities for training physicians in management. The authors discuss existing sources of funding and highlight one management training program that uses various mechanisms of a new funding model that can increase the number and diversity of learning opportunities, not only in management but also in all disciplines where training traditionally has been underfunded. The basic mechanism of this new model is as follows: a privately funded program uses a locum tenens arrangement whereby a physician fellow works in a community-based private practice in order to produce both compensation for work done and funding for training at an academic institution. Finally, the authors suggest that academic institutions and managed care organizations might consider such a model as one means of using clinical income to expand management training within the contexts of their existing academic missions and patient care commitments.

Fellowships and Scholarships↗
PubMed1992

Learning generics.

The growing use of generic drug substitution may have important implications on quality of care. This study was conducted to determine resident physicians' knowledge of restrictive prescribing policies at the hospitals where they primarily practice.

Chemistry, Pharmaceutical↗
PubMed1991

Impact of the Medicare fee schedule on an academic department of medicine.

OBJECTIVE: To examine the effect of the Medicare Fee Schedule (MFS) on Medicare revenues in the department of medicine at an urban academic medical center after the MFS is fully implemented. METHODS: Department revenues from Medicare were compared with projected revenues using the MFS proposed by the Health Care Financing Administration on June 5, 1991. National Medicare claims data were used to determine differences in service mix between community and academic internists and the impact of the geographic component of the MFS on department revenues. RESULTS: Department revenues from Medicare in 1996 are projected to be 25.5% lower under the MFS than if the current system had continued. Subspecialty sections that perform large numbers of procedures and special tests had the largest decrease in revenues (eg, gastroenterology, -29.8%); however, this did not differ greatly from decreases in sections that mainly provide visits and consultations (eg, general internal medicine, -24.7%). CONCLUSION: The proposed MFS is projected to lead to substantial reductions in department revenues from Medicare. While relative values for services and geographic location will play a role in how individual departments fare under the MFS, the value of the conversion factor used in the final MFS will be the factor of greatest importance.

Academic Medical Centers↗
PubMed1991

The cost of monitoring medical care in Pennsylvania.

We estimated the cost of the Health Care Cost Containment Act in Pennsylvania to be over $19 million; the yearly direct cost of KePRO activities to be over $14 million; and compliance costs for peer review to possibly be as large as $27 million, based on our high estimate. We also found that medical records, utilization review and administrative departments in Pennsylvania hospitals have collective annual budgetary expenditures of close to $2.4 billion. In addition, we estimated Pennsylvania physicians to spend from $14 million to $17 million each year on administrative and fiscal activities related to reimbursement. Our cost estimates for non-clinical expenditures were based on the best data available at the time, though in many cases this data was crude. However, we believe that this data is a useful starting place for a dialogue about the cost and effectiveness of these programs. In reporting the cost of these activities it was not our intent to judge the value of any individual program. Instead we hope that we have taken a first step in the process of collecting cost data so that actual costs for non-clinical activities can be appropriately evaluated. Future studies of non-clinical expenditures should not only include direct program expenditures but also the economic impact on providers in complying with the mandates. Finally, efforts to reduce duplicate and unproductive regulatory programs will be necessary in working toward a cost-efficient system. Legislative efforts, such as the Physician Regulatory Relief and Improvement Act (H.R. 4475 and S.B 2051), aimed at the so called "hassle factor" will be helpful.

Cost Control↗
PubMed1990

When laboratory tests are abnormal and the patient feels fine.

With routine biochemical screens, the problem is often with the tests, not with the patient. Nine of the most common offenders, which provide little if any useful information in the absence of clinical manifestations, are reviewed.

Blood Chemical Analysis↗