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Patients as consumers want the highest level of medical service they can afford. Some are willing to pay premium rates for greater access to their primary care provider and more personalized medical attention. With increasing cuts in reimbursable income, more doctors are attracted to the concept of Concierge Medicine. But, given the disparities that exist in healthcare delivery, is this such a favorable trend? Our Special Report looks at all sides of this practice management concept that is gaining more currency within the healthcare profession.
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By J&C Research Associates
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Improving Patient Satisfaction and Customer Care
This edition of the Jackson & Coker Industry Report takes a different focus. A chief concern of hospital administrators and practice managers is improving patient satisfaction. After all, patients who are treated competently and have a positive experience during their medical office or hospital visit are more likely to speak favorably of the facility and of those who cared for them. Outstanding patient care results in favorable public relations, resulting in more patient visits that boost the facility’s financial bottom line.
One perspective on improving patient satisfaction is offered in our guest feature article entitled “Healthcare Means Patient Cure And Customer Service—Customer Service Really Does Matter.” It is a personal commentary written by Dale Mask, whose consulting firm provides customer service training to various industries including health care. Mr. Mask explains the importance of medical facilities treating patients as valuable consumers of healthcare services. In his view, demonstrating quality customer care is at the heart of responsible health care delivery.
A different perspective on enhancing patient satisfaction is set forth in our Special Report: “Concierge Medicine—A Growing Trend?” Simply put, some patients are willing to pay a monthly or yearly retainer—and additional fees for service—in order to receive more personalized attention, including no-wait visits, communicating with their provider via cell phone and e-mail, and other benefits associated with “boutique medicine.”
Needless to say, the concept of concierge medicine is not without ethical controversy, especially considering the fact that millions of Americans have no insurance coverage at all (see our March edition on Universal Health Care). There are other legal issues associated with transitioning a medical practice to a retainer fee-based model, especially if existing patients can no longer afford treatment.
As always, we don’t propose to have the definitive answers to hot topics debated within the healthcare profession, but we at least put the appropriate questions in proper perspective.
Cordially,
Calvin Bruce
Managing Editor
Weaning Your Hospital off Medicare
Source: HealthLeadersMedia.com
Date: 06/01/2008
The coming baby boomer retirement wave bears with it a wave of Medicare dependents for hospitals to deal with. Hospital administrators know well the difficulties of dealing with Medicare and, as such, may be reluctant to have business depend so greatly on them. So how to wean a hospital off Medicare? An article from HealthLeadersMedia.com explores a number of means to do just that.
-The article points out that consolidation among hospitals is more likely in the coming years. For instance, the states of New York and New Jersey have both determined strategic hospital closings necessary to help certain institutions thrive with lower payment levels. This consolidation wave is not likely to be solely closures and acquisitions but also agreements to cooperate among larger and smaller institutions. Under such agreements, hospitals would share best practices, financial systems, operating agreements, referral support, and even physicians and residents.
-Some forecast cuts in Medicare payouts. Faced with this proposition, some administrators actually want such cuts to occur in order to more quickly bring about solvency within the hospitals that survive the event.
-The article predicts that hospitals will be less able to work over the privately insured to cover Medicare shortfalls. The decline of “cost-shifting” should be accepted sooner rather than later, as hospitals will have to shift costs to a model that doesn’t rely as heavily on private, third-party payers.
-Some hospitals are expanding their offerings as a means of increasing revenues. This diversification leads institutions to focus less on acute care and more on outpatient and wellness care.
-Other hospitals are focusing on quality. The proposed shift to performance-based pay has hospitals focusing more on outcomes and being at the forefront of quality service. Reduced mortality and more positive outcomes, in addition to resulting in healthier patients, will result in higher pay for physicians and hospitals. Forward-looking administrators are altering institutional policies to reflect this coming reality.
-Finally, some hospitals are attempting to make patients care more about their treatment. More compliant patients—patients who follow doctors orders, show up for follow-up appointments, etc—end up placing less of a burden on the system through their healthcare choices. As a result, greater emphasis is being placed on patient education initiatives and follow ups by some hospitals.
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First Medical Tourism Guidelines Issued by AMA
Source: Occupational Health & Safety
Date: 06/18/2008
The American Medical Association adopted nine principles at its annual policy-making meeting in Chicago in order to provide the first ever guidance for patients considering traveling abroad for healthcare. According to the AMA, medical tourism is a small but growing trend in the United States, with 150,000 people heading abroad for medical procedures in 2006.
Among the nine principles adopted, the AMA suggests that patients should be referred only to institutions accredited by recognized bodies such as the Joint Commission International or the International Society for Quality in Health Care. In addition, “local follow-up care should be coordinated and financing arranged to ensure continuity of care when patients return home.”
Until the cost of care in the United States is effectively addressed, the AMA suggests that these principles will help to ensure that the care U.S. patients receive abroad is effective and safe.
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FTC: Clinic Rules Not What Doctor Ordered
Source: Chicago Tribune
Date: 06/14/2008
The FTC has deemed efforts to regulate retail clinics promoted by the Illinois State Medical Society anti-competitive and harmful to consumers. In a letter to a legislator that requested the agency’s input, the FTC indicated concern that a bill to increase regulation by requiring permits, curbing advertising plans and requiring more physician involvement would put the many retail clinics typically staffed by advanced-degree nurses known as Nurse Practitioners at a competitive disadvantage with similar healthcare facilities that are not held to the same standards.
The retail clinic model has been praised by health insurers, employers and consumer groups as a way to address the national problem of access to medical care. Unlike most doctors’ practices, most clinics are open seven days a week, twenty-four hours a day. Merchant Medicine, a Minneapolis-based research and consulting firm, suggests that nearly 1,000 retail clinics exist in the U.S. This number will likely continue to grow, as bigger retailers forge ahead with further development.
Doctors claim that their primary concern with the retail clinics is not loss of income, but proper patient care.
It is believed that the FTC’s letter will thwart the legislation, although it is unlikely that action will be taken on the bill until November.
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Debt Load
Source: H&HNMag.com
Date: 06/01/2008
Uncompensated care—including both charity and bad debt—rose to $31.2 billion in 2006, approximately 5.7% of total hospital expenses for the year. The underinsured are quickly becoming as big a source of bad debt as the uninsured. As a result, hospitals are adopting some new and controversial measures to make good on invoices.
A large and increasing amount of debt comes from the after-insurance portion of the hospital bill, as patients fail to pay the balances remaining after their insurance provider has paid. This has led to a push among hospital administrators to adopt front-end solutions. These include software that estimates—with the help of practice and payer histories— charges before treatment is administered, providing patients a firm number to expect after their insurance has paid its portion. Some also engage in up-front payments, with verification of coverage and payment authorizations performed before treatment is administered.
Controversially, some institutions are utilizing credit scores to make decisions on payment plans and eligibility for charity care. Critics cite the possible effect of such policies on the treatment uninsured patients may receive, but proponents cite the limited application of such policies and financial straits in which hospitals find themselves today.
To encourage faster payments, some institutions are making portals for online payments available to patients. Adventist Health Services expects some 10% of patient payments within its system to be online by the end of 2009, up sizably from 2.7% in 2008.
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Minnesota Adopts Bill Creating Medical Homes
Source: amednews.com
Date: 06/16/2008
In May, Minnesota adopted a bill designed to boost preventative care through new types of physician payment, care coordination, and health information technology. Supported by the Minnesota Medical Association, the bill offers patients the opportunity to choose a medical home and provides publicly and privately funded pay for physicians to coordinate care. The care coordination payment is intended to encourage doctors to see fewer patients in their office but give better care to more patients over time by communicating with them more over phone, email, in group settings or through an office care coordinator. The e-prescribing provision requires all physicians to send prescriptions electronically by Jan. 1, 2011; however, the act does not include funds to help physicians adopt e-prescribing. The standard for qualification as a medical home is not due to be spelled out until July 2010.
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Universal Healthcare Momentum
Source: Physician’s News Digest
Date: 06/01/2008
Continuing the trend of individual states acting to solve their healthcare woes on their own, a universal healthcare bill is making its way through the New Jersey State Senate. The first part of the bill, two years in the making, has passed the Budget and Appropriation Committee as well as the Health and Human Services and Senior Citizens Committee. Proponents look to get final passage in both houses by June 30th and begin passing the second part of the bill soon thereafter.
The bill, proposed by State Senator Joseph Vitale, expands eligibility and outreach for New Jersey FamilyCare, establishes a coverage mandate for children, and reforms aspects of the individual and small employer healthcare markets. The second phase will create a state-managed, commercial grade plan for all residents of New Jersey and a collaborative care system for the remaining uninsured.
The plan was assembled over two years with the aid of 20 experts in the field. It also includes reforms aimed at allowing premium differentials to young adults making up to 350% of the poverty level. People on individual plans would be protected from rate hikes limited to 15% annually.
Concern expressed by physician groups point out possible spikes in healthcare utilization in underinsured areas after the passage of the bill, possibly overwhelming the health worker infrastructure in such areas. This, they warn, could result in physician migration to avoid forced participation, which would deprive already needy areas of even more healthcare workers. Proponents point to the need to address underinsured and uninsured citizen needs as overriding these concerns.
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Barcode Systems to Reduce Hospital Drug Errors Not Foolproof
Source: MedPageToday
Date: 07/01/2008
Designed to prevent drug errors in hospitals, the barcodes that are supposed to match up drugs and dosages with patients may themselves be subject to errors, according to a study performed by University of Pennsylvania researchers.
The study of barcodes use in five hospitals found nurses overrode alerts indicating problems in 4.2% of patients, which accounted for 10.3% of all medications ordered. The study also found instances of inability to scan codes or correctly use them among nurses.
The study monitored barcode usage in one 470-bed academic tertiary care Midwestern hospital and four hospitals that are part of a 929-bed healthcare system. The researchers shadowed nurses, interviewed staff about systems, and looked at reasons given for overrides.
The study found 15 ways of working around barcodes, including duplicate patient ID bands carried on nurses’ wrists, nurses carrying numerous pre-scanned meds at once, and nurses disabling system alarms so as not to disturb patients. These opened the door for any number of medical errors.
The study found valuable benefits to the use of barcodes despite these troubling flaws. The study authors counted 23,828 alerts resulting in user change rather than user override. These findings are generally in keeping with previous studies indicating deviation from protocol and human error as the primary factors in system flaws.
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The Administrator’s Desk: Dealing With PTO Time
Source: Physician’s Practice
Date: 06/01/2008
The old practice of delineating specific numbers of days for vacation, personal, and sick leave is, in some cases, giving way to a new system of Paid Time Off (PTO) hours from which employees can draw at their discretion. While easier and more flexible for employees, this can present a headache for administrators if improperly implemented. An article in Physician’s Practice examines some ways to keep PTO policies straight and your office productive.
PTO presents a number of possible |