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Complimentary copy only,
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By Dr. Marshall Goldsmith
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What motivates physicians to succeed?
In any field, what motivates professionals to achieve personal success depends a
great deal on both internal and external forces. This edition’s Special Report,
“Motivating Physicians,” examines some of the motivational forces that propel
doctors to succeed and find meaning in their professional line of work.
Providing additional insight on the topic of inner motivation is a guest feature
article penned by a leading business consultant, Dr. Marshall Goldsmith. His
article, entitled “Personality Self-Discovery and ‘MOJO,’” provokes readers to
seriously consider what aspects of their work are most enjoyable, versus what is
tolerable or even makes them “miserable.” Dr. Goldsmith theorizes that what
gives persons happiness and meaning directly correlates with the inner, driving
force that expresses itself in work that is challenging and productive.
This observation raises certain pragmatic questions for physicians. What aspects of
their work are most personally and professionally fulfilling? Is their
personality conducive to making the wise life choices that promote happiness and
meaning? Do they gain from work more than what they bring to work? Are there
ways to “reframe or redefine” their work to make it more stimulating and
rewarding?
Hopefully, these complementary articles will propel readers along a
path of self-discovery that will benefit them throughout their professional
career.
Cordially,
Calvin Bruce
Managing Editor
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By J&C Research Associates |
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“Know thyself” is a key tenet of philosophy that has a bearing on the medical
profession. Physicians who have a good understanding of their basic personality
traits and what constitutes their inner driving force have a better
understanding of how to work effectively in a clinical setting.
Beginning next
week, you will have the opportunity to participate in a brief online survey to
assess your basic personality type as it compares to other physicians in your
medical specialty. The results of this anonymous survey—which takes only 10-12
minutes to complete--will be sent to you confidentially.
In considering your
fundamental personality traits and “MOJO” (as defined by Dr. Marshall Goldsmith
in this issue’s guest feature article), you can better understand what enables
you to perform effectively and affords you the greatest satisfaction as a
medical practitioner.
After taking the survey, you will immediately receive your
confidential personality profile, and next month receive the composite results
of other practitioners’ personality assessments.
To
see a sample of the DISC report you will receive upon completion of your survey.
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Readers’ Forum: Discussions in Healthcare
There are many timely issues related to the health care industry. In addition to
the topics covered in our regular newsletter content, a new feature will address
important matters in a reader-interactive format. We invite you to participate
regularly in our Readers’ Forum and voice your views on lively discussion topics
such as “Revamping the Health Care System.” We welcome suggestions of topics
that would enhance our ongoing discussions and appeal to a broad segment of the
health care community.
How to Get Your Piece of the Stimulus Pie
Source: Physicians News
Date: 03/30/2009
By now, most everyone has heard of the American Recovery and Reinvestment Act of 2009, the $787 billion “stimulus bill” passed by Congress earlier this year. The bill has the stated goal of spurring growth across numerous industries in the wake of the stalled economy. Health care providers aren’t left out of the bill, as it apportions some $51 billion in funds for the industry; but what can your practice do to get a piece of the pie? Well, if you’re willing to invest in electronic health records, you’ll qualify for a slice of $19 billion in specially-designated funds.
While the stimulus bill puts aside money to spur utilization of the health care industry, a good portion of that money—about 40 percent—goes toward modernizing the industry. A sizeable majority of hospitals and practices still rely on non-electronic methods of record keeping. The bill aims $19 billion at incentivizing the adoption of electronic medical records among those organizations. Starting in 2011, providers that qualify as “meaningful users” of electronic health records will be able to receive $40,000 to $60,000 in incentive payments over five years by way of increased Medicare payouts. While the specifics are not exactly spelled out in the bill, it is likely that e-prescribing, electronic exchange of medical records, and interoperability of systems will be important factors. Health and Human Services will be working throughout 2009 to set the necessary criteria for certifying systems and is expected to have a final report by January 2010.
Upon qualifying as a “meaningful user,” organizations will qualify for payments of 75 percent of that year’s Medicare and Medicaid charges, up to a maximum of $15,000. The maximum payment is increased to $18,000 if the first year is 2011 or 2012. For each subsequent year within the five-year period, payments decline: $12,000 will be paid in year two, $8,000 in year three, $4,000 in year four, and $2,000 in year five.
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Emory Avoids Major Layoffs, Uses Worker Ideas to Cut $30M
Source: Atlanta Journal-Constitution
Date: 04/01/2009
Like most other hospitals across the nation, the current economic crisis has hit Emory Healthcare hard. In the face of widespread layoffs, more patients are coming in without insurance and unable to pay. With the concurrent drop in the stock market, Emory’s investment holdings have plummeted by $50 million, and the 10,700-employee health care system has needed to cut $30 million in costs in the space of a few months. Instead of terminating employees automatically, however, the system turned to those employees for advice on how to save money.
As Emory’s investment portfolio sagged and capital projects were put on hold, the institution also saw a decrease in the number of profitable elective surgeries. The organization turned to its employees to see if they had money-saving suggestions. Recommendations rolled in by the hundreds from all levels of staff. In a recession that has forced sixty percent of Georgia hospitals to cut or consider cutting staff, Emory employees proved willing to sacrifice benefits to preserve the jobs of their coworkers. At the end of March, administrators notified employees which of the cost saving measures would be implemented. The list included the following:
-Matching at 50 cents on the dollar for the first 4 percent of contributions to the employee savings plan, down from a dollar-to-dollar match. The move will save $5 million to $6 million a year.
-Eliminating extra pay for certain shifts and jobs.
-Eliminating additional pay for working the day after Thanksgiving and on Christmas Eve.
-Ending bonuses for referring successful job candidates.
Administrators called the employee response “incredible” and credit it with the fact that large-scale staff reductions are now off the table. Workplace consulting experts contend that employee consultation on financial matters is a very useful tactic often employed in businesses with large unionized employee bases. They say the strategy can result in greater employee buy-in on the final strategy, as the employees feel they have had some say in their work situation.
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Healthcare Overhaul Cost May Reach $1.5 Trillion
Source: The Washington Post
Date: 03/17/2009
President Obama campaigned on the promise of reforming the American health care system. Since taking office, he has shown a willingness to adhere to that promise, citing a $634 billion “down payment” on health care reform put forward in his budget. Health care policy experts, though, claim the figure should be higher… much higher: with costs estimated to reach $1.5 trillion, more than twice Obama’s proposed down payment.
Spending more than any developed country in the world, the United States currently pays $2.4 trillion per year on health care. Still, an estimated 48 million Americans are uninsured, with the number of underinsured reaching the millions as well. As the cost of health care continues to rise, the problem is expected to get worse.
Some health care policy experts say the president’s figure will have to be doubled, and then some, to fully cover the health care gap. Between $1.5 and $1.7 trillion wll be necessary, they contend. Guaranteed coverage is likely to cost $125 to $150 billion per year when fully phased in, according to representatives from the New America Foundation.
Representatives from the AARP go further, contending that no one knows where the money will come from to cover the discrepancy. For their part, administration officials claim the cost will be covered through spending cuts and tax increases and that the president’s figure covers at least a majority of the total costs. Critics counter that the proposal is meant to be a permanent fixture of American society, like Medicare, and that, as such, its cost matters a lot, as an unsustainable, unaffordable model may, over time, come to be more of a burden than the current one.
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Partnership Aims to Help Uninsured
Source: Healthcare Finance News
Date: 03/03/2009
The Foundation of Health Care Education (FHCE) and Catholic Healthcare West (CHW) have partnered to help with the health insurance enrollment process for uninsured Americans who are unaware of their eligibility for government programs, in hopes of reducing both unnecessary emergency department visits and the cost of care.
CHW hospitals treated 177,377 uninsured individuals spread over 1.3 million visits for a total cost of $157 million in 2008, according to CHW spokeswoman Tricia Griffin.
By using FHCE’s database of government-sponsored programs, CHW helps eligible patients get enrolled and posts links to Medicaid and Medicare insurance information on its website. CHW also directs uninsured patients to FHCE’s helpline.
In addition to its work with FHCE, CHW helped develop the Healthy San Francisco program and developed the Access to Healthcare Network in Nevada and MercyCare Plan in Arizona.
FHCE is in talks with other health care systems in California and in Florida to implement a similar program, according to Ankeny Minoux, FHCE’s president. “Groups all have their own niche to help out with the uninsured,” she said.
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No Job, No Bill: Physicians Tell How They Help Longtime Patients Struggling During Recession
Source: American Medical News
Date: 03/16/2009
A six-physician ob-gyn practice in Minneapolis decided it wanted to assure patients that it wouldn’t abandon them during tough economic times. So, to fight the trend that sees appointments moved up when layoffs are announced, the practice is letting all 10,000 of them know that if they are laid off and lose their insurance, they can get one free preventive visit and one Pap smear per year until they get another job and insurance.
According to experts, such a move is an excellent way to engender patient loyalty, because when the economy gets better, those patients will remember how they were treated when times were tough. Experts also say the money lost in offering free preventive care to the unemployed is likely to be far less than the costs these patients might run up if they wait to see you only if they are very sick. Thus, this initiative communicates to patients that the practice is a big believer in prevention, both to keep patients healthy and to keep health costs down.
Of course, “discretion is key.” Patients receiving free care should be integrated into office schedules just as any other patient, and physicians also need to set clear limits. “Any free-care policy should spell out who is eligible, the nature of the care available for free and what is the patient’s responsibility to pay.”
Experts say there are other ways physicians can help unemployed patients as well, such as payment plans and assistance in getting them state aid or Medicaid.
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Doctors Increasingly Close Doors to Drug Reps, While Pharma Cuts Ranks
Source: American Medical News
Date: 03/23/2009
Pharmaceutical companies battered by an economy in recession and scrutiny of their relationships with physicians are re-examining the value of sending drug representatives into doctors’ offices.
At its peak in 2007, the American pharmaceutical industry fielded 102,000 sales representatives, a figure that has decreased to 92,000 since then. The consulting firm ZS Associates’ U.S. Pharmaceuticals Practice projects the number will fall to 75,000 by 2012 at the latest, saving the industry $3.6 billion.
According to another consulting group, New York-based TNS Healthcare, pharmaceutical companies’ return on investment in sales has plummeted. Specifically, for every 100 representatives who visit a practice, 37 place their products in the office's sample cabinet, and only 20 speak to a physician in person. Peter H. Nalen, president of Compass Healthcare Communications, believes that “pharmaceutical companies are realizing there are other ways to reach the doctor instead of banging on the door of the doctor who just doesn't want to talk to you.”
Other figures underscore the changing relationship between pharmaceutical sales reps and doctors. About one in four physicians works in a practice that refuses to see drug representatives, and of doctors who do see them, about 40 percent will meet with detailers only with scheduled appointments.
While conflicts of interest do present a concern, a lot of doctors are simply just pressed for time. As a result, drug companies are trying to reach out to doctors over the Internet. About 45,000 doctors meet with detailers using online video, and 300,000 physicians say they are open to doing so, according to a September 2008 study from drug marketing research firm Manhattan Research.
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Not So Hot [Hospital Construction]
Source: H&HN Magazine
Date: 03/01/2009
The recent economic downturn has seen reverberations throughout many sectors of the health care world: staffing, reimbursement, and other fields. If recent numbers are to be believed, though, the financial troubles are also having a negative effect on the ability of hospitals to expand and improve their facilities. An article in the March issue of H&HN Magazine has details on the latest economic impact: the building freeze.
When the credit markets froze in the fall of 2008, the effects on health care facility construction came quickly. Whereas previously, the hospital construction market was in the midst of a boom no one expected to end, administrators suddenly found themselves helming massive institutional expansions without the credit to back them up. Low-cost borrowing options dried up along with patients’ ability to pay. As a result, many hospitals shelved proposed projects and others ceased projects outright even when ground had already been broken on them. A recent survey found 42 percent of respondents indicating higher financing costs causing project delays or cancellations, and 35 percent reported delays due to the recession’s effect on their growth.
In addition to this, the costs of operating continue to rise. Costs per square foot for hospitals are expected to rise fourteen to sixteen percent due to fluctuations in building materials’ commodity prices. In addition, the continuing trend of creature comforts in patient rooms—such as electronic entertainment and private rooms—exert upward pressure on costs.
While the situation is serious, administrators indicate that they hope the current slowdown in activity is more of a blip in the near decade-long rise in building activity. It’s likely to be just a blip, they maintain, so long as the current recession does not stretch beyond a year or so. In the meantime, academic medical centers and larger hospitals are said to be best positioned to weather the current crisis.
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Tennessee Medical School Plans to Eliminate Ethics Department
Source: American Medical News
Date: 03/26/2009
Organizations nationwide are looking to cut costs wherever they can, but is it ethical for a medical school to cut its… ethics department? A plan to eliminate the medical ethics department at the University of Tennessee Health Science Center’s College of Medicine is being met with opposition by bioethicists that claim the proposal would deprive medical students of critical training.
The Department of Human Values & Ethics is one of eight medical school departments facing cuts due to a university-wide $38 million budget shortfall. According to Executive Dean Steve J. Schwab, MD, the bioethics department is particularly beleaguered because “it has minimal funded research programs.”
The plan to eliminate the department was put forward in a February 2009 memo, which contained a plan to pare the ethics department down to one half-time faculty member tasked with coordinating ethics training as a part of clinical rotations.
Bioethicists at the University of Tennessee and elsewhere worry that if the proposal goes through, other medical schools will soon follow suit. UT bioethicists counter that the claims of the infeasibility of their department ignore the vital role ethics plays in medicine.
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Survey: “Top Docs” List Not Tops to Patients
Source: Physicians News
Date: 03/26/2009
While the “Top Docs” lists published annually in metropolitan magazines across the United States may cause a stir within the health care industry itself, a recent survey finds that the lists may not figure nearly as much into patient decision-making as the industry might assume. In fact, health care consumers tend to view these lists as more of marketing tools for hospitals than guides to the best healthcare.
The survey, conducted by Philadelphia-based market research firm the Melior Group, examined the opinions of 355 health care consumers. The top finding of the survey was that consumers, in fact, did not view the Top Docs lists as a viable means of choosing a physician. According to the survey, consumers still largely rely on traditional methods of choosing a physician, such as following the recommendations of other physicians and choosing within an insurance network. Only one in ten survey respondents indicated that the Top Docs lists were of primary importance in their decision-making.
Respondents indicated that, while the lists might indeed be a sign of the quality of the doctor, they were more likely used as marketing tools for hospitals and practices, with three in four respondents indicating that this was their opinion. While the lists were recognized as primarily marketing tools, they do have some effect on consumers.
The survey authors believe that, while the results show that consumers are not immediately and directly swayed by the lists, the Top Docs lists are likely to continue to be published, as they appear to have sufficient impact to be seen as valuable differentiators for institutions in a crowded market.
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Medical Migrants
Source: The San Diego Union-Tribune
Date: 03/08/2009
The life of the average young doctor is one of establishing oneself through practice, paying off medical school debts, and generally feeling one’s way around the business of practice, though an increasing number of doctors are taking what some might consider an unconventional path that affords time for different pursuits. An article in the San Diego Union-Tribune explores important aspects of the locum tenens lifestyle.
Locum tenens allows doctors an itinerant practice lifestyle that can take them around their community or across the nation. Doctors work on limited contracts for different hospitals and travel as necessary. As a result, they are exposed to varying locales and practice styles, which results in, some contend, a more well-rounded physician when they do manage to settle down.
Locum tenens practice is increasing in frequency in the United States with the recession cramping organizations’ ability to properly maintain staffing levels. Locum tenens doctors fill the void created by departing doctors, saving patients and revenues while the hospital finds replacement staff. Additionally, they work to mitigate the effects of the physician shortage, which is expected to grow in the future. As a result, some 54% of facilities planned to use locum tenens doctors in 2007, up from 51% in 2004. In a report published this past October, The Physicians’ Foundation claims 7.5% of doctors plan locum work in the next three years.
In rural communities, locum tenens doctors may be the only physicians available. In larger communities, they may see patients during overflow periods or perform any number of other “floater” duties deemed necessary. For locum tenens doctors in general, and especially those new to the medical profession, it’s particularly appealing to practice at a wide range of health care facilities.
In some instances, pay may be somewhat lower for locum tenens practitioners—by some accounts up to 30% lower per day in comparison with what full-time staff physicians receive. However, that computation generally does not include daily car rental and living expenses, malpractice insurance coverage, or licensing fees—expenses which the placement firms typically cover. For their services in matching qualified providers with practice opportunities, locum tenens agencies keep, at a minimum, 10 to 15% of what they charge clients.
Although U.S. health care providers expect to spend more than twice on locum tenens staffing for 2009 than they did in 2003, there are questions about quality of care, as some researchers claim patients are less satisfied with locum tenens physicians, particularly when their cases involve complex medical problems.
On the other hand, these researchers acknowledge that higher quality of care is, to some extent, reflective of how well the physician knows the patient. Traveling practitioners don’t generally have the same opportunity to develop the kind of doctor-patient rapport that regular providers establish, of course.
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The Administrator’s Desk: Motivating Staff in Lean Times
Source: Physicians Practice
Date: 04/01/2009
Faced with lower reimbursements, rising costs, and the widening economic crisis on the whole, profits are down in practices across the nation. As such, practice administrators may be struggling with decisions on what to do regarding employee compensation. How do you tell your staff the yearly five percent bonus will have to be scaled back in light of the bottom line? An article in April’s Physicians Practice looks at some methods of alternative compensation that can help keep your staff happy while keeping your books balanced.
Central to employee compensation in the face of economic downturn is the communication of financial information to physician owners—that is, keeping the staff aware of the practice’s finances. Managers need to communicate information and be the drivers behind creative ideas in alternative compensation so that group morale stays high. In years of profit shortfall, nonmonetary perks can mean the difference between keeping and losing your staff. Some ideas for alternative compensation include:
-Increase benefits such as flexible scheduling, which is highly valued by medical office staff.
-Provide free health care services to immediate family members of your staff. Receiving this perk can be highly motivational, given the rising costs of health care in general.
-Reimburse educational expenses that earn employees new credentials. If you can’t reimburse for the instruction itself, you can at least give time off so they can take the classes on their own.
-Granting new titles to reflect seniority and greater responsibility is a solid method of rewarding employees that have shown real initiative.
-Recognition of employees publically--in the form of a practice-wide e-mail or a word of thanks at monthly meetings--also has positive motivational impact.
-Keep employees informed of the financial position of the practice on a regular basis to ensure that they are on board with management’s cost-saving decisions and not taken by surprise in a year without bonuses.
-Ask higher level staff if they are willing to forgo a raise or sacrifice some of their pay so that others can be compensated and keep their jobs.
-Tie bonuses to performance. Linking monetary increases such as bonuses to commonly understood performance objectives generally heightens productivity.
These are some of the practical ways that practices can retain valuable staff members during a time when tightening the belt is a requirement, not an option, for maintaining profitability.
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The Hardest Cuts of All
Source: H&HN Magazine
Date: 03/01/2009
The ongoing economic crisis has walloped all segments of the economy and all segments of the health care industry. In response, organizations are cutting costs wherever possible. An article in the March issue of H&HN Magazine examines the trends in the most painful of cost-cutting measures: staff reductions.
Across the nation, unemployment figures are up, and hospitals have not proven to be immune. In the face of changes in payer mixes, declining investment income, and underperforming patient volumes, several large systems have announced staff reductions numbering in the hundreds. That these have occurred in a market thought stable as recently as last fall only accentuates the speed and severity of the recession’s impact on hospitals. Just six months ago, Michigan’s Beaumont Hospitals seemed well-positioned to weather a reduction in outpatient growth, but the shift in payer mix has caused administrators to eliminate open positions and reduce managerial and CEO pay by four and ten percent respectively.
Even hospitals that have avoided layoffs are cautious about the future. Administrators are waiting to see the general shape of the Obama administration’s health care proposals before making large decisions on future staffing levels. Among those making cuts, information technology and middle management appear to be the departments first on the chopping block, though administrators indicate that they will hold off such reductions as long as possible.
While reductions may be unavoidable, analysts caution hospitals against making drastic reductions that would limit long-term growth and advise deployment of staff to focus on patient care, with an eye toward increasing productivity instead of solely cutting staff. Broad cuts are generally unadvisable, as such rash moves may impact revenue streams and worsen a situation in unforeseen ways.
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Human Resources: Union Friendly
Source: HealthLeaders Media
Date: 03/20/2009
Some observers believe a number of factors are converging to create an unprecedented climate for union growth in the health care industry. First, the recession and its widespread, well-chronicled layoffs have many workers antsy about job security and angry about the status quo. Second, hospitals stocked with thousands of relatively well-paid employees are ripe targets for dues-seeking unions. Hospitals are among the largest employers in any community. Finally, the power shift in Washington—with Democrats controlling the White House, Congress, and the federal bureaucracy—will likely result in labor-friendly legislation and appointees in key federal agencies like the National Relations Labor Board.
Some health care industry consultants contend that the proposed “Employee Free Choice Act” holds much for health care administrators and hospital operators to be concerned about with regards to their staffs. The Act, which if passed is expected to add as much as thirty percent to American unionized worker rolls, would expand union access and power. The Act, expected to sail through the House before meeting opposition in the Senate, calls for mandatory binding arbitration if unionized workers and their employers can't reach agreement on a contract within 120 days of forming a union. Some analysts urge caution and preparedness, likening the EFCA to a natural disaster ready to hit unprepared hospitals.
Monica Russo, president of the 15,000-member SEIU—Healthcare Florida union, doesn’t believe that hospital executives should be afraid of unions. Rather, she contends, hospital administrators should look upon the passage of the Act as an asset likely to improve the delivery of care and move the country a long way toward repairing its health care system.
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The Problem Employee
Source: H&HN Magazine
Date: 03/01/2009
No one likes to fire people. Most people would like to give others the benefit of the doubt, hoping that one of any number of disciplinary or workplace rehabilitation steps will make a troublesome employee straighten up and fly right. The problem is exacerbated when the employee is an especially skilled one: a talented physician, say. Yet an article in the March issue of H&HN Magazine purports that the solution for hospitals dealing with problem employees is not to engage too much in the motivational tactics of which management is so enamored of recently. Rather, the article contends, a willingness to show these employees to the door may be just what your organization needs to correct its culture.
The author, a former military medical instructor now with his own consulting practice, contends that the primary issue at hand in dealing with a problem employee is one of choice. The behavior-based expectations, training and retraining, rewards and recognitions, and staff satisfaction programs that managers tend to use nowadays—he contends—are no substitute for a solid culture of discipline and accountability. By the time a physician is becoming a problem in your organization, these behaviors are already well-ingrained in his personality. The author argues that the rehabilitative efforts of modern management styles can only result in at best a temporary, superficial change.
Faced with possible disciplinary action, most problematic employees will modify their behavior temporarily, shocked into corrective action. Over time, though, these behaviors are likely to return as the stress of discipline becomes more distant. If this pattern emerges with an employee, the question then is how long you are willing to invest time in that person. It’s not necessarily about firing them, but rather creating a culture of accountability.
While it may be difficult, and your organization may suffer from the loss of talent in the short term, ridding one’s organization of such employees or bringing them under control is a necessary step in ensuring the health of your organization.
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Employment & Compensation
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Who’s Hiring in the Health Industry? The Insurance Companies
Source: Health News Digest
Date: 03/29/2009
According to author Scott Golden, Chief Financial Officer at Golden & Cohen, health insurance companies will increasingly be a good place to look for work as the current economic downturn continues. He claims that whatever specific route the Obama administration takes in terms of providing more Americans with access to health insurance, “the health insurance industry will see many changes and opportunities in the coming years.” Golden outlines a number of possible scenarios and the opportunities that might result from them:
-Individual health insurance for all. If the Obama administration mandates that U.S. companies provide benefits to all of their employees, new insurance benefits firms will likely spring up to provide service to those new accounts, because very few insurance brokerage firms specialize in the individual health market. However, if the government makes it cheaper for employees to buy their own coverage this will obviously be a huge opportunity for brokers who anticipate this outcome and poise themselves to respond.
-Group insurance for small businesses. If group insurance is mandated by the Obama administration, there will be a real need to help small businesses implement new plans. If this scenario takes off as expected, there will not only be opportunities for health insurance brokers, but for accountants and financial experts as well.
-Expansion of Medicare. Should the Obama administration decide to expand the Medicare program to cover individuals in addition to the elderly, it is likely to be complicated and will need to be explained to consumers. The opportunity exists for consultants and brokerage firms to step in to help translate the new programs and options.
-Expansion of Medigap. Expansion of the Medicare program would provide a windfall for any insurance company that can successfully explain and market Medigap policies, which allows private insurance companies to sell insurance and fill the “gaps” in Original Medicare Plan coverage.
-Writers, speakers needed. As new policies are put into place, there will be a tremendous need for instructional guides and easy-to-read self-help books that teach consumers how to navigate the new health insurance options.
In all likelihood, the outcome of health care reform will involve a combination of these scenarios, Golden concludes, which represents great opportunity despite the inherent challenges.
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Stanford Medical Faculty Must Reveal Industry Income
Source: Bloomberg News
Date: 04/01/2009
Stanford University announced that its Medical School will post on a website income earned by faculty members from consulting with outside groups and from royalty payments for inventions. Faculty members will have to reveal payments of more than $5,000 a year from a single commercial entity. The new policy will take effect later this year.
The move comes on the heels of other moves by the institution to lessen either the influence or the appearance of influence on medical study at the institution by corporate and commercial interests. In August, Stanford said it would stop accepting support from pharmaceutical or device companies for educational programs for doctors.
Experts agree that Stanford is “pace-setting” recent efforts to bring back disclosure and public accountability in light of the increased visibility of financial relationships between drug and medical device companies and academic researchers, particularly the scrutiny paid by Senator Charles Grassley (R-Iowa), who explicitly criticized Stanford’s disclosure rules in a statement in the Congressional Record in June.
Grassley pointed to a Stanford psychiatrist with a sizeable interest in a commercial entity, claiming the failure to disclose such an interest constituted a conflict of interest. Grassley has also criticized similar incidents at Harvard Medical School and Emory University. Stanford, for its part, maintains that the psychiatrist was operating within the bounds of institutional policy and the law. Still, the recent move is seen as the institution “getting its own house in order” and is hailed as an example by experts.
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One Third of Healthcare Providers Receive No Additional Compensation for On-Call Coverage
Source: Healthcare Finance News
Date: 04/01/2009
According to the Medical Group Management Association’s inaugural Medical Directorship/On-Call Compensation Survey Report, thirty-eight percent of health care providers do not receive additional compensation for on-call coverage. More specifically, thirty percent of providers in hospital-owned group practices reported that they do not receive additional compensation for on-call duties, compared with forty-two percent of providers in non hospital-owned practices.
Neurological surgeons reported the highest daily compensation for on-call duties ($2,000), compared with pediatricians ($895) and urologists ($500). Physicians in multi-specialty groups reported higher compensation for on-call coverage than their peers in single-specialty groups. This trend also occurs in cardiology, obstetrics and gynecology, orthopedics and family practice. Only neurological specialists reported a higher daily rate for on-call compensation in a single-specialty group ($2,850) than in a multi-specialty group ($1,450).
There were regional variations as well: Neurosurgeons in the eastern region of the United States received almost 71 percent higher compensation for on-call duties ($2,850) than peers in the western region ($1,667). General surgeons in the eastern region received $500 daily for on-call services, while their peers in the Midwest earned $1,000 daily.
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Negotiating Physician Compensation Contracts
Source: Physicians News
Date: 03/05/2009
Whereas in the past, professional opportunities for physicians tended to be limited to private practice, teaching and research, the modern workplace presents physicians with a number of options. Hospitals, payers, pharmaceutical companies, and numerous other firms offer positions ranging from front office executive to consultant for physicians. At the same time, the general trend regarding these positions seems to be toward a standardization of compensation for physicians. This comes about as physicians want to know what they can expect with regard to pay, and organizations want to know what they should expect to pay. Additionally, all parties must maneuver within the constraints of the Stark regulations, IRS Intermediate Sanctions, and CMS compliance programs. An article in Physicians News provides hints on how to negotiate the best possible compensation package.
Physician compensation packages fall under the purview of the Stark regulations, which limit financial arrangements between physicians and other provider entities to prevent inducement of referrals for Medicare patients. Additionally, IRS Intermediate Sanctions prevent overcompensation of individuals by nonprofit organizations. Finally, the CMS Compliance Program, intended to prevent inappropriate or unnecessary services for patients, also comes into play. In addition to adhering to these, any arrangements should satisfy three key areas for a healthy compensatory relationship. Agreements should be clearly written; they should specifically describe the services to be performed; and they should describe the method and amount of compensation as well as providing the rationale for such by way of a fair market value analysis.
In developing these agreements, negotiations may want to take into account objective data from public sources, such as tax returns or specifically conducted surveys. Also, proprietary surveys of other positions in related fields are acceptable benchmarking tools. Historical compensation data, though it may not reflect the scope of services to be provided, can serve as a comparative reference point in negotiations.
It is important to keep in mind that compensation should and must be directly related to services provided, incorporating factors affecting the difficulty of the position, time invested, and any other mitigating factors. Fair market analyses should explain any special circumstances affecting compensation, such as specific specialties required for a position. With the necessary attention paid to these factors, compensation negotiations will likely fulfill the needs of all parties, resulting in a much smoother process in integrating physicians into non-practice organizations.
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Is the Solo Practitioner a Thing of the Past?
Source: Healthcare Finance News
Date: 03/03/2009
According to the Medical Group Management Association’s (MGMA) annual physician compensation survey, the number of hospital-owned physician practices has been climbing steadily over the past four years. MGMA President Bill Jessee believes the negative economic situation is forcing physicians to give up some of their professional autonomy rather than worry if they can make both payroll and their own income.
Others in the industry, such as author Randy Bauman, believe that solo and small physician groups, lacking in leverage to negotiate payment rates, among other things, have effectively lost the managed care battle.
While the trend is minimally disruptive for consumers, as physicians stay with their patient base, the practices themselves are financially taken over by hospitals. As a result of diminishing profit margins and Medicare reimbursements, Jessee expects that the trend of physicians selling practices will accelerate over the next few years.
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Don’t Let Fear of Liability Deter You from Being a Good Samaritan
Source: Modern Medicine
Date: 03/06/2009
You’re out in public and run across a situation requiring your skills as a physician. What do you do? Are you liable for any potential harm done to the person you mean to help? An article in Modern Medicine explores the limits of your liability as a Good Samaritan should the necessity to act arise.
The author, a health care attorney in New York, writes that public policy in every state encourages health professionals to render aid in an emergency situation, and so-called Good Samaritan laws typically apply to physicians who voluntarily provide service outside the routine practice of medicine. Despite these protections, physicians are often hesitant for fear of being held liable if something goes wrong.
The author outlines how to qualify for Good Samaritan protection- i.e., treatment must be rendered in a true emergency situation; the medical care must be “voluntary” (the doctor must not seek remuneration); and payment cannot be sought or accepted. Indeed, while informed consent conversations are often impossible in emergencies (especially if the patient is unconscious or disoriented), most state laws allow for this contingency. Further, malpractice insurance policies cover medical treatment in Good Samaritan situations.
In sum, a Good Samaritan “will be exonerated as long as he acts in good faith. Fear of liability shouldn’t deter you if you want to help out.”
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Organized Medicine-Backed Lawsuit Knocks Down Hospital’s Attempt at Economic Credentialing
Source: American Medical News
Date: 03/16/2009
In a decision that could serve as a national precedent, an Arkansas court has ruled that Arkansas Baptist Health’s economic credentialing rule reduces patient choice and the health system may not continue to enforce the policy.
In 2003, Baptist Health, Arkansas’ largest hospital system, instituted its economic conflict-of-interest policy. The policy precluded staff doctors with interest in competing hospitals from having privileges. The policy—in effect from 2003 until an injunction in 2006 pending litigation—resulted in the loss of privileges for twelve cardiologists who owned a specialty clinic. Those doctors sued, joined eventually in their complaint by the AMA and the Arkansas Medical Society, as well as the Litigation Center of the American Medical Association and State Medical Societies.
Baptist Health’s policy was based on the reasoning that physician conflicts of interest resulted in higher paying patients being funneled away from the hospital by doctors to clinics wherein they have an interest. As a result, Baptist Health argued, the hospital would be left solely with less profitable patients, resulting in a negative financial impact. The avoidance of this financial hit was the primary justification for the policy, they contend.
The court, however, ruled that the policy was intended to suppress competition rather than advance patient care. Furthermore, the policy, the court found, had been adopted without evidence of, or analysis of, the impact on Baptist’s bottom line and despite a shortage of cardiac beds in the region. The policy also applied to non-referring physicians.
As there are relatively few decisions impacting economic credentialing, the decision could have a nationwide impact as a precedent. Laws restricting or prohibiting economic credentialing exist in thirteen states, though Arkansas is not one of them. The plaintiffs in the case herald the decision as a victory for patient care and continuity of care, while Baptist Health administrators say they are reviewing their options with regard to modification of the policy or appeal.
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Internist to Hospitalist
Source: LocumLife
Date: 03/15/2009
One of the emerging trends in the medical field is the shift among internal medicine physicians from traditional primary care practice to acute care. For doctors contemplating the shift from internist to hospitalist, an article in the March issue of LocumLife examines the plusses and minuses of the change and how a locum tenens tenure can be a viable means of testing out the role.
The hospitalist life holds a set of qualities that appeal to certain types of doctors. The time commitment is lower than that of the general internist, and work-hour flexibility and compensation are generally more attractive. Hospitalists deal only with inpatients, and, to a great extent, don’t need to develeop relationships with patients beyond their visit. They see them only in-hospital, returning care control to their primary care providers upon discharge.
Typically, it is younger doctors who switch from internist to hospitalist, though some inpatient experience is key regardless of how long they have been practicing medicine. Physicians looking to make the switch will need to be proficient in a wide variety of medical procedures, comfortable in the ICU, and possess a good bedside manner.
Accepting locum tenens assignments can prove to be a path well-suited to testing the hospitalist waters. Locum tenens hospitalists are well compensated, earning $90 to $140 per hour on average. Furthermore, they are likely to enjoy the complexity of hospital care and the variety of patients seen. Experts suggest requesting thorough orientation at the beginning of each assignment in a new facility or department, though, as policies and standards can vary wildly. Practically speaking, tenens doctors must be open minded about the conditions and resources available from facility to facility.
In making the jump, locum tenens physicians should realistically assess their own abilities, perhaps even taking refresher courses if it’s been a while since they performed certain procedures. A general refresher on the skills to be required in a position is also advisable. Furthermore, they should be prepared for a faster pace and expect to be quite adaptable, depending on circumstances. If they are well suited to the role, though, it can result in a very rewarding experience and even a new career path.
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Colonoscopy: Prime Time for Primary Care?
Source: JAMA
Date: 03/04/2009
Commentary in the March 4 issue of JAMA addresses the question of whether there will be a shortage of doctors available to perform colonoscopies in the near future, and if so, whether primary care physicians should be trained to step in and help alleviate the problem.
According to a recent meta-analysis of twelve studies, properly trained primary care physicians can more or less perform colonoscopies as well as GI specialists in line with quality benchmarks set by the American Society for Gastrointestinal Endoscopy.
The American College of Gastroenterology, on the other hand, disputes any such conclusions based on these studies.
The meta-analysis was conducted primarily because of concerns over relatively low colorectal cancer screening rates and a rapidly aging population. The Lewin Group has also just released a study claiming that if screening rates hold steady, the U.S. will need 1,050 more GIs by 2020 to keep up with the demand for colonoscopies.
According to one physician involved with the meta-analysis, Dr. Scott Strayer, “It seems like a logical jump that if primary care physicians are [performing] colonoscopy safely and effectively, perhaps we can train more primary care providers to perform this procedure and increase access to this life-saving procedure.”
Others claim that simple reforms can increase the number of patients receiving screenings without taxing GIs with an overwhelming increase in procedures overall. Some do concede, however, that at this point, improvements in technology will not have as much of an impact on efficient high-quality care as personal training.
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Ambulatory Care Provided by Office-Based Specialists in the United States
Source: Annals of Family Medicine
Date: 04/01/2009
Increasing use of specialist services in the United States is leading to a perception of a specialist shortage, according to nationally representative visit data obtained from the National Ambulatory Medical Care Survey (NAMCS) for the years 2002 through 2004. The aim of this study was to examine the content of care provided by specialists in community settings, including visits for which the patient had been referred by another physician.
Overall, 46.3% of visits were for routine follow-up and preventive care of patients already known to the specialist. Referrals accounted for only 30.4% of all visits. Further, 73.6% of all visits resulted in a return appointment with the same physician, in more than one-half of all cases as a result of a routine or preventive care visit.
The study concludes that ambulatory office-based activity of specialists includes a large share of routine and preventive care for patients already known, not referred, to the physician. It is therefore likely that many of these services could be managed in primary care settings, lessening demand for specialists and improving coordination of care.
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Lag in Students Choosing Internal Medicine Lamented
Source: ModernHealthcare.com
Date: 03/19/2009
While the nation’s hospitals and medical schools struggle to address the oncoming physician shortage, smaller categorical shortfalls within the overall shortage pose a threat to the future logistics of American medicine. In particular, the nation appears to be approaching a shortage of physicians practicing internal medicine in the near future.
Even as the National Resident Matching Program matched some 15,638 medical school graduates this year, only 2,632 (about 16%) of those were entering internal medicine. This is a figure that has declined about 1% per year over the last two years. Compared to 1985’s numbers, the figure is down more than 30%. Further, among those graduates planning to enter internal medicine, as many as three-fourths of them intend to ultimately practice in some subspecialty or another. Thus, even though the number of overall graduates continues to go up—with some 30,000 applicants for 22,427 positions, a 4% increase over 2008—they are increasingly in other specialty fields, leaving general internal medicine with a shortfall of practitioners.
Representatives from the American College of Physicians lament this trend, pointing out that internal medicine practitioners will be increasingly important, considering the aging American populace, which will need access to the services they provide. The best solution, the ACP contends, is for Medicare reimbursement rates to primary care physicians to be raised, with the hopes that the financial incentive will prove incentive enough for future doctors to enter the field.
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Payer & Reimbursement Issues
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Seven Strategies to Capture Market Share
Source: SG2 Health Care Intelligence
Date: 03/31/2009
A recent survey by Citigroup of more than 100 hospitals found a five to six percent drop in patient volume nationwide during the fourth quarter of 2008. This is in keeping with studies showing an overall reticence among Americans to go to the doctor for fear of cost, including a Kaiser Family Foundation study showing such tendencies among 22 percent of respondents.
Year over year, outpatient surgeries are down five percent from 2007 to 2008. In light of all this, hospitals are scrambling to hold on to whatever patients remain. The best strategy when faced with tough times is to confront them in an even tougher manner. Analysts recommend going into your market aggressively to capture whatever volumes still exist. A few suggestions for doing just that include:
Maximize Referral Channels. Ease of access to a hospital system is an indispensible facet of success. When organizations lose patients to competitors, it is often because there is unnecessary obstruction to their services. Inefficiencies in transferring patients and other such problems can only serve to hurt your volumes. To get around these obstacles, the use of physician liaisons in reaching out to referrers is advisable. Also, organizations should reevaluate how well referring physicians align with organizational goals. Organizations should connect physicians with staff colleagues that are interested in receiving referrals through arranging meetings among staff physicians and referring physicians.
Woo the Splitters. If your hospital operates in a market where independent physicians split their time at more than one hospital, you’ll want to find out which hospital your “splitters” are happier at and identify ways to make sure yours is the best institution for these doctors.
Recapture What You Lost. If your organization has experienced a decline in OP imaging and surgical volumes, now is the time to reclaim these volumes. In the face of the recession and Medicare cuts, independent practices are often incapable of keeping up the capital requirements of maintaining such equipment. You can bring these physicians back to the table, buying out their interests or even partnering with them to better manage their facilities.
Fill the Access Void. The recession has seen a spike in the numbers of uninsured and underinsured patients visiting the ER. Keep these patients within your system by increasing their access to basic and primary care services. This can be accomplished with urgent care centers, partnerships with retail clinics, or cooperating with Federally Qualified Health Centers in your market.
Take Your Show on the Road. Need to gain some ambulatory market share? Expand your services into new markets. Think about establishing specialty or primary care outreach clinics.
Play Hard Ball with Employers. Large, self-insured employers are looking to cut health care costs. By directly marketing to these entities, you can increase your volumes. Perhaps partner with an employer to provide primary care services via onsite clinic or dedicated clinics for their employees.
Focus Marketing Efforts on Patients. Use direct marketing to reach out to existing customers as well as prospects. Direct mail, follow-up calls with ambulatory patients, creative marketing for patients recently out of a job--all of these can help draw in people that might otherwise go to your competitors or not seek medical treatment at all.
Of course, implementing such measures won’t work the same for every institution. As such, organizations should establish benchmark metrics to measure facets beyond market share for regular evaluation of progress. The successful organization will collect and analyze data on ancillary volumes, referrals, financials, patient and physician satisfaction and inpatient admissions and transfers.
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Is There a Personal Doctor in the House?
Source: Annals of Internal Medicine
Date: 03/03/2009
A recent editorial in the Annals of Internal Medicine takes a closer look at the idea of increasing reimbursement to primary care practices that can claim they are a patient-centered medical home. CMS’s position is to require practices to demonstrate they do, in fact, serve as a medical home and reduce overall health care costs. Furthermore, CMS is working on measures to clear the way for reimbursement changes. In light of this environment, the author scrutinizes the latest study proclaiming the benefits of the patient-centered practice.
The recent study, also published in the Annals, shows that “patient-physician connectedness was a stronger determinant of delivered preventative services than proven predictors, such as patients’ age, sex, and race or ethnicity.” This is a positive conclusion, but the study does not mark the end of the debate.
According to the editorial, issues include questions about how rigorously the study defined a personal patient-physician relationship (the author recommends determinations based on administrative data, not simple patient or physician self-reporting) and whether improved patient-physician “connectedness” will actually increase instances of preventative care for patients across the board, particularly when it comes to preventative services that require more effort from patients outside of the doctor’s office. Furthermore, the role private insurers play in influencing patient behavior adds complications.
The conclusion seems to be that the recent study is an important development but that there is still serious research to be done on this major issue. As the editor warns, “For many, the patient-centered medical home is a ‘make-or-break’ opportunity to secure the future of primary care as a medical specialty in the United States” and the debate is moving faster than the evidence.
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Medicare Payments Still Adequte: MedPAC Chair
Source: Wall Street Journal
Date: 03/17/2009
Payments made by Medicare to hospitals and providers are, in fact, sufficient to cover the costs of efficient hospitals, despite even the negative Medicare margins reported by some organizations. This was the contention of the chairman of the Medicare Payment Advisory Commission (MedPAC) in testimony before the House Ways and Means Health Subcommittee.
The chairman argued that MedPAC’s research found that hospitals under great financial pressure were able to constrain costs and reduce the impact of Medicare’s margin. Hospitals with low levels of Medicare revenue were most often hospitals with higher non-Medicare revenue sources. Additionally, the chairman pointed to continuing hospital openings as a sign of the adequacy of Medicare payments, claiming such openings as an indicator of increases in access to hospital services.
The Ways and Means Health Subcommittee’s ranking member, however, argued that Medicare underpays hospitals and physicians, shifting the burden for these underpayments to the privately insured and, effectively, forcing them to subsidize the publicly insured.
Medicare margins for hospitals are projected to be negative 6.9% for 2009. In 2007, they were calculated at negative 5.9%. The March 2008 MedPAC report recommended raising pay rates at the full rate of inflation for 2010 as well as implementing a quality incentives program.
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Credentialing, Licensure, Quality Management
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Accreditation’s New Player
Source: HealthLeaders Magazine
Date: 03/12/2009
For three decades, the federal deeming authority for hospital compliance with Medicare Conditions of Participation has been a status nigh unattainable for would-be contenders. The deeming authority market is dominated by the Joint Commission, an Illinois-based company which handles accreditation for around 4,250 hospitals. That amounts to about eighty percent of the accreditation market in the United States. A distant second, the American Osteopathic Association, handles accreditation for 200 hospitals in 31 states. Last fall, however, a new player emerged with the aim of carving its own space as the first new deeming authority in more than thirty years.
DNV Healthcare Inc.’s accreditation program—National Integrated Accreditation for Healthcare Organizations (NIAHO)—is the only program based on ISO9001, the international standard for quality management systems. That system measures accountability and quality across dozens of industries, requiring certified businesses to keep detailed records and undergo regular reviews and audits. Proponents contend this system results in a collaborative relationship, wherein accreditors wind up providing advice on compliance with accreditees. Additionally, they say the system aids adherents in staying current in compliance through yearly updates, a system they maintain is preferable to the three-year surveys of the Joint Commission.
For its part, DNV counts twenty hospitals among its accreditation clients, a number of which have switched from the Joint Commission to the smaller upstart. Administrators expect these ranks to grow as word spreads of the new accrediting body.
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How Can Primary Care Cross the Quality Chasm?
Source: Annals of Family Medicine
Date: 04/01/2009
According to the authors of this article, a group of medical doctors and healthcare professionals from across the country, the “chasm between knowledge and practice [recently] decried by the Institute of Medicine (IOM) is the result of other chasms that have not been addressed.” These chasms are a result of “problematic concepts, attitudes, traditions, time frames, and financing approaches among the various participants” and include:
-The chasm between what we know and what we need to know to improve care;
-The chasm between those who provide primary care and those who do not fund, study, support, or publish practical primary care studies; and
-The chasm between research and quality improvement (QI).
In order to fundamentally “facilitate the production and use of the knowledge needed for primary care to cross IOM’s chasm,” the authors believe “major changes are needed,” including the following:
-Admission by all primary care professions that we have quality problems that require our unified attention and action;
-Conversion of the paradigm from “translate research into practice” to “optimizing health and health care through research and QI”;
-Development and facilitation of more partnerships among clinicians, researchers, and care delivery leaders for engaged scholarship in both research and QI;
-Modification of the agendas and methods of funders and researchers so they emphasize the problems of patients and patient care and support practical time frames and research designs; and
-Facilitation by funders and journals of the dissemination and implementation of lessons from QI and practical research.
The end result, hopefully, will be demonstration of a higher level of quality in the practice of primary care medicine in all clinical settings.
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The Total Picture: Developing a Patient Experience
Source: Trustee
Date: 02/01/2009
As health care becomes more and more of a commodity, patients expect more and more to be valued as traditional consumers. Hospitals taking advantage of this tendency—by providing the best clinical care, supporting patients’ emotional needs, and creating a fine patient experience—are likely to reap sizeable benefits in the days to come.
The Cleveland Clinic Health System has determined to focus on satisfying multiple needs of its patients, both physical and emotional. Their model is based on the belief that a satisfied consumer is likely to return as well as tell friends and family. To this end, the administration created a new C-suite position: the CXO, Chief Experience Officer. The CXO is charged with raising institutional commitment to the customer experience. The creation of the role was thought to fulfill a symbolic and strategic goal at the same time, helping put patients first.
Cleveland’s move comes at around the same time regulatory changes aim to motivate greater efforts on the part of hospitals to increase patient satisfaction. CMS recently implemented a rule reducing hospitals annual payment update by 2% if they are not reporting patient satisfaction scores. The CMS/AHRQ system allows for standardized measurement of the hospital experience by institutions. A 2008 Gallup poll showed use of the system was tied strongly to stronger patient relationships and performance outcomes.
Cleveland Clinic’s Patients First initiative being implemented across the Clinic’s twenty institutions entails each hospital having its own CXO. All of these officers collaborate and share best practices. The program was developed with board guidance to ensure universal board support, and efforts are made to constantly engage and involve the board.
The organizers of CCHS’ efforts are also collaborating with human resources to develop a positive culture for employees, with the mindset that it will result in better overall service. This means pushing wellness initiatives as well as other measures meant to increase the overall happiness of employees. CCHS administrators report noticeable improvements in overall culture and patient experience, results which have strengthened their resolve to deliver the best patient experience possible.
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Engaging Employees
Source: H&HN Magazine
Date: 02/10/2009
When designing a performance improvement initiative, getting input and involvement from all employees is vital. Without buy-in from everyone involved in the process, the initiative may be doomed to failure. General Motors learned this lesson the hard way. After numerous failed attempts to improve quality over the years, the automaker is now in dire straits. Some hospitals are improving performance using a different approach, though.
Advocate South Suburban Hospital in Hazel Crest, Illinois actively sought involvement from all staff members when it decided to try to improve performance in its emergency department. The director of performance enhancement and operations improvement responsible for implementing the changes made a point of reviewing any changes with employees before implementing them, seeking their opinions and explaining the reasoning and evidence behind the new procedures.
When some staff members were still skeptical, she took case studies of some of the department’s worst problems and asked them to work through them from a patient’s perspective and think about what they would change. When some were still unconvinced, she asked them to make the changes exactly as requested for two weeks, with the promise that at the end of the two weeks, if performance had not improved, the procedures would be re-visited and their input would be sought.
As a result of this employee-centered process, the hospital saw drastic improvements in its emergency department’s performance. Patient satisfaction went from the 16th percentile to the 95th, the percentage of patients leaving the emergency room without being treated dropped from 6 percent to 2 percent, and the average length of stay for fast-track patients dropped from 3 hours to 75 minutes.
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One Doctor’s Plan for Improving the Hospital Communication Process
Source: Medical Economics
Date: 03/06/2009
After a prolonged episode involving an ICU patient who arrested during hemodialysis and lay unconscious connected to a mechanical ventilator, the author seeks to shake free from the “new era of mistrust” in the field of medical care by advocating that bonds of trust need to be forged quickly.
The key element in any relationship is trust, he says, “a precious but fragile concept that is increasingly being threatened in this new era of medicine.” While many patients and their families still feel quite vulnerable and at the mercy of total strangers when confronted with serious medical issues, “hostility and mistrust have not always been as prevalent as they are today.”
Furthermore, most primary care physicians now find it less cost-effective to attend to their hospitalized patients, which fragments care and makes medical teams appear to patients and their families as “lacking coordination or being aloof.” Add to all this the grim economic reality that health insurance companies are reluctant to pay for prolonged hospital stays and the author sees a very difficult situation.
The first step to correct these systemic problems and forge a bond of trust is for hospital-based physicians to acknowledge that the problems exist and to bring them out front in the very first patient encounter. The author offers a sample opening statement and suggests faxing patient history, physical examination, and discharge summaries to the patient’s primary care physician and frequently faxing important progress notes as well. If post-hospitalization follow-up is a bit complicated, he says, he will typically also call the attending prior to discharge.
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Online Records Get Patients Involved in Care
Source: The Wall Street Journal
Date: 03/18/2009
They’re all the rage in Washington politico-speech nowadays—electronic medical records—the panacea that will cut costs and reduce medical errors. Critics say they’re no cure-all; proponents point out that errors are down and efficiencies are up. The Obama administration’s stimulus bill provides $19 billion in incentives to hospitals and physicians for their adoption. While the jury may still be out, some organizations are finding additional use in EMRs through increasing patients’ involvement in their own health and treatments.
Large managed care groups have found that EMR systems can help get patients more involved in their own care through what they call Information Therapy, which results in reliable information being passed electronically directly to patients so they can manage their own conditions without necessarily going to a doctor for the smallest problem. Information therapy includes online self-management programs and virtual coaching sessions for a number of health issues. It allows doctors to pass information on to patients such as sites that can answer their further questions about afflictions or treatments.
Kaiser Permanente, one of the largest providers in the nation, has begun directing members to its My Health Manager website, which is linked to Kaiser’s EMR system. Patients can get additional information on their conditions, e-mail doctors, or access online medical encyclopedias. An increasing number of other providers are beginning to offer similar services.
These systems are also quite customizable to individual patient needs. For instance, a patient that hasn’t refilled a vital prescription can receive alerts whenever he visits the site or even e-mail alerts to his personal account. Such alerts could, presumably, be sent also to his doctor and regular pharmacist, increasing coordination among providers. The result is a system which engages and helps patients along electronically throughout their treatments. For smaller practices and payers, there are still concerns about the affordability of such systems. For these, experts point out a number of free or low-cost solutions that accomplish much the same thing with a lower financial impact.
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Bad Bet on Medical Records
Source: The Washington Post
Date: 03/17/2009
In this editorial column co-written by two medical professors, the authors state their belief that President Obama’s $20 billion proposal specifically for health IT is the “wrong investment to make at this time.”
The assumption underlying the proposed investment in health IT is that more and better clinical information will improve care and save money. The authors concede that it is true that computerized records in some settings might improve care; but, they claim, the benefits of health IT have been greatly exaggerated. In fact, large, randomized controlled studies in this country and Britain have found that electronic records with computerized decision support “did not result in a single improvement in any measure of quality of care for patients with chronic conditions including heart disease and asthma.”
Furthermore, according to the authors, other evidence suggests that adoption of some computerized systems has not helped but harmed patients. For example, after the Children’s Hospital of Pittsburgh added automated prescribing recommendations to a commercial electronic records system, the institution documented a more than threefold increase in the death rate among child patients.
In the near term, the authors believe that health IT systems are an expensive and still unproven technology for most physicians in the United States. Before moving ahead, they suggest the administration consider conducting “well-controlled research on the cost-effectiveness of health IT in office practices, which are the bulk of the U.S. medical system.”
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Physician Practice Management
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When Patients Declare Bankruptcy: What Happens to Your Unpaid Bills?
Source: American Medical News
Date: 03/09/2009
As corporate layoffs mount, the number of individuals filing for bankruptcy also goes up. Chapter 7 filings were up 40% for the year 2008, while Chapter 13 filings rose 14%. In these sorts of filings, practices are placed at financial risk, as bills may go unpaid.
The first option to consider upon receiving notice of a bankruptcy filing may be to aggressively pursue any money you can get or even to fire the patient from the practice. This is inadvisable, however, as failure to respect the rules protecting debtors could put your practice at risk of fines or sanctions. Instead, physicians are advised to show compassion and follow proactive collection strategies to minimize losses from patient bankruptcies.
Upon notice of bankruptcy, practices must cease collection attempts for bills incurred before the filing date or they risk violating court orders. Patients can still volunteer to pay any debts but are less likely to do so if the collector is continually harassing them. Instead, experts recommend propositioning the patient: if you will pay your debt, I will continue to treat you and trust you.
It is also important to note what sort of bankruptcy the patient has gone into. Chapter 7 bankruptcies carry little chance of repayment, while Chapter 13 bankruptcies set up payment schemes, though Chapter 13 arrangements often turn into Chapter 7 bankruptcies. Therefore, it may simply not be worth the time and effort to pursue collections.
You may be faced with the option of joining a reaffirmation agreement with the patient’s other collectors, but experts warn these are better suited for tangible goods, not past services. Instead, they suggest putting bankrupt patients on payment plans and watch lists. If necessary, noncompliant patients may be fired.
To best avoid the situation in the first place, experts recommend timely checkups on insurance plans to verify insurance and more prompt collection of co-pays. Credit checks on patients are also an option. Experts recommend keeping an open mind regarding the treatment of previously bankrupt patients, however, as they are more likely to pay, given that they can only declare bankruptcy once in eight years.
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Do You Speak the Language?
Source: Trustee
Date: 03/01/2009
Hospital services must rise to the challenge of the increasing numbers of the U.S. population with limited English proficiency (LEP). In order for hospitals to provide the best level of care for the approximately 23 million people living in the U.S. with LEP, their language and culture needs must be addressed in hospitals’ goals and strategy as a funded core service.
Hospital language and cultural services may be implemented in several ways, often through the use of on-site interpreters who are trained in medical terminology, but also through phone services, patient education brochures, and universal signage. The International Medical Interpreters Association (IMIA), the certifying body for medical interpreters, states that it is important that interpreters in medical encounters understand the nuances and hidden sociocultural assumptions that are embedded in language. The IMIA also works with hospitals to provide “Access Symposiums” that teach health leaders about the importance of medical interpretation at every level of the system.
Other agencies, such as the Joint Commission, are working to develop standards for culturally competent care that includes language differences. The Commission’s National Quality Forum (NQF) is already in place to enforce reporting issues of safe practices, self-reporting on adverse events, and cultural competency. The national language organization, Language Line Services, works within the U.S. and the United Kingdom to provide medical interpreters in government, travel and other fields, as well as advising on potential legislations and regulations that have an impact on health care interpretation.
The Harborview Medical Center in Seattle, which serves a population of LEP patients who speak 80 different languages, provides a case study of the importance of cultural and language services in a medical system. The manager of the Interpretive Services and Community House Calls at the hospital works to ensure that the needs of LEP patients are an automatic part of how the hospital does business. This includes language services at registration, a Community House Calls program available to the six largest languages served by Harborview that refers interpreters who go into patients’ homes as “cultural mediators,” and administrative involvement in the patient/provider interactions.
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Solved! The Dangers of Samples
Source: Physicians Practice
Date: 04/01/2009
The economic downturn makes it hard for patients to afford doctor visits, let alone pay for any prescriptions given to them as a result of those visits. Giving out samples of drugs is an option for doctors looking after their patients’ well-being, but what about liability concerns? An article in the April issue of Physicians Practice looks at how to handle drug samples and properly help patients through these tough times.
Giving out samples may not be the best way to manage lower-income patients. According to recent research, poor children were no more likely to receive samples of prescriptions than were those from families with much higher incomes. The same holds true for adults. Samples are only partly beneficial for patients with chronic afflictions that require continual medication. Simply giving them away instead of prescribing cheaper alternatives such as generics winds up costing the system and your patients more money in the long run.
Additionally, giving out samples is a practice that unbalances your practice’s books and, if the samples are old, can actually put your patients at greater risk. It is not unheard of for practices giving out old samples to be called before the state board of medicine or even into court due to misuse of samples.
For practices that continue to distribute samples, it is advisable to follow a few simple rules:
-It’s advisable not to dispense drug samples to employees. If you do, follow the same steps you would for patients.
-Get advice in writing from your malpractice carrier regarding your sampling policies and procedures.
-Lock your sample closet. (Otherwise, drug samples are readily accessible to persons unauthorized to dispense them.)
-Dispose of expired samples on a monthly basis. (This will prevent drugs with expiration dates from being given to patients, an act that can lead to certain litigation.)
-Keep a record of sample dispensing in the patient’s chart, noting the lot number and other pertinent information.
-Ask sales reps for generic samples. (Such samples will be “fresh” and less potentially injurious to recipients.)
Following these guidelines should minimize any problem associated with dispensing drug samples, given the aforementioned cautions discussed.
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