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By J&C Research Associates
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A Look Back and Ahead
As 2009 comes to a close, it’s fitting to review
some of the major trends, issues and questions facing the health care industry. Our Special Report focuses on these
key concerns as it addresses health care and the economy, how legislation is
moving through Congress to “fix” the health care system, the impact of
technology on practice management, the influence of social media on the medical
community, and benchmark cases in the medical-legal realm.
Next month’s edition will focus on Physician
Compensation and “Return on Investment.” No matter what version of health care reform is passed by Congress and
signed by the president, physicians and other providers will continue to be
concerned about their immediate income and long-term earning potential. Hospitals and group practices,
likewise, will take a closer look at anticipated revenue associated with
different physician specialties and service lines. Our online ROI calculator offers
administrators a tool that makes these calculations quick and convenient.
Lastly, we wish a Happy Holiday and prosperous
New Year to all of our readers! May the
joy of the season give added meaning to all of our personal lives and
professional involvement in the health care industry.
 Also check out our singing “Holiday Video” on
Jackson & Coker’s YouTube channel.
Cordially,
Calvin Bruce
Managing Editor
More on Social Media Networking…
Several
issues ago, the Jackson & Coker Industry Report focused on the growing trend of
hospitals using social media outlets to advance their mission and doctors
relying on social media sites for job hunting and career advancement. We are pleased to mention that Jackson & Coker now actively engages in
communicating with the medical community via LinkedIn, Facebook, YouTube and
Twitter. In fact, we have developed separate Twitter sites for the main medical
specialties that we represent. Please take time to check out all of our social
media initiatives—and give us your feedback.
JacksonCoker.com
Top Drivers of Costs in 2010
Source:
Managed Healthcare Executive
Date:
10/01/2009
All of the talk on legislative health care reform centers on reducing costs. So how is it that managed health care executives are seeing government legislative mandates as the biggest factor driving costs in the year 2010?
Managed Healthcare Executive just released its 2009 State of the Industry report, which outlines responses to the annual State of the Industry survey. Among this year’s questions, participants were asked to identify factors they believe will do the most to drive costs in the coming year. Among their findings, legislative mandates were deemed to be the top driver of costs in 2010. Close behind were pharmaceutical costs, followed by uncompensated care. Rounding out the top ten were administrative costs, patient behavior, increased demand, hospital inefficiencies, diagnostics, defensive medicine, and labor costs.
It is assumed that the coming legislative mandates will result in higher costs for insurers either through payment, increased coverage, or increased administration to ensure compliance. Technology, also touted as a cost-cutter, is actually likely to increase industry costs in the short run due to the price of adoption of standards on both ends.
Industry representatives say that the survey results fly in the face of conventional wisdom largely due to legislators and consumers failing to understand the true financial impact of mandates. Additionally, the economic downturn has caused declines in revenues for all of the major plans, an additional driver of costs.
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Can Universal Healthcare Work? A Look at Israel's Successful Model
Source:
Physicians News
Date:
10/01/2009
As health care reform continues to top the nation's headlines and everyone looks to the models of other countries to see what works, some are proposing that the United States look to its closest ally in the Middle East as a possible model. An article in Physicians News takes a look at the Israeli national health care system.
Israel's health care system existed even prior to the Jewish state's formation in May of 1948. The nation has more than forty hospitals and medical centers as well as more than 2,000 community-oriented primary care clinics. Citizens are required to join one of four health care funds providing basic coverage and have the option of purchasing additional coverage. Additional legislation provides a patient bill of rights and ensures coverage for citizens regardless of age or state of health. Health funds are barred from denying access to medical diagnosis and treatment, preventative medicine and health education, hospitalization, surgery and transplants, first aid, and access to hospital transport. Additionally, patients are guaranteed medical care, a second opinion, patient dignity, and privacy and emergency care.
As a result, Israel ranks among the world leaders in life expectancy, infant mortality, and other key indicators. The nation attempts to limit health care costs through the adoption of health information technology. Israel has a 95% adoption rate for electronic medical records, compared to a 15% rate in the United States. Due to this, a great deal of transparency is enabled in the system with regard to drug interactions, patient history, and other crucial factors. While the system isn't perfect, the numbers show that it works a great deal better than the current American system. In restructuring our health care system, it might not be a bad idea to look at Israel for guidance.
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Nonprofit Hospitals' Woes an Opportunity for Big Players
Source:
The Wall Street Journal
Date:
10/15/2009
The turmoil in the health care sector and the larger economic downturn have combined to throw everyone for a loop, but does anyone look to come out ahead in the midst of such upheaval? An article in The Wall Street Journal contends that it might just be the for-profit players who benefit most from the current climate, possibly at the expense of their nonprofit competitors.
Nonprofit hospitals, facing investment losses due to the stock market upheaval in addition to payer troubles and patient inability to pay, have seen their balance sheets drastically impacted by the current financial climate. Their for-profit peers, though, have seen their stock prices double overall from year lows. While the credit crisis and recession have squeezed their nonprofit competitors, these companies have taken the opportunity to win patients from them and even acquire facilities. As nonprofit facilities look to cut costs, for-profit companies continue to invest, with some planning to spend up to 5% of revenues on capital expenditures. The for-profit institutions foresee market share increases over the next year, as they have easier access to debt refinancing and capital pools, which translates into increased ability to aggressively pursue patients.
On the whole, the nonprofit hospital industry looks to be in for a prolonged era of consolidation, wherein larger hospitals acquire smaller ones, joining forces to shore up their balance books. This represents a large opportunity for for-profit institutions, as what isn't absorbed into their nonprofit peers may constitute profitable acquisitions for them.
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Harvard Team Grows Heart Muscle
Source:
Boston Globe
Date:
10/16/2009
Tangible results continue to emerge from the study of the potential of embryonic stem cells, as a group of Harvard researchers have announced the creation of a strip of pulsing heart muscle.
As the Boston Globe reports, researchers at Harvard University have made sizable progress in applying scientific advances to actual treatments with the development of a method to generate major organ tissues from embryonic stem cells. According to a study published in the Journal of Science, researchers at the Wyss Institute for Biologically Inspired Engineering have grown a strip of heart muscle from the embryonic stem cells of a mouse. The advance opens the door for further advancements in regenerative medicine to develop new treatments for human maladies.
The team used pluripotent stem cells–undifferentiated cells with the potential to develop into any organ tissue–to grow a strip of ventricular muscle cells. These are the cells that are damaged during a heart attack. The cells were then seeded on a thin film that would encourage the formation of cardiac muscle. The resultant strip of muscle was shown by researchers to exert force upon the strip film upon which it was grown, mimicking the motion of a heart muscle contraction.
The discovery possibly heralds the development of stem cell-based treatments that could advance regenerative cardiovascular medicine. While it is still a proof of concept, researchers estimate that clinical trials could begin within five years.
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Watching the Big Board to Reduce Overcrowding
Source:
H&HN Magazine
Date:
10/16/2009
Electronic bed tracking systems: can they improve patient throughput? Experts say yes, but it’s not as simple as putting the “big board” up and watching throughput improve. Instead, improvement from these systems is heavily reliant on staff buy-in. An article in H&HN Magazine looks at how to get such a system working for your hospital.
The article looks at the bed tracking system in place at Lehigh Valley Hospital in Cedar Crest, PA, which traces the patient throughput process from start to finish. Representatives from each patient care unit in the hospital meet daily to discuss the number of projected patient discharges. These figures are entered into the bed tracking system and the administrators are then able to see how many beds are likely to be available.
In planning the system, LVHN staff placed emphasis on a hospital-wide system as opposed to a system for one department. The goal of the system is to integrate all of the LVHN facilities to best allocate resources throughout the network.
Since implementing the bed tracking system, LVHN has seen decreases in the number of patients leaving the ED without being seen, an increase in the volume of admissions, and improved times in length of stay and operating room holds. Administrators credit the bed tracking system with the improvement.
Central to the success of the system, though, was engendering employee compliance. It was difficult to get employees to buy in fully and not fall back on old habits, but by fully explaining how their old practices were decreasing the efficiency of the new system, administrators and organizers were able to bring recalcitrant employees around to the new way of doing things. The administrators advise getting clinicians on board early in the planning process so that they can catch problems. Beyond that, senior support is absolutely indispensable, and experts recommend always listening to staff input.
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Mining for Gold in Prescribing Records
Source:
HealthBeatBlog.org
Date:
10/22/2009
Drug companies are spending less money on direct-to-consumer marketing. While this means a likely decrease in "talk to your prescriber" ads on television, the pharmaceutical companies still have to get their marketing done somehow; so what are they turning to? How about your prescription pad?
Advertising expenditures for DTC marketing were down 8% last year, according to some figures. Other studies found that 58% of pharmaceutical industry marketers planned a decrease in DTC advertising this year. This decrease is partly due to the lack of new blockbuster drugs and an overall distaste among consumers for the now ubiquitous pharmaceutical advertising. Additionally, increased legislative oversight of pharmaceutical advertising is leading to a drop in DTC ads. In response, these companies are increasingly focusing on physicians.
Most physicians are already familiar with "detailing," whereby sales reps drop by practices with free samples, articles, literature, and branded office supplies; but increased regulation in this field as well is leading the pharma companies to try more creative outreach methods. Pharmaceutical makers are now turning to data mining as a means of reaching physicians. Using companies such as IMS Health and Verispan–which collect data on prescribing habits–pharmaceutical companies can tailor marketing materials to specific providers.
While some see such practices as an invasion of privacy, major physician associations such as the AMA are actively involved in the data mining process. In fact, the AMA recorded $44 million in profits from the practice in one year. The practice constitutes a risk to privacy, though, as it's not exactly certain that all private information is removed from the data profiles before they are turned over to the pharmaceutical companies. The practice shows no sign of stopping, though, as pharmaceutical companies now enlist pharmacy chains and prescription drug benefit managers in furthering their physician marketing efforts. CVS, for one, now collaborates with pharmaceutical companies in aggressively marketing products to doctors.
In response to outcry from physician and patient advocacy groups, New Hampshire recently passed a Prescription Privacy Law, which limits the practice, and Vermont has passed a similar law requiring an opt-in on the part of physicians for the data mining to be legal. While it's generally acknowledged that there needs to be an outlet by which pharma companies can market their goods, the controversy illustrates the ethical and privacy issues that arise from their practices.
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Predicted Pent Up Demand 2010
Source:
Managed Healthcare Executive
Date:
10/01/2009
Of course, everyone wants to achieve the goal of increased coverage for the currently uninsured, but what will the real cost of such a benefit extension be? If you believe the executives of managed health care companies, the ultimate result is increased demand and perhaps an increased strain on the already stretched-thin primary care system.
Responding to a survey, nearly one in five executives indicated that they foresee an increase of 10% to 15% in demand for health care services over the next twelve months if large-scale reforms are implemented to increase coverage. The demand, they say, will come from two areas: patients who have urgent conditions for which they cannot currently seek treatment due to lack of coverage, and patients who are relatively healthy but will seek out more coverage due to the fact that they are responsible for less of the overall cost.
The most important unknown in all of this is how many of the uninsured are healthy and how many are ill. No matter the number, the industry leaders predict that the influx of patients will put further strain on the already shorthanded primary care physicians.
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Ask the Right Questions to Hire the Right Physician
Source:
Medical Economics
Date:
10/09/2009
Time to add a new physician? While thinking of the skills you’d like to have in your next recruit, it’s not a bad idea to hone your own skills a bit. Your interviewing skills, that is, as most physicians have received little to no training in how to conduct interviews for staff. Asking the right questions can ensure that you bring the right people into your practice. An article in Medical Economics has the details.
A critical first step is to identify your ideal candidate. Find five to ten qualities you want or don’t want in a candidate. These will form the basis of your evaluation of each candidate. The questions you ask a candidate will be based from this list; so be sure to pick factors that narrow down to the best fit for your practice’s needs. Consider your practice culture, the overall goals and guiding ethic of your organization, and structure your interview questions to identify candidates that fit this mould. Also, make space in your interview to discuss compensation with recruits, so they know what to expect.
As to your pool of candidates, word of mouth is a valuable source of candidates. Contact your former residency program for possible candidate referrals. Meanwhile, advertise in journals if you want to reach older doctors and online if you need younger candidates.
In the beginning of the interview, you’ll want to find out how well a candidate fits your practice. A half-hour or hour-long phone interview should suffice. From there, bring promising candidates in for some face time. Ask them why they got into medicine and what they’re hoping to get out of it. Ask follow-up questions to really probe the recruit’s job-hunting motivations. Then describe the position in detail and see if it fits with the candidate’s interests. Thereafter, bring recruits that pass this stage into the actual practice. See how they interact with your current staff, and get a feel for how they’ll work within your offices.
Finally, measure what you’ve found out about your candidate against your practice’s desires. If you’ve got a good fit, offer them the job.
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Locum Tenens Field in Recovering Economy
Source:
LocumLife
Date:
10/15/2009
The economic downturn threw everyone in the health care industry for a loop, but locum tenens practitioners are especially affected by the economy. Trouble in the economy has meant shorter sabbaticals, delayed retirements, and slashed budgets: all of which add up to fewer temporary opportunities for locum tenens professionals.
But there is good news, as recruiters indicate that the signs of economic recovery are beginning to show in the locum tenens market. Some are even speculating that a rebound in the real estate and stock markets will lead to a resurgence in the locum tenens field.
The downturn also hasn’t been universally bad for locums. Some hospitals have relied more heavily on temporary physicians at a time when permanent staff recruits have been unable to sell houses or relocate. In this time of slow recovery, experts recommend that physicians ride out the economy, patiently waiting for better positions and remain flexible with a willingness to adapt to changing situations. One might consider a shorter assignment or even practice in a rural area.
It is necessary to keep one’s credentials up to date in order to be able to work on short notice. Providers can go on the offensive by consulting recruiters about which areas have the highest demand and becoming licensed in those states. In general, it is best to maintain a strong relationship with a recruiting agency by staying in touch, responding to potential opportunities quickly, returning paperwork in a timely manner, and making yourself user-friendly. The economy, like many things, moves in cycles; so it’s best to keep your head up during the down times and keep going strong so you’ll pull through stronger than ever when things look up again.
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Employment & Compensation
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Locum Tenens Physicians Find Assignments Online
Source:
LocumLife
Date:
10/15/2009
The Internet: it’s not just the productivity-killing entertainment portal you think it is. In fact, the advancement of social media and job sites on the Internet have led to numerous opportunities for health care professionals to explore career options, locum tenens practitioners being no exception. An article in LocumLife examines how to best make use of these technologies when looking for your next assignment.
For physicians surfing the web, there may seem like an overwhelming array of job sites, but these sites can typically be broken down into a few categories, which may help job seekers approach them more strategically:
-Generic job boards–Physician listings aren't as common, but they can be found.
-General health care job boards provide a cross-section of health care positions.
-Physician job boards tend to have specialty focuses, generally for permanent positions, though some include temporary positions.
-Niche locum tenens boards are geared primarily toward locum professionals, making it easy to find locum openings across the country.
-Government employer boards are for physicians looking for government work, and numerous opportunities in various government fields are listed.
-Professional organization boards–While employment opportunities aren't the main focus of these sites, usually they still have a job listing section.
-Recruiter/agency boards–Recruitment firms often maintain their own sites for finding and placing talent. Keep in mind that the competition among agencies often results in duplicate postings by different recruiters.
-Health care employers’ job boards–Increasingly, individual employers maintain their own job boards online, with the Cleveland Clinic serving as one example. These sites are useful for finding opportunities at specific institutions or in particular regions.
The features available on these boards vary widely, with some offering message centers, chat capabilities, online applications, and calendar functionalities. Dependent on the site, these can make your job search much more efficient. Additionally, job seekers will want to look out for RSS feeds. These Really Simple Syndication options allow you to keep track of postings without necessarily visiting individual sites on a regular basis.
In using these services, it's best to keep a few things in mind. You should maintain an electronic CV so that employers can easily and quickly assess your suitability for a position. It's also a good idea to optimize your listing for search engines, including keywords making you more likely to pop up when an employer is searching to fill a position. If you're a radiologist looking to be employed in Texas, for instance, make sure the keywords for your CV match that. Additionally, make sure the site you're joining is able to preserve your anonymity.
In all, it's best to keep in mind that your presence in cyberspace can have a real impact on your future employment prospects. Anything you put online is searchable and leaves a footprint; so it's prudent to be cautious as to what you post about yourself. Don't speak ill of employers or colleagues, and generally be smart about what you say. If you're careful, online job searches just might land you the position you've been seeking.
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Physician Executive Compensation: Clinical Expertise and Business Acumen Are Valued
Source:
Physicians News
Date:
10/05/2009
The American College of Physician Executives (ACPE) has released the results of its 2009 Physician Executive Compensation Survey. Among its chief findings: an increase in physician executive compensation of about 12% from 2007 to 2009. An article in Physicians News has further details.
The survey, which was distributed to the ACPE’s 2,131 members, covered compensation by organization type, size, location, scope of operations, and personal experience and responsibilities, among other factors.
Specific findings of the study include the following:
-Physician executives earn on average 10% more with an MBA, a Master of Medical Management, or a Master of Health Administration degree.
-Chief Executive Officers/Presidents earn 22% more with an MBA.
-Department Chair/Chiefs earn 25% more with an MMM.
-Medical Directors earn 18% more with an MHA.
The study also found financial performance and clinical quality as primary drivers of compensation, along with organizational goals and satisfaction levels of patients, physicians, and employees.
The findings of the study were seen to be consistent with trends observed with regard to leadership in the marketplace. In a time of great reform, the study’s findings show that organizations have a need for physicians who can lead an organization as well as practice medicine. Primary concerns include enhancement of organizational and clinical effectiveness, and physician executives are rewarded for achieving such goals.
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Survey of U.S. Physicians Released, Finds Less Than 60% Providing Charity Care
Source:
Cataract Outsourcing
Date:
10/16/2009
Fewer than six out of ten physicians provided charity care in 2008, but nearly three in four physicians were accepting all or most new Medicare patients—this according to the latest figures from the Center for Studying Health System Change. Among the Center’s other key findings related to the physician work environment are the following:
-Three of four U.S. physicians were male, but females constitute four out of ten physicians under 40.
-One in three physicians works in a solo or two-physician practice.
-More than eighty percent of physicians surveyed work full time.
-More than half of physician respondents own part or all of their practices, while the remainder were employees or independent contractors.
-Fifty-three percent of physicians reported accepting all or most new Medicaid patients.
-Nine in ten physicians reported accepting all or most new privately insured patients.
-Nearly nine in ten physicians had managed care contracts in 2008.
The study, for which physicians were surveyed on numerous criteria from demographic information to practice organization to career satisfaction and more, included responses from more than 4,700 physicians.
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Locum Tenens: Tips for Adapting to Your Home Away from Home
Source:
LocumLife
Date:
10/15/2009
One of the most satisfying elements of locum tenens practice–traveling–can also be one of the most difficult to adjust to for some mobile providers. Locum professionals travel around the country from assignment to assignment, and it might sometimes be difficult to keep a real home on the road. A recent article in LocumLife recommends ways to “take home with you” for a taste of familiarity on those long assignments away from your real home.
The locum tenens professional will want to make sure to bring along items that increase comfort away from home. A dedicated travel pillow can help, as can a cell phone for keeping in touch. If you can get a connection to the Internet, videoconferencing with friends and family is now possible if you have a laptop with a camera. Also, when arriving at a new location, it’s a good idea to visit the local grocer to get food and drinks for the hotel room and check for a business center or fitness center within your hotel.
One important thing to remember is that the place where you stay has a vested interest in ensuring that you have a pleasant experience; so don’t hesitate to ask for anything that is likely to make your stay better. If excess noise is a problem, request a different room. Usually, hotels are more than willing to accommodate you in order to increase your satisfaction. Lastly, don’t forget their reward programs. Over time, these can save you much in the way of costs, and guests that check in using reward programs are specifically targeted for better service.
Take advantage of all these things on your next assignment, and home might not seem so far away.
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CBO Says Tort Reforms Could Reduce Deficit, Healthcare Spending
Source:
Congressional Budget Office
Date:
10/09/2009
Although the issue has been avoided to date, a recent report from the Congressional Budget Office indicates that tort reforms could, in fact, reduce the federal deficit and overall health care spending. The news comes from a recent letter to Senate Finance Committee member Orrin Hatch, in which the CBO forecast a reduction in total national health care spending by $11 billion in 2009 through the implementation of a package of tort reform proposals nationwide.
The letter claims that that figure results from a medical liability premium spending reduction of .2% and additional savings of .3% from slightly lower use of health care services. The estimates account for the potential cost savings accrued by medical malpractice reforms already extant across the nation. Additionally, the CBO estimated that a package of tort reform proposals could result in a reduction of federal budget deficits by roughly $54 billion over the next ten years.
Tort reform is often offered by Republicans as a crucial element in health care reform. They charge that Democrats are unwilling to make the necessary reforms due to their reliance upon trial lawyers for donations. The Obama administration, for its part, has commenced several tort reform studies around the nation to determine the efficacy of this sort of reform as a method of cost reduction.
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I'm a Doctor. So Sue Me. No, Really.
Source:
Salon.com
Date:
10/27/2009
Medical malpractice reform is generally touted as an underrated solution to much of the nation's health care woes, but how effective would a large alteration of tort regulations be in reducing overall health care costs? An article in Salon gives an answer that might be surprising.
The story is familiar. Fearful of lawsuits, doctors practice "defensive medicine," wherein they perform treatments and prescribe medications that might not be necessary just to make sure they absolve themselves of liability. This overtreatment, supposedly, is a root cause of the skyrocketing cost of care. But in fact, as the author contends, the conventional wisdom is wrong when it comes to defensive medicine and medical malpractice, citing Congressional Budget Office figures that show that the number of malpractice suits has remained steady since the mid-1990s through the mid-2000s. Other studies actually indicate that the number of suits has dropped 8% in the same time period. While the payout per claim has increased, studies suggest that this is due to selectiveness among trial lawyers as to which cases they will choose to pursue. Even with the increase in payouts, the CBO estimates that malpractice suits account for less than 2% of overall health care spending.
As for frivolous lawsuits, studies on the prevalence of such suits are spotty, as they tend to be privately funded, involving a small number of claims and a narrow focus on particular hospitals or specialty types. Studies from earlier in the decade suggest that seven out of ten suits in the U.S. are closed with a victory on the part of the physician. Additional studies from Harvard researchers suggest that people who do sue are doing so with good reason.
Furthermore, CBO reports find little evidence of tort reforms impacting medical spending, with no difference in per capita spending between states with the reforms and those without. CBO reports also raise questions about the claim that high costs of malpractice coverage are driving physicians out of business. Such claims were found to be largely the result of additional factors, such as rural locations and the general physician shortage on the whole. It is possible, then, that tort reform is a major issue largely for rural physicians, who are already both short in supply and financially strapped.
So is all that to say that the system works as it currently exists? Not exactly. The system isn't perfect. But those pushing tort reform as a cure-all might not be giving the full picture in their push for a more lenient system.
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Repayment of Stark Violations Can Be Tricky
Source:
Medical Economics
Date:
10/23/2009
Stark compliance is a tricky business. Stark regulations govern noncompliant referrals and the claims pursuant to those referrals, but not the referral itself. Navigating this regulation can prove to be a headache, but an article in Medical Economics provides a heads-up on what to look for when settling a Stark issue.
Noncompliant claim submittal typically results in a bigger headache since such claims trigger overpayments and civil-money penalties of $15,000 per violation. For circumvention violations, the penalty is $100,000. Stark regulations govern internal group practices as well, including improper compensation formulas, in-office ancillary services, and numerous other forms of noncompliance. It's best to ensure that your practice or group is fully compliant with Stark policy with regard to group structure and payment arrangements, or else risk the fate of an Iowa hospital recently made to pay out $4.5 million in fines for paying physicians beyond fair market value.
It's also difficult to determine if you're in violation without notification from Stark regulatory bodies, as the laws are rather complex, with exceptions permitting referrals in certain cases. Noncompliant parties are offered the opportunity to fix noncompliant transactions within a time period, but these periods often only help for technical violations. For instance, a grace period is allowed when only one side has signed an agreement and the agreement hasn't been fully executed. Further complicating the matter is the fact that the Office of Inspector General no longer allows reporting of Stark violations in voluntary disclosure programs.
It's not always necessary to repay the government for Stark violations. Sometimes the remedy is the reconciliation of payments made through the noncompliant structure. If there's anything to be learned from the experience of other institutions, it's that one should only undertake to achieve compliance with the assistance of a trained legal professional, as doing it wrong might land you in even more trouble than you were already in previously.
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Is Human Rights Prepared? Risk, Rights and Public Health Emergencies
Source:
Medical Law Review
Date:
05/08/2009
In an increasingly interconnected world, information, capital, and people flow more freely as do infectious diseases, making it necessary for governing bodies to be prepared to deal with public health crises in a timely manner. However, the actions governments undertake in these situations also carry the potential for an impact on human rights. So, is the human rights legal establishment prepared to deal with situations brought about due to public health crises? At least one human rights lawyer says no.
Since the turn of the century, governing bodies have stressed the importance of proper public health incident management as a crucial element of national and global security, as diseases are now able to cross borders and infect citizens of the richest and poorest countries. Well-publicized incidents such as the Anthrax threats of 2001 and the SARS outbreak of 2003 are just a couple of examples of the critical role public health has been found to play in national and international security. Such incidents illustrate the need for cooperation between national governments and international bodies, as breakdowns in communication between such bodies have resulted in disease spread and economic damage.
Some have raised concerns, though, over possible continuation of human rights abuses under the guise of public health management. The human rights proponent should be skeptical of proclamations of greater international cooperation, as state players can use such cooperation to advance their own agendas. Human rights advocates should therefore devote greater attention to interpretations of the interplay between rights and risk. It is this intersection that causes much of the concern over rights abuses with regard to public health, as it is possible for organizations to override rights they perceive as ultimate risks to security. In the public health emergency field, there is the risk for collisions between cultures, histories, and agendas in a time of crisis.
While globalization represents an immense challenge for those charged with maintaining the security of their populations, it is evident that there needs to be a guard against the excesses of national and multinational institutions with regard to keeping the balance between human rights, dignities, and fundamental freedoms when weighed against the necessities of national and international security. In such a time, it falls to human rights proponents to ensure that all parties work together to ensure public health and public rights are in balance.
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Urologists Prepare for Enforcement of “Red Flags Rule”
Source:
Urology Times
Date:
10/01/2009
By government mandate, the health care community is gearing up to combat identity theft. Doing so requires compliance with a number of new regulations. Is your practice ready? An article in Urology Times takes a look at what to expect from the new regulations.
More than 8.3 million Americans have their identity stolen each year. Of those, about 4.5% are medical identity thefts. This works out to about 373,000 instances per year in which someone pretends to be someone else in order to use that person’s health insurance. As a result, the Federal Trade Commission will, on November 1, begin enforcing a rule that will require physicians’ practices and hospitals to develop written plans for identifying and responding to warning signs of identity theft.
The Commission recommends increased monitoring of customer accounts and account numbers to prevent misuse. Also, it is advisable, if theft is suspected, to notify payers as well as law enforcement agencies.
The Commission’s rules will require that agencies investigating identity theft verify that practices have on file a written record of their anti-theft measures. Beyond the written policy, many practices may find that very little actually changes in their daily operations. Some report only having to add a request for photo identification into their patient check-in processes.
The rule has come under some protest, though, as the American Medical Association and other groups contend that physicians are not creditors and, thus, shouldn’t be subject to the regulation. As they appeal physician status under the regulation, however, these groups all advise compliance with the regulation until a final ruling is released.
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The Crisis in College and University Mental Health
Source:
Psychiatric Times
Date:
10/10/2009
Is America neglecting the mental health of its brightest young citizens? Are the tragedies at Virginia Tech and Northern Illinois University indicative of a larger problem that is going unaddressed? A number of studies on the topic raise questions as to whether the nation is putting the proper emphasis on mental health among its college students.
Among the 17.5 million university students in the United States, about 8.5% sought counseling through their school. An additional one-third of the students were seen by college-based counselors in other settings. Nearly a quarter of university students seeking counseling are on psychiatric medications, and student self-reports indicate that more than one in seven students report anxiety symptoms, with nearly one in five reporting depression symptoms. As a result, students are more likely to engage in excessive consumption of alcohol or risky sexual behavior.
Clinicians discussing the university situation tend to emphasize the outpacing of service capacity by service demand. College mental health centers simply lack the resources and structure to deal with such a widespread problem. Additionally, the lack of insurance coverage among students makes access to services more difficult. What's more, college students are legally adults; so there's no real power in the administrative realm to make them seek mental health help.
What, then, is the role of psychiatry in the midst of this crisis? Fewer than 1% of college counseling centers are directed by psychiatrists, and nearly a third of schools don't provide any sort of psychiatric services. A Presidential Task Force on Mental Health was convened in 2004 to address the problem, but solutions are slow to come.
Looking at the problem, it's clear that the mental health community needs to take a more vocal role in advocating for policies that increase access to these vital services among America's college population. This sort of action will require a greater effort by mental health professionals and students to become aware of the laws regarding mental health provisions for college students. Despite the problems currently facing the population, mental health work among college students can be quite rewarding, and it is a field that, with the proper incentives, could draw some of the brightest talents the specialty has to offer, thus ensuring that the upcoming generation has the services needed to make sure they are productive members of society.
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Community Health Grows Up
Source:
Trustee Magazine
Date:
10/02/2009
The pressure’s increasing for hospitals to engage in more sophisticated community health programs. While this is part and parcel to the mission of a hospital, it’s likely best for institutions to develop a specific goal with regard to community health. Hospitals should devise ways to measure how their investment in the community is paying off.
The time has come for community health to be taken more seriously as a hospital program. That means hospital administrators need to set goals and see that they are met. This might mean developing new committees on community health and community benefit. Lancaster General (Lancaster, PA), for example, has elevated community health to the board level by establishing a committee that receives regular updates on community health metrics from designated staff. Additionally, the hospital created a Chief Mission Officer position a few years ago, further strengthening the community health role.
Community health is more easily integrated into hospital functioning if administrators build programs with evaluation in mind. Consider what metrics you will want to measure to gauge success, and ensure that the program you devise is capable of such measurements. This is easiest if a program has specific goals. Lancaster General’s smoking cessation program, for example, is measured by keeping track of whether or not patients have actually quit.
It is also important to avoid unrealistic expectations. Trying to accomplish too much too quickly is a recipe for failure. Keep the lines of communication open with the public so that they can give continuous feedback and let you know what the community believes it needs.
Finally, it’s easy to let these programs take the financial hit under tightened budgets. A way to avoid this is to be able to demonstrate the effectiveness of the program with clear data. Put in place an evidence base for tracking progress and your program is sure to survive the next round of cuts.
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10 Steps to Improving ASC Profitability
Source:
Cataract Outsourcing
Date:
10/05/2009
An article in Cataract Outsourcing takes a look at ways ambulatory surgical centers–and, of course, other clinics–can cut costs through proven methods. ASCs, like other practices, vary in profitability. If implemented properly, though, the following ten steps can provide a significant boost to short- and long-term profitability.
-Recruit additional physicians–While it seems like the time to cut staff rolls, increased physician rolls give you a stronger capital base and bring in new patients.
-Review managed care contracts–Determine which payers are underpaying you for which services and make sure you walk away with a contract that reimburses your practice for what it’s worth.
-Know your costs–Go through your expenditures in detail. When you fully know your costs, you’ll fully know how much your practice needs to stay afloat.
-Reduce supply costs–Go directly to suppliers and consider competing bids. Consolidate purchases so as to reduce costs as well.
-Reduce staffing costs–Hire part-time instead of full-time employees. Shorten turnover time in the operating room. Don’t open on days with an unprofitable number of procedures scheduled, and consider leasing unused space.
-Limit capital expenditures—During a downturn economy, plans for capital expenditures might best be put on the “back burner” of consideration.
-Start or convert to a monthly profit-distribution plan–This is a powerful way to center investor physicians’ focus on the performance of the center.
-Offer buyback options–Consider repurchasing shares held by extant owners no longer closely aligned with the center.
-Amend your operating agreement–It’s best to amend them before there is a need to do so. If your operating agreement doesn’t include a non-compete clause, you’ll want to add this.
-Consider strategic partnerships–If you can enter into a partnership with a third-party management company or joint venture party, that might be the best thing, as they will have more capable billing and collections systems and administrators.
There’s no certain way to make sure you’ll stay afloat in these tough times, but applying these ten suggestions to cut costs is a solid place to start.
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Payer & Reimbursement Issues
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The Dashboard Dilemma
Source:
Trustee Magazine
Date:
10/09/2009
Do your trustees have all the data they need to pull your institution through tough times? It’s easy to check on metrics such as days cash on hand and operating margin, but are these the best and most reliable indicators? An article in Trustee Magazine takes a look at some of the best options.
The hospital’s “dashboard” isn’t always the easiest thing to read. Key to proper monitoring of an institution’s performance is knowing what to look for in the first place. If more patients show up without the ability to pay, that means increasing debt, which likely means increases in bad debt. It’s essential to make sure your metrics are oriented toward the problems at hand and the problems likely to arise in the near future.
Hospital finances are weaker in the face of the recession. While it is important to broaden your view, it is also important not to lose sight of traditional metrics. Pay attention to debt covenants–those provisions placing liquidity requirements on the hospital–because these have arisen recently as a threat to hospitals due to large investment losses. Hospitals should also look out for weak market demand, declining cash flow margins, investment losses, and weaker balance sheets.
Simply eyeing profitability doesn’t cut it anymore, as administrators want to keep an eye on the figures that tell how your institution is going to be doing in the future. With that in mind, keep an eye on your days in accounts payable; discharged, not final billed; and physician performance metrics. As to Medicare, it’s highly advisable to start looking at the Medicare cost coverage ratio. This will help you keep an eye on how close you are to breaking even on Medicare.
Looking past finance, hospitals will also want to keep an eye on quality of care. This is an increasingly important metric in the future, as it is likely to determine reimbursement rates in the years to come. Also, it has a sizable effect on patient returns, which has an effect on the bottom line. By keeping your eye on the right metrics, you can take steps to strengthen your hospital’s financial position if it’s showing signs for concern.
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Medicare's No-Pay Rule Has Little Financial Impact
Source:
American Medical News
Date:
10/26/2009
As part of the effort to decrease health care expenditures, the Centers for Medicare & Medicaid Services has declared that it will cease to pay hospitals for "reasonably preventable" hospital-associated conditions. Such nonpayment is estimated to save the system millions of dollars per year and encourage improvement of safety and outcomes. But a new study out from Health Affairs claims that such measures will have a negligible effect on real health care costs. So is it worth it?
The study, conducted by UCFS School of Medicine researchers, found that the nonpayment rules will cost about $368 per facility, or $2.7 million dollars on the whole. The cost of implementing new procedures is likely to lessen hospitals' likelihood of implementing the reforms necessary to prevent these hospital-associated conditions.
The study examined discharge records at California hospitals in 2006. Since California already required documentation of Present-On-Admission conditions, the state was an ideal model for evaluating the effectiveness of the practice. Researchers looked at eight of ten Medicare no-pay conditions, finding that the actual number of cases that would be affected by the new regulations is too small to have a sizable impact on overall health care savings.
Furthermore, the study authors cite efforts and policies already in place among hospitals to reduce these sorts of conditions, as hospitals already have a professional and ethical duty to make sure patients receive quality care. Still, the findings cast doubt on what is touted as a significant cost-reduction facet of impending health care reforms. CMS looks to examine the impact of its no-pay rules next year. The rules are unlikely to affect physician compensation.
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Plans Clamp Down on Utilization
Source:
Managed Care Magazine
Date:
09/12/2009
Is the payer system giving your practice no end of trouble with the prior authorization process? You're not alone. Insurance company policies are increasingly resulting in incurred costs for practices and alterations to physician decisions. An article in Managed Care Magazine discusses what’s at stake.
Nine out of ten doctors say they've had to change treatments due to insurance company policy. Typically, these treatment alterations have to do with prescribed drugs. A recent survey of California physicians found 87% of respondents indicating that insurance company limitations pose a major problem in their practice. These physicians claim the companies exert pressure upon them to change treatments. And this isn't just a question of inconvenience to practices: experts estimate the impact of dealing with payers at $31 billion per year, or seven percent of the nation's total health care expenditures.
The story of physician troubles with payers is nothing new. The 80s and 90s saw the rise of MCOs, which led to physician unhappiness as well. Eventually, health plans backed off and exerted less influence on physician decisions. Prior authorization policies, though, have remained and resurged in the last decade. The problems that existed in prior decades have reappeared as well.
Dealing with multiple plans is often cited as a stumbling block for practices, as it seems that no two plans handle authorizations in the same manner. Changes could be on the way though, as the Healthcare Administrative Simplification Coalition is pushing for the adoption of new technology to streamline the authorization process.
Other advocates are working to roll back health plans' power on medical decisions. Some legislation has been proposed that would ensure automatic approval of requests when plans don't respond in a timely manner to requests. The payers, for their part, are working to meet physicians halfway, moving the authorization process online and increasing staff dedicated to authorizations. A pilot project is in the works to allow online authorizations. The process isn't likely to disappear, but hopefully, enough progress can be made to make sure that patients are treated responsibly and doctors equitably.
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Can 'Bundled' Payments Help Slash Health Costs?
Source:
USA Today
Date:
10/25/2009
As the quest for health care solutions continues, payment model proposals abound. It's likely that some combination of existing models will be grouped together to constitute "reform," but could a bundled model of payment be the best way to reduce health care costs? USA Today takes a look at the model and attempts to figure out its applicability to health care reform on the whole.
Under a bundled payment model, Medicare makes single reimbursements to hospitals and physicians for procedures as opposed to separate payments to both physicians and medical facilities. It's thought that this payment model could be a means to drive down costs while encouraging closer cooperation between physicians and hospitals for the delivery of higher quality care. Proponents of the model point out that the current payment model is inherently inefficient, as it rewards even treatment mistakes that result in readmissions. To this end, a number of pilot programs have been developed in which Medicare pays providers a bundled rate for service provided. Depending on the results of the projects, the model could see greater expansion in the years to come.
Proponents of the model tout the efficiencies introduced into the system through the simplified payment method. The current pilot program will run three years and includes five hospitals in Colorado, New Mexico, Texas, and Oklahoma. It is estimated that through the program, Medicare can reduce costs by 4.4% on heart and joint surgeries. A similar program was undertaken with coronary bypass surgery in the mid-1990s. That program saved $42.3 million over three years, with costs dropping between 10% and 37% at participating facilities. However, those facilities saw no resultant increase in business. That project, however, did not include an incentive for Medicare beneficiaries to come to participating hospitals.
The idea of bundling has met with some resistance, though, as opponents argue that bundling runs the risk of causing increases in costs as the funding for Medicare dwindles over the next decade or so. The pilot program, though, has led to slight profits among participating hospitals. Additionally, participating hospitals have seen decreases in the costs of providing service as practitioners have sought to reduce the amount of medical supplies used and gone for cheaper alternatives when possible. Not all costs have dropped, however, as one facility estimates expenditures of half a million dollars on claims processing and advertising due to participation in the program.
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Credentialing, Licensure, Quality Management
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Eliminating Infections, Saving Lives
Source:
H&HN Magazine
Date:
10/05/2009
A new article in H&HN Magazine takes a closer look at what is being done to combat hospital-associated infections, which, as the author points out, kill more people per year than AIDS, breast cancer, and auto accidents combined
Hospital-associated infections (HAIs) are estimated at about two million per year, with a cost to the health care system of $4.5 billion. To combat this problem, numerous government and professional agencies have undertaken to improve awareness and decrease the likelihood of these infections. Among them, HHS Secretary Kathleen Sebelius has cited the Keystone Project as a success story.
The Keystone Project represents a collaboration between the Michigan Health & Hospital Association Keystone Center for Patient Safety & Quality and Johns Hopkins University. The project, which began in 2003, has involved 132 ICUs working to reduce HAIs by implementing “Comprehensive Unit-Based Safety Program[s]” and evidence-based intervention “bundles.” Each bundle targets an infection type, such as ventilator-associated pneumonia.
In implementing the project, unit leaders learned that it is essential to have a strong evidence base for any practice changes. This requires spending the time to develop educational tools and presentations. Additionally, communication of expectations is essential, as all staff involved should be made aware of what their expected role will be. With these practices in place, hospitals are likely to improve their quality and, at the same time, lower costs. Indeed, reduction of hospital-associated infections is the most action-ready goal of the health reform debates today.
The Keystone Project, which is funded by the AHRQ, is reported to have saved 1,500 lives and $200 million in reduced care.
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Putting Quality First
Source:
National Committee for Quality Assurance
Date:
10/01/2009
The economic impact of the health care crisis is no secret. Legislators are, of course, working to develop some sort of health care reform, but what else is going on within the field? The National Committee for Quality Assurance (NCQA) has put forth a number of proposals aimed at making sure that any reforms passed assure high quality and high performance care.
NCQA holds four precepts at the core of its policy proposals:
-Holding health plans and providers accountable for quality and efficiency of care;
-Making coordination of care and primary care priorities in any reforms;
-Promoting the use of health information technology;
-Investing in evidence stewardship to use best practices to ensure the best outcomes.
To this end, the NQCA has sent a number of proposals to legislators with the goal of ensuring the quality of any legislative measures passed. A March 2009 letter pointed out the need for the qualities enumerated above. A following letter in May of 2009 pointed out the need for improvements to the requirements for the Physician Reporting Initiative and reimbursement policies under Medicare Advantage. Additionally, the letter addressed the need for improvements to quality management policies and needed changes to the Medicare Shared Savings Program, and called for alterations to policy regarding chronic care management and transitional care reimbursement.
A second letter in May called for the establishment of a National Insurance Exchange as a crucial step for the expansion of coverage, quality, and affordability. Such a measure would require the provision of coverage for all Americans as well as the development of a nationally recognized accreditation board for payers participating in the Exchange. Still another letter to legislators called for the adjustment of reimbursement for over-valued physician services. Essentially, the proposal argued that changes to the reimbursement structure were necessary to bring down care costs. That letter also addressed variations by region in health care spending and financing of medical education as a means to reduce the impact of the coming physician shortage.
Lastly, a June 2009 letter to the Chairman of the House Committee on Energy and Commerce pointed out the decline of performance on key measures such as mammograms for women 40 to 69, flu shot prevalence among Medicare beneficiaries, and colorectal cancer screening.
No matter what form health care proposals eventually take, it's certain that professional organizations and those close to the health care field will be needed to ensure that legislators develop a system that works to provide the best care possible. With regard to quality of care, at least, the NQCA is working continually to make sure the right proposals are passed.
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Three Ways to Keep Health Quality Simple
Source:
HealthLeaders Media
Date:
10/29/2009
“Quality” is a word you probably can't get away from in health care today. Everyone is focused on improving quality outcomes as a means of either increasing market share or decreasing costs or some other reason. So what if increases in quality could be derived simply from increases in communications?
Representatives from the Plain Language Group claim that good communication leads to good quality health care. And what drives good communication? A principal in the group breaks it down to three E's:
-Effectiveness–Effective communication is essential, but a skill many physicians lack. Providers have a tendency to overload patients and others with information, which results in forgotten orders and decreased quality of care. Instead of deluging others in information, it's best to communicate in written instructions that your audience can understand. Try testing out language on people in order to gauge its accessibility. This can help you find out which communication methods are effective and why.
-Efficiency–Plain language and communication also helps to increase efficiency. If your patients and co-workers clearly understand the orders you've given, then you're less likely to see unnecessary hospital returns due to unclear or vague health care data.
-Economy–Written communication can help decrease costs as well. Poor communication can result in malpractice cases, which help no parties and increase costs all around.
Of course, "speak plainly" isn't a silver bullet policy suggestion. But you might be surprised at how effective quality communication can be in improving quality of care. When your patients understand and trust your communication, they are less likely to sue and more likely to follow orders, and that's bound to result in better outcomes on the whole.
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Medical Societies Push Standards for Robotic Surgery
Source:
ABC News
Date:
09/17/2009
Technological advances increasingly allow for fewer invasive surgeries through the use of robotic surgical instruments. With the increased technical ability, though, come increased responsibilities; and some groups are arguing for more regulation of the use of robotic surgical equipment.
At the World Congress of Endourology in Munich, concerns have been raised regarding the use of robots in surgery. While the use of such technology allows for less invasive procedures, there are concerns with regard to standards of training and exactly when the use of such technology is appropriate. Some say that doctors are too eager to operate already, and that the use of robot technology makes them even more likely to operate when it might not be necessary. Additionally, there are no universal guidelines among facilities governing the use of robotic surgical implements and no credentials to verify surgeons’ competency with the equipment. Professional organizations are thus attempting to develop standards to which they hope individual hospitals and medical societies will adhere. Largely, these standards push for greater resources for training on these tools.
Nine out of ten prostate cancer patients choosing surgery prefer robotic-assisted procedures. While the benefits of such procedures include less trauma, blood loss, and overall improved outcomes, the lingering controversy illustrates the fact that the use of such technologies needs to be governed, as they are not always the appropriate method. And, even when they are, much care must be taken in assuring that practitioners have the proper training to ensure that they are utilized to their fullest beneficial extent.
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Physician Practice Management
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2010: The Year to Update Your Strategic Plan
Source:
Sg2
Date:
10/06/2009
Could this time of uncertainty be the best moment to reevaluate your institution’s strategic plan? An article from Sg2 Health Care Intelligence contends that the coming year is the best time to go about mapping the foreseeable future for your organization and outlines a few things you need to take into account.
Regardless of incoming policy on insurance, policies on payment are pretty much unavoidable. Provider reimbursement rates won’t continue to rise at the rates of the past five years, and greater cooperation will be necessary between physicians and hospitals. In order to get your strategic plan in line, consider the following:
-Clinical integration–How are you going to work with your employed and affiliated physicians to enhance quality and cut costs?
-System of Care–Reimbursement will be directly tied to outcomes and quality of care, especially for chronic patients.
-Independence–While the horizontal integration of the 1990s is likely gone for good, the trend is still toward greater doctor-hospital integration.
-Primary care–Your organization needs to build a strong primary care base, despite an undeniable shortage in the market.
-The physician business–Figure out how your organization benefits from physician employment.
-Your competitors–Keep an eye on the competition clues as to what will work for your institution.
-Leaders–Experts warn that the next five to ten years are the domain of inspired, business-savvy physician leaders.
-IT–New system implementations must be strategic.
-Your board–Does your board have the determination, time, and ability to address the preceding issues?
As a next step, run through multiple scenarios mapping out the impact of approaches available to your institution on the preceding issues. If current operations and planned adjustments do not bode well for your institution’s competiveness, it may be time for major restructuring.
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Potential Traps in a Practice Sale or Purchase
Source:
Physicians News
Date:
10/09/2009
The hostile economic climate and state of uncertainty in the health care industry have not led to a halt in the selling of practices. Indeed, the trend is accelerating in certain sectors, as hospital alignment is an increasingly popular option. But, in selling a practice, it’s necessary to keep an eye out for the not-so-obvious pitfalls. For potential sellers, unawareness of these factors could lead to serious trouble.
Most people know the obvious points to a practice sale, such as price and payment terms, doctor employment by the purchaser, and dates of closure; but it’s also important to keep an eye out for the transfer of assets in the sale. Usually, cash and accounts receivable are not a part of a sale contract. Also, sellers tend to have practice assets which they would like to retain, such as diplomas, artwork, collectibles, and so on. In constructing sale contracts, the details regarding such items should be clearly spelled out so that both parties know what they are giving and getting.
Also key to the sale of a practice is the involvement of an attorney. While most people are pretty sure they can read through a contract and know what they’re getting into, it’s still best to have a trained legal eye going over legal documents to catch anything you otherwise would miss.
With regard to pre-paid expenses and accounts payable, it is essential to lay out the economic impact of any outstanding commitments. For example, many sellers agree to pay for expenses related to pre-closing activities, no matter when the bill comes in. In turn, the buyer agrees to pay all bills related to the activity post-closing. In this way, order is maintained with regard to who is responsible for what financial arrangements. Whether accounts receivable is part of the sale or not is up to the concerned parties.
Real estate is often a major hang-up in a practice sale. The details of the contract will hinge upon the nature of the practice space. If it is owned by the seller, then the seller may want to retain ownership. If it is leased, then the contract may have to take into account whether or not the landlord will allow assumption of the lease. No matter the case, the contract should have protections built in for both parties regarding the real estate aspect of the practice.
This is by no means a complete listing of the possible hang-ups and pitfalls in negotiating a practice sale, but if you keep an eye out for these things, you’ve already gone a good deal of the way to ensuring a smooth sale.
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Nickel and Dime Leakage That's Costing You Big
Source:
Physicians Practice
Date:
11/26/2009
In tough economic times, every dollar counts, right? So, could your practice be leaking funds in ways you've never imagined? An article in Physicians Practice takes a look at how to shore up your bottom line by cutting unnecessary expenditures.
Pennies make dollars, and, if you take a hard look at your practice's balance sheets, you're almost certain to find needless expenditures that have an impact on the bottom line. Most practices know to look out for the big things: proper coding, avoidance of audits, proper collections of co-pays, negotiations with payers, claims automation, and so on.
But what about vendor charges? How closely have you examined those? For instance, your practice could be paying out for redundant information technology services such as virus protection. Or, perhaps there are under- and unused maintenance contracts with insurers. These sorts of things add up. For this reason, it's best to take a detailed look at your balance sheets. Review key contracts and see what you're paying for and whether it's worth it. Some things to consider include:
-Janitorial contracts–If you're not getting a competitive rate, you'll want to renegotiate. Does your office need five cleanings a week? Why not cut it to two and make sure they do a really good job each time?
-Maintenance agreements–Updating that old, (mostly) reliable copier could result in decreased technology costs. Spend a little bit more to get a newer model and you're likely to see the maintenance bill go down.
-Overtime–Is your staff grabbing an extra fifteen or twenty minutes here or there? Maybe padding the paycheck a little each week? If you don't have a concrete overtime policy in place, your practice could be leaking thousands of dollars a year in overtime pay.
-Credit card processing–Are you getting the best rate for your processing services? If you shop around a bit, you could save $30 dollars a month on processing fees. That $360 a year might not seem like much, but every dollar counts.
Measures such as those mentioned above won't, individually, add up to massive decreases in practice expenditures. Taken together, though, in addition to further penny-pinching measures, steps like the ones above could very well wind up being the difference between a struggling practice and one that weathers the current economic climate.
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Medical Supply Costs Stabilize
Source:
American Medical News
Date:
10/09/2009
Medical and surgical supply costs have grown relatively little over the past year and are likewise not expected to grow much over the next year, according to data from both a prominent data research center and the Bureau of Labor Statistics.
Premier, a hospital and health system-owned research center, analyzed data from 2,200 hospitals and 63,000 other health care sites to find trends in medical supply costs. Based on their analysis, Premier projects that inflation for medical and surgical supply costs will range from 1.6% for imaging supplies to 4% for laboratory supplies through 2010. For cardiovascular and surgical services, supplies are forecast to rise by about 3.2%.
The Bureau of Labor Statistics released figures indicating that the annual medical supply inflation rate was 1.3% in August. This was down from 2.6% for August of last year. Supplies continue to outpace the general rate of inflation, with the Consumer Price Index dropping 1.5% from August 2008 to August 2009.
Experts attribute the stability in price largely to budget cuts, as health care institutions are not stocking up on supplies as they once did. Experts, however, still warn that costs for medical isotopes, oil-based equipment, or any equipment in high demand are still likely to increase.
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How to Say No to Patients
Source:
Physicians Practice
Date:
10/05/2009
We’ve all seen the ads: “Ask your doctor about…” whichever medication is being advertised. And so patients ask. But how do you tell them, “No”? In an increasingly consumerist health care industry, it’s essential that doctors know how to tell the customer that he’s not always right. An article in Physicians Practice has the story.
Doctors are charged with doing the right thing by their patients and their practices, but sometimes the right thing is telling a patient no. When doing so, it’s highly beneficial to start showing that you’re coming from a caring and cooperative position rather than one of frustration and annoyance.
The current climate is forcing numerous practices to say no more often, whether it concerns rescheduling patient appointments or denying clemency for a co-pay. Of course, patients tend to think they have a “right” to certain services or a specific treatment. When denying something to a patient, it is important to let the patient know where you are coming from as a physician. That is: why you’re saying no. If a physician takes a caring and thoughtful approach to aiding patients, she’s more likely to find patients complying with her orders.
If, however, a physician takes a defensive or aggressive position with regard to a patient, the patient may not pay, follow orders, or even come back. Don’t be so quick to assign bad intentions to patient requests, and when turning them down, make sure to fully explain yourself in a manner that lets the patient know that you are in fact helping them with this decision. The customer may not always be right, but it’s generally a good idea to treat them in a manner that assures they’ll stay a customer.
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Patient Surveys Can Help Practices Improve
Source:
American Medical News
Date:
10/05/2009
Patient surveys—could they do more than gauge patient satisfaction? A number of clinics are using the surveys in a way you might not imagine, as an article in American Medical News explains.
Typically, health plans use patient surveys to grade physicians on various aspects of their practices. But a recent trend has found clinics using a National Quality Forum-endorsed survey tool to more tightly focus their practices on patient-centered care.
The tool–the Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey–is a product of the Agency for Healthcare Research & Quality. It consists of a free survey which provides a standardized measure of patient satisfaction with all aspects of the clinical experience. The tool has found use in Massachusetts General Medical Group, which surveyed its patients in 2007, finding poor ratings for the clinic’s staff. Alterations to clinic policy following the survey resulted in significant increases in patient satisfaction with clinic staff.
Clinics using the tool indicate the desire to achieve across-the-board positive ratings as a driving goal. Increasing patient satisfaction depends on the whole health care experience, and these surveys are proving a useful tool to evaluate the patient experience from one end of the practice to the other.
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