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Jackson & Coker has embarked on a year-long survey to test the possible linkage of personality traits among practicing physicians with their choice of medical specialty and with their job satisfaction. Healthcare employers who are permitted to view the general personality assessments by particular specialties have a better understanding of how to relate to the doctors in ways that will enhance their on-the-job performance and will support the organization’s physician retention efforts.
Over a period of several months, survey participants—numbering over 800 thus far--completed the “Extended DISC,” a well-regarded, nationally recognized personality inventory. Participants responded to a total of 68 questions that revealed dominant and secondary personality traits, as well as provided indication of what drives and motivates them personally. The survey analysis and summary of this ground-breaking study point out some interesting findings related to personality make-up of the majority of doctors—and differentiated according to gender and age categories.
This study will continue over the next year as we test the results of personality assessments being given, for instance, to entire hospital staffs: clinicians, administrative staff and executives. The composite results will prove highly beneficial in determining what roles are best suited to healthcare professionals according to their fundamental personality make-up and favorable ways of interacting with their colleagues. We anticipate further survey results having important implications for physician hiring and retention as other personality patterns are likely to appear.
DISC Survey Analysis:
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Physician
Recruitment and Retention: Helpful
Strategies
It’s estimated in the next eight years, there
will be a shortfall of at least 80,000 practicing physicians in the
United States.
No one can currently predict how many
more practitioners will be required if the Obama Administration’s proposal for
universal health care allows millions more currently uninsured residents to
receive nationalized medical care.
For this reason, recruiting and retaining
top-notch physicians is a high priority for hospitals, clinics and health
systems across the land. This issue
addresses the matter from several perspectives.
Our Special Report, “Successful Physician Recruitment and Retention,”
discusses what makes for a good fit with the
health care organization’s personality,
the cultural fit, and retention strategies enacted before and after the
doctor and his family relocate.
A companion guest feature article is entitled
“Enculturation—Key to Physician Recruitment and Retention,” co-authored by Mike
Hiffa, Vice President of Human Resources for Jackson Healthcare. The article
points out the importance of ingraining in new hires the core mission, values
and business objectives of the organization in order to promote their loyalty
and enthusiastic contribution to the group’s success. Doctors who fully support the
hospital’s or medical group’s commitment to best serve their community are more
likely to want to maintain their
affiliation with their employer.
Making a good personality match is also
important for physician recruitment and retention. This edition of the
Jackson & Coker Industry Report also includes an analysis of “Extended DISC”
personality traits associated with various physician specialties. Hospital administrators are advised
to consider this linkage when contemplating extending a permanent employment
offer.
This analysis is the initial reporting of a
long-term, in-depth survey that will include more physician groups as
participants over the next year.
This edition also spotlights a new feature,
Healthcare Executives’ Insights, that serves as a platform for industry leaders
to express their informed views and opinions on timely issues concerning the
health profession. JCIR interviewed
Jerry Weissman and David Baker of Community Health Systems and share their
perspectives in a Q&A format.
Cordially,
Calvin Bruce
Managing Editor
Jerry A. Weissman – Vice President, Medical Staff Development, Community Health Systems
David Baker – Regional Director, CHS. - Click Here -
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By Mike Hiffa, JD, and Calvin Bruce, CPC |
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By J&C Research Associates |
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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 timely, thought-provoking topics such as “How the Cost Center Mindset Is Costing Hospitals Millions”. We welcome suggestions of topics
that would enhance our ongoing discussions and appeal to a broad segment of the
health care community.
Positioning Your Hospital for Brighter Days
Source: H&HN Magazine
Date: 06/01/2009
The economic turmoil of the past few months has thrown everyone for a loop, hospitals included. An article in the June issue of H&HN Magazine contends, however, that while times might be tough, emphasis placed on the right aspects of your strategic plan is the best way to weather the storm.
One major effect of the economic turmoil has been a change in the way hospitals are handling expenditures. What is happening is that more and more institutions are lowering the cost level at which expenditures have to be approved by higher administrators. Whereas it was common before to see new hires brought on with only a department manager’s approval, now it is not unheard of to see such hires requiring the approval of higher administrators. Experts recommend cutting off any potential discord over such measures by including staff in explanations of the effects of the economic climate on the hospital.
Prior to the economic downturn, many hospitals were focusing on capital expenditures, but the credit crunch put these issues on the back burner. Expansion projects that had previously been approved and even started were put on hold. With the credit markets a bit looser now, it may be time to reexamine capital projects that were stalled. Hospitals should take another look at their long-term goals to make sure capital expenditures are in line with them and the bottom line.
The economy’s troubles have also increased the pressure on private practice physicians. Indeed, hospitals are reporting upticks in the number of physicians looking to sell practices and join hospital staff. This can be a good way to increase revenues at institutions, but measures to increase efficiencies should be taken. Hospitals should employ productivity standards in hiring physicians and look into bundled payment models, as these are likely the way of the future in health care compensation. In all, these tough times aren’t necessarily a reason to stick one’s head in the sand. Rather, the right strategic plan, with the determination to see it through, can lead your institution to higher heights beyond the current lows.
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Protect Yourself and Your Patients During this Economic Meltdown
Source: Physicians News
Date: 06/11/2009
As the economic doldrums drag on, your practice is increasingly likely to encounter patients with decreasing ability to pay. Doctors, of course, need money for their services to continue to operate. However, the physician's code makes it difficult, if not unseemly, to turn away patients in need. An article in Physicians News gives some tips on ensuring that your practice and your patients stay healthy in these tough economic times.
Study after study shows increasing numbers of Americans losing access to affordable health care either through layoffs or increased consumer pay load. A recent report from Families USA found that 32% of New Jersey residents had spent a significant amount of time without coverage. Additionally, prescriptions go unfilled and simple ailments turn into serious afflictions as they go untreated.
In the face of this, doctors can still provide services to financially strapped patients. In doing so, though, it is important to keep a number of things in mind.
-Proactively contacting patients with letters seeking to work with them through financial difficulty is a winning strategy. You should encourage patients to seek out a solution before skipping an appointment due to hardship.
-Keep records of any contact with patients detailing date, issue, and resolutions proposed for their hardships and treatments. Also note patient responses.
-Have your practice follow up on canceled or abandoned appointments and prescriptions. Maintain contact with these patients and work out payment agreements or alternative care plans.
-Direct stressed patients to resources to help them with insurance and prescription difficulties.
In doing so, you’ll want to check with your medical liability carrier. Even in offering assistance, it is advisable to cover one’s bases. If a patient skips a medication or appointment and falls seriously ill, you’ll not want to add your troubles to theirs by suffering through a lawsuit as well.
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Healthcare Expenditures: A Look Ahead
Source: LocumLife
Date: 06/15/2009
The KPMG Healthcare & Pharmaceutical Institute recently released the fourth edition of its “Healthcare Industry Report,” which examines the healthcare industry from multiple perspectives. The report forecasts a grim outlook for the American system. CMS figures show the US spending $2.4 trillion on health care in 2008. That colossal figure breaks down as follows:
-12% paid by consumers
-34% paid by private health insurers
-7% paid by other private funds
-47% paid by various levels of government.
The consumer contribution takes into account both the uninsured–who pay out of pocket for everything–and the insured–who pay out of pocket for deductibles, co-payments, and uncovered expenses. Roughly half the US population is covered under private plans, which include employer-sponsored plans for employees and health policies purchased outside the workplace.
CMS additionally forecasts costs for health care ten years into the future, and it is here that the current figures balloon. By 2017, expenditures are expected to grow to $4.3 trillion, approaching double their current level. Health care spending is expected to grow at 7% per year, while the economy is only forecast to grow at 5%. This will culminate in health care expenditures amounting to nearly one of every five dollars spent in the United States by 2017. Worse, payer group expenditures are expected to remain about the same over the same period; so all players can look to see their expenditures double by 2017.
The KPMG report also points out the net liability for Social Security and Medicare, currently at $42.9 trillion. While the big topic of the day is reform of the health care coverage and delivery system on the whole, the report specifies that the biggest problems are rapidly increasing cost and inconsistent quality of care. Without addressing these issues, it contends, any reforms will be incomplete.
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It’s Time for a New Model of Health Management
Source: Managed Healthcare Executive
Date: 06/01/2009
The health management models of the last thirty years have been valiant but ultimately flawed and incomplete models, and a new method of health support is essential in this time of change. This is the assessment discussed in an article in Managed Healthcare Executive.
The article divides the health management process over the past thirty years into three groups. Beginning in the 1980s, single-disease programs were developed to address specific ailments and keep them from ballooning into larger problems. These approaches, however, could not account for co-morbidity management and thus gave way to Total Population Health Management (TPHM) in the late 1990s. But while it was more effective than its predecessors, time has shown TPHM to be inadequate for addressing the needs of the modern health care consumer and market.
As a result, the author puts forward the idea of the personal health support model. Whereas TPHM relies largely on reworked disease management programs and health coaching for those members choosing to participate, this new model encourages greater member participation. The model works with individual interventions based on member-set criteria. The focus is not the disease, but increasing the personal health of the individual. This personal model incorporates wellness programs, health coaching, disease-focused programs, complex care programs, and end-of-life programs to increase patient-doctor communication. Additionally, the model incorporates technological offerings to make patient monitoring easier and more automatic.
The author argues that the collective models of the past just do not cut it in today’s medical world. Rather, policymakers should steer toward greater technological implementation, which allows for greater personalization of the health care provision model.
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Hospital Capital Expenditures to Remain Weak Through 2010
Source: SG2 Health Care Intelligence
Date: 06/10/2009
In light of decreased fiscal flexibility, hospitals are largely sitting tight on capital expenditures. This assessment accords with polling results from the recent Tenth Annual Non-Profit Health Care Conference. The results of the poll reflect a poor outlook for non-essential capital expenditures over the next fiscal year.
The poll at the Non-Profit Health Care Conference surveyed executives from 28 of the nation’s strongest health care systems. Results indicated that capital spending would be down through fiscal year 2010, some 15% lower than fiscal year 2009. Fiscal year 2009 was, itself, down 20% to 30% from 2008. Respondents indicated that senior management approval is increasingly necessary for equipment purchases. Some reported $50,000 thresholds for approval. Executives also indicated that capital freezes were likely to continue, though they did not seem to expect these cutbacks to have a negative effect on quality of care. The trend appears to be hospitals favoring brick-and-mortar capital expenditures, those ones already begun, that is, over new equipment acquisitions. What is being purchased appears to be largely IT and, to a lesser degree, radiology equipment.
In the face of such cutbacks, experts advise that staff pressing for equipment purchases frame their requests to accentuate the equipment’s effect on lowered costs or improving throughput. In the case of suffering bottom lines, it is incumbent to demonstrate how an upfront expenditure will, in the long run, wind up saving an institution money or drastically improving patient outcomes.
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Prevention Efforts Provide No Panacea on Health Costs
Source: Wall Street Journal
Date: 06/12/2009
Much of the talk in the way of health care reform centers on an increased focus on preventive care, under the reasoning that keeping people from getting sick is less costly than treating them once they become sick. But could this tactic for addressing America’s health care woes turn out to be ineffective or, worse, even more costly an option than the current system? An article in the Wall Street Journal looks at why preventive care might not be as good a solution as some might think.
The article focuses on a number of studies that undermine the common wisdom that preventive care should be a huge component of health care reform. A Congressional Budget Office report recently concluded that increased use of preventive care would generate only modest cost reductions over ten years. What’s more, the report found that preventive care could very well increase costs. This is because any preventive care measures would focus on the whole population, and it is likely more expensive to preventively treat everyone than it is to treat those that are already sick. Additionally, preventive care measures only work when people follow the advice given them by doctors, and studies indicate that change of behavior is hard to maintain. Additionally, other studies have examined preventive care initiatives, finding that targeted preventive care is likely more effective than general preventive care.
In all, the article claims that the efficacy of these measures is overhyped at best and misleading at worst. Still, payers are lining up to join in preventive care measures, even though previous efforts have had spotty results. Some commentators even contend that the whole idea is approaching the problem from the wrong direction, claiming that focusing on cost reduction is the wrong way to go about implementing health care reforms.
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Poor Communities Have 22% Higher Hospitalizations
Source: Managed Healthcare Executive
Date: 06/12/2009
The disparity in health care provision between low-income Americans and their higher-income counterparts remains wide despite efforts to close the gap.
According to AHRQ’s newest data release—Hospital Stays among People Living in the Poorest Communities, 2006—hospitalization rates in the poorest areas are 22% higher than those in higher-income areas. The disparity widens when the numbers are examined more closely.
-Among 45- to 64-year-olds, hospitalization rates were almost 50% higher for poorer Americans than other income groups.
-Ambulatory-care-sensitive conditions ranged from 32% to 87% higher.
-Asthma (87%), diabetes with complications (77%), and skin infections (49%) were among other ailments with much higher hospitalization rates in poorer communities.
-Lower income patients were more likely to receive most of the top twenty procedures performed in each hospital. Lower income patients were 81% more likely to receive eye and ear procedures, 47% more likely to be vaccinated for hepatitis B, and 32% more likely to receive respiratory intubations.
The study authors warn that managed care executives with enrollees from poor communities should take extra care that outpatient services are available to prevent hospitalizations and that patients are encouraged to make follow-up examinations and keep appointments.
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Choosing Centralization vs. Decentralization
Source: H&HN Magazine
Date: 06/08/2009
In the midst of global economic downturn and turmoil in the health care marketplace, the debate over centralization versus decentralization in provider organizations has gained new life. Organizational changes are generally accepted as a necessity in this time of turmoil, but which direction should your organization take? An article in H&HN Magazine gives some pointers on choosing a path.
A crucial realization in the debate over centralization versus decentralization is that there is no cure-all strategy. That is, what works in one instance may not work in the next, even within the same institution. A good deal of research on organizational structures has been carried out, with the results indicating that in some situations it is better to consolidate decision-making while in others, it is best to disseminate such power among numerous levels. It has been found, though, that any reorganization should focus on creating balance in an organization. Reorganizations should focus on creating structures to support strategy, encouraging ease of decision-making and putting the right people in the right places for the right jobs.
CEOs would do well to use their time making their organizations work better, as a modernized organizational design can generate more and better gains than would other measures. Additionally, researchers have found that in some cases, centralized leadership should be restricted to obligatory tasks, such as legal and regulatory requirements or basic governance functions. In reorganizing, be sure that any centralization efforts add clear value to operating units.
In transforming the operating model of your institution, a good rule of thumb is that centralization is advisable if the primary goals of reorganization are increasing efficiencies, control, and coordination. If your organization has goals of increasing creativity, innovation, entrepreneurialism, or product offerings, then decentralization may be the way to go.
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Why the Hospital-Physician Staffing Structure Must Change
Source: H&HN Magazine
Date: 06/01/2009
Everybody needs to get in line. At least that might be the lesson one would take from a recent gathering of physician executives. A Chicago-area panel in March explored the standards of physician-hospital alignment, finding that the current structure was pretty well agreed upon to be in need of realignment. An article in June’s H&HN Magazine has the details.
The physician executive panel, convened by Health Forum in March of this year, examined the ways hospitals and doctors could collaborate to increase quality, safety, and overall performance. Findings from the panel varied from institution to institution, but all acknowledged some degree of difficulty in getting employed physicians to line up with larger improvement goals. Executives cited the lack of unified quality strategies, the increased use of hospitalists, and decreasing compensation rates as reasons for difficulty in securing physician cooperation. Among those noting successes, incentive plans, quality metrics, and quarterly report cards were noted as winning strategies for improving physician cooperation with larger goals.
The article notes that success in establishing and reporting performance metrics among physicians depends largely upon physician relationships with hospitals. Metrics and quality standards are generally viewed as encroachments upon physician autonomy and perhaps even deleterious to physician motivation. To counteract this effect, experts advise senior executive participation in quality training programs as a sort of good faith measure to demonstrate executive commitment to quality.
Additionally, it would appear a realignment of typical medical staff structures is necessary. Critics of the current structure cite its age, inflexibility, and unsuitability for the modern health care world. This, of course, is made difficult due to the uncertain state of the current efforts to remake American health care delivery. Until the dust settles from those efforts, it may be difficult to know exactly which staff alignment strategies will work best. Suffice it to say, though, the medical staff arrangement of the past fifty years is bound for change in the near future.
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The COO’s Leadership Role in Implementing Strategy
Source: H&HN Magazine
Date: 06/22/2009
Most agree that hospitals need to streamline operations and trim costs, and there’s no shortage of ideas as to how to do so; but how is it that good strategies are never implemented, or, worse, their implementation seems to result in increased operational complexities and costs? According to an article in H&HN Magazine, this is precisely where a hospital’s Chief Operations Officer needs to exert himself to pull an organization through the pitfalls of operational transitions.
Strategic planning sessions often come up with admirable strategic objectives which are then “implemented” to varying degrees of success. Sometimes these strategies never materialize in daily operations. At other times they’re implemented only on the smaller scale, with a select group of employees working on corporate initiatives while the majority of employees carry on as usual. This is due in part to the tendency for these objectives to lack measurable outcomes. In this case, the COO is the operative that must find out exactly what strategic goals are achievable and how. COOs must take the lead in implementing strategy and seeing it through to success, or face the blame for their failure.
If the formulas for running organizations worked as simply as advertised, anyone could do it. The truth is that these methods require effort by operations managers to turn the strategy into action. In order to do this, five essential steps must be taken:
-Establish clarity of key job roles and their impact on strategy.
-Identify key work processes and process redesigns reflecting new strategies.
-Identify the appropriate outcome and process metrics.
-Establish accountability throughout strategic planning implementation.
-Build organizational competency for project management. Everyone needs to know where they fit in the strategy and what their responsibilities are.
These processes may add costs to the project, but it is the COO’s role to build management infrastructure, accountability, and performance so that strategies can be turned into action. In short, it is the COO’s job to make sure managers are doing their jobs and conforming to organizational goals, thereby constraining costs in the long run. The COO must take over and succeed where broad, formulaic initiatives have failed; because if they didn’t work in the past, they surely won’t today or tomorrow.
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How to Communicate Effectively With Your Staff
Source: Urology Times
Date: 07/01/2009
Effective communication is essential to the functioning of perhaps everything. So how is it that so often failures to communicate introduce barriers to the smooth functioning of a practice? An article in Urology Times looks at the best ways to deliver your message to your staff and peers and be understood in the process.
Breakdowns in communications lead to breakdowns in operations. In medical practice, this can result in adversely affected patient outcomes. To avoid this, it’s advisable to follow a few simple steps.
-Don’t avoid conflict. Ignoring problems between staff won’t make them go away. Quite the contrary, it tends to make them worse, as negative feelings fester and compound themselves. If a staff member isn’t carrying his share of the load, and other workers see this, that spreads the negativity and lowers morale. Deal with small problems earlier to spare yourself having to deal with larger ones later.
-Think before you speak. The way you say things matters. If you approach a staff member in a combative manner, they’ll likely become defensive, and that accomplishes nothing. Be broad in your criticisms and specific in your praise.
-Be consistent. If you treat your administrative staff the same way you treat your nurses, you’ll likely find better work from all parties.
-Communicate often. Let people know when they’ve done something well. This increases confidence and strengthens unit ties.
-Offer simple recognition. If someone’s gone the extra mile, let them know you appreciate it. They’ll likely keep exceeding your expectations as a result.
Communication isn’t necessarily as easy as a list might make it sound, but if you work at it, you can succeed in communicating effectively. As a result, you’re likely to find a more harmoniously operating staff.
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Employment & Compensation
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Take the Family with You
Source: LocumLife
Date: 05/15/2009
The life of the locum tenens practitioner is already known to be full of travel, and practitioners always rate the ability to travel as a high-satisfaction aspect of the locum lifestyle. But could your next assignment become fun for the whole family? An article in LocumLife explores how to turn an assignment into a family getaway.
Bringing your family along with you on assignment can be very rewarding. The pressures of being in a new place can be alleviated by having familiar faces waiting for you at your home away from home. You can also take the opportunity to explore your new surroundings with your family.
In looking to bring your family with you, be sure to follow a few helpful hints:
-Plan ahead and see if you can pay for your family’s travel with frequent flier miles or an airline credit card. Money saved is money you can use to further enjoy your working vacation.
-Be sure to take in the sights. It’s both culturally rewarding and personally relaxing to engage in well-planned sight-seeing.
-Take in the local culture. Interact with residents wherever you can. They’ll know the best places to see, the cheapest places to eat, and the best times to visit these eateries. After all, they do live there.
Generally speaking, the locum tenens life means you travel alone a lot, but that doesn’t always have to be the case. Why not bring members of your family along on your next assignment and mix a little play with your work?
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Practical Guidance to Help You Understand and Plan for On-Call Coverage Payments
Source: Cataract Outsourcing
Date: 06/02/2009
For a number of reasons, the need for on-call physicians has increased greatly in the last several years. At the same time, a shortage of available staff has become apparent, and the cost of retaining on-call physicians has risen as well. This has resulted in the discontinuation of some lines of service in some institutions. An article in Cataract Outsourcing examines the trends with regard to on-call physicians, imparting some tips on how to pay them correctly.
The shortage of on-call staff arises from a number of factors, though chief among them are the general physician shortage and the aging of the U.S. population. The numbers work out so that there just aren’t enough doctors to serve America’s aging boomers. Added to that, young doctors avoid call time as best they can to achieve a healthy family-work balance.
In response to the difficulty in getting doctors to work call hours, a number of institutions have set up differing types of payment models for on-call hours. Some utilize stipends and hourly rates, while others have fee-for-service models. Still others provide payments for “excess call” or simply pay the physician’s malpractice insurance. Additionally, some organizations are finding success by hiring dedicated physicians for certain areas with high call hour needs, such as obstetricians and general surgeons. Still others are finding that locum tenens professionals are a valuable tool for filling the gap.
No matter the arrangement, regulatory boards have established that on-call coverage arrangements should reflect Fair Market Value for services rendered. Additionally, any per diems should be designed for the compensation of the call burden, and on-call physicians must provide continuing care to emergency patients regardless of their ability to pay. Finally, the medical center must be able to demonstrate that it does have a legitimate need for on-call coverage. Following these measures will ensure that on-call arrangements are at low risk for fraud and abuse.
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More Practices Refusing to Accept Credit Cards From Patients
Source: American Medical News
Date: 06/22/2009
As the burden of care is continually shifted from payers to patients, more and more practices are turning up their noses at the most popular form of payment: the credit card.
Since 2003, credit cards have been the most popular form of payment, passing paper checks. But a study conducted by SK&A Information Services has found that a third of physician practices do not accept credit cards. This is up five points from last year. The study, a telephone survey of 202,650 physician offices, found that credit card acceptance seems to be linked to its reliance upon patient self-pay. Among different specialties, plastic surgery (91%) had the highest rate of acceptance, while pathology (21%) had the lowest.
Physicians tend to shy away from credit card payments due to the extra cash banks skim off transactions. When a purchase is made with a credit card, banks tend to take about three or four percent off the top of every payment in fees. Additionally, there is a significant start-up cost in installing the necessary machinery. A number of bills have been presented before Congress to address the issue, but none has the full support of the merchant market.
Some, though, contend that the convenience of credit card transactions more than outweighs the cost of the transactions. Practice management consultants advise accepting credit cards, as their transaction costs are little compared to the costs of issuing paper statements, dealing with bounced checks, and any number of other hassles arising from non-credit card collections. Paying a few dollars in order to get a $45 co-pay up front might not seem so bad compared to trying to get a patient to pay up a month after the fact.
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AMA Fight for Medical Liability Reforms Continues
Source: Physicians News Digest
Date: 06/08/2009
While the debate over health care reform in America consistently grabs headlines across the nation, no real progress on the issue can be made without addressing the issue of medical liability reform. So says an article in Physicians News Digest, arguing that sizable alterations in the way the nation handles malpractice law are necessary to address the root causes of the explosion of health care costs in this country.
Medical malpractice lawsuits are proposed to be the root cause behind much of what ails the American health care system. Medical liability leads to defensive medicine, unnecessary procedures, and other ills. Some reports estimate the impact of defensive medicine to be between $70 and $126 billion per year. Reforming the liability system would free up physicians to practice with less fear of litigation.
The AMA’s argument for liability reform hinges on alternative dispute resolution and health courts. Alternative dispute resolutions, their proponents claim, would lead to more efficient functioning of medical litigation. Meritless claims would be identified and disposed of, and patients would see more of the money from victorious claims. Health courts would ensure that medical liability claims are heard by members of the judiciary with some actual knowledge of the topic at hand.
These sorts of reforms are not long shots, as California and Texas have already enacted reforms in medical liability law. Additionally, the Obama administration has signaled openness to liability reform as part of its health care reform initiative.
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Doctors Group Sues Health Alliance
Source: Cincinnati.com
Date: 06/04/2009
Troubled provider group Health Alliance of Greater Cincinnati encountered additional problems recently in the form of a lawsuit from a group of doctors alleging the group has not lived up to its side of a buyout agreement.
Two years ago, Greater Cincinnati Associated Physicians–which reported 2006 revenues of $12.9 million–was sold to the Health Alliance of Greater Cincinnati for more than $15 million dollars. Under the terms of the sale, Health Alliance was to pay a $100,000 signing bonus to each of the 28 doctors affiliated with the practice. The doctors allege that these payments have yet to be made.
Additionally, the physicians claim retaliation on the part of Health Alliance by sending incompetent support staff to their offices as well as nonpayment of bills and withholding of administrative assistance as required by the terms of the sale. The physicians’ suit claims that this has resulted in an inability of the physicians to maintain an appropriate standard of care for their clientele. The doctors seek termination of the sale and prevention of Health Alliance from further retaliation in addition to monetary damages and attorney fees.
For its part, representatives for Health Alliance–which has seen Christ hospital and two St. Luke Hospitals in northern Kentucky leave the group–claim the doctors have not adhered to the terms of the agreement, calling the allegations invalid.
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Doctor Gets Jail Time for Online, Out-of-State Prescribing
Source: American Medical News
Date: 06/01/2009
A Colorado physician has been sentenced to nine months in jail for prescribing an antidepressant to a California teenager over the Internet. The case, some say, could have ramifications for e-prescribing across the nation.
The case centers around a Fort Collins, CO, physician charged with a single felony count of practicing medicine without a valid California license. The physician prescribed the antidepressant fluoxetine to a California teenager without an in-person evaluation. The teenager later committed suicide, though subsequent investigations determined that the drug had nothing to do with the suicide.
The case is unique in that justices in an appellate court allowed authorities to cross state lines to prosecute charges against the physician, arguing that he could reasonably foresee the results of his practicing without a California medical license.
The physician’s attorney claims this is a troubling precedent that calls into question the validity of e-prescribing across the nation, as physicians would under the ruling be required to be licensed in all fifty states to avoid any possibility of prosecution. California authorities counter that there are already measures in place to allow out-of-state doctors to prescribe, but the physician did not follow them in this case.
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Sometimes a Placebo Is the Way to Go
Source: Medical Economics
Date: 06/19/2009
Maybe the patient is a hypochondriac; maybe the patient’s symptoms will go away on their own and he just needs something for peace of mind; or maybe the patient is just demanding the newest pill advertised by TV commercials every ten minutes. No matter the cause, many physicians at some point find themselves prescribing placebos. But what are the ethical implications of such a prescription, and how do you protect yourself from any possible legal actions? An article in Medical Economics examines the ins and outs of placebo prescribing.
According to a recent survey published in the British Medical Journal, about half of American doctors report regularly giving patients placebo treatments. Most of these do not inform the patient that they are being given a treatment–usually an analgesic or vitamin–that will not actually help their condition. Further, sixty percent of survey respondents indicated willingness to prescribe sugar pills for patients experiencing chronic pain if the placebo effect were shown to be more effective than no treatment.
The issue with placebos arises largely from what to tell a patient. Nearly seven in ten doctors in the study said they told patients the placebo was “a potentially beneficial medicine” not typically prescribed in their situations. Herein, of course, arise some legal and ethical concerns. It is generally advised that patients be made fully aware of treatments, and state laws hold that physicians are responsible for giving patients sufficient information about treatments to make informed decisions. But telling a patient he is being given a placebo runs the risk of negating the placebo effect.
A way around this is for physicians to fully document the reasons why a patient is being given a placebo. If information might damage a patient, physicians are not–in some states–required to tell a patient. As such, fully detailing why in your judgment this is the best course of action for a patient is a solid course of action if you feel the need to prescribe a placebo. Additionally, written documentation is essential in the case of legal action.
Despite the possible pitfalls, placebo prescribing still has its place in practice. Given the current legal climate, though, physicians would be well served to be certain they are consistently offering the best prescribing care and maintain detailed records where placebos are used.
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No Relief: Shortage Keeps Older Docs on the Job
Source: MSNBC
Date: 06/24/2009
It’s common knowledge by now that the United States is on the verge of a physician shortage. With the country forecast to be short anywhere between 85,000 and 200,000 doctors by 2017, everyone from the government to medical schools to hospitals is trying to head off the coming shortfall of physicians. At least one group of doctors is doing their part also, as older doctors are staying on the job to serve their communities, even into their seventies and eighties. According to some estimates, these doctors constitute about two percent of the primary care physicians currently operating, but they provide an indispensable service to afflicted communities.
As health care reform measures are intended to shore up the insurance system in this country, their potential success threatens to flood the health care provision workplace with even more patients. Younger doctors are tending to opt for specialty practices which allow for greater compensation as well as more flexible work loads and hours. Specialty physicians can make nearly three times as much as primary care physicians while not seeing nearly as many patients. Additionally, primary care compensation rates under Medicare are lower than for specialties. As a result, the number of medical graduates going into primary care fell by half between 1997 and 2005.
Experts estimate that the US will need forty to fifty percent more family practice doctors than it currently has to avoid crisis. Among those primary care doctors serving, at least 4,500 are older than 75. And the numbers do not look to improve. The distribution of primary care physicians by age is strongly skewed toward older clinicians. Over half are over the age of 45, and those under 45 do not appear to constitute nearly enough of a replacement for their older counterparts.
While legislators and health care organizations ponder realignments and incentives to increase primary care rolls, rural communities–where there are sometimes only 80 physicians per 100,000 people–suffer especially hard, as they have a tougher time attracting doctors in an already diminished field. As the solution is worked out, though, a cadre of seasoned practitioners remains in the field into their eighties, unwilling to abandon their patients, but waiting for some economic relief.
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Database Takes Patients for Billions, Study Finds
Source: New York Times
Date: 06/24/2009
Two-thirds of the nation’s health insurance industry has made use of a faulty database, resulting in overcharges for American patients amounting to billions of dollars.
Congressional investigators charge that UnitedHealth Group subsidiary Ingenix maintained a faulty database that they say allowed insurance companies to deliberately skew data, resulting in underestimations of the cost of medical services. The resultant underpayments to physicians, they say, pushed the burden for compensation unnecessarily onto consumers.
The investigation’s findings dovetail with a separate and continuing investigation by New York attorney general Andrew Cuomo, which focused on Ingenix data use by only a few larger payers. Among these were Aetna, Wellpoint, and Cigna, which, along with nine other companies, have already reached settlements with the state of New York. The congressional finding, however, implicates twenty regional and national insurance companies in use of the flawed information.
UnitedHealth, for its part, admits no wrongdoing with regard to Ingenix, and has agreed to close the database and partially finance the generation of a new one to be operated by an unaffiliated nonprofit group. Additionally, UnitedHealth has agreed to pay $350 million as a settlement for charges of deliberate manipulation of pay rates to underpay doctors.
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Family-Centered ICU Care Satisfies Patients, Loved Ones and Providers
Source: Sg2 Health Care Intelligence
Date: 06/08/2009
Health care provision continually becomes more and more consumer-centered. That means a greater focus on patient satisfaction and patient experience in more and more areas of practice. The latest department to begin to feel the push toward the patient experience? The Intensive Care Unit.
ICUs are typically very patient-centered, as the patients treated there are in the most precarious of situations. With the growing influence of patient satisfaction as a predictor of return patients and business, ICUs are increasingly having to take steps to make the experience of the patient’s family a remarkable one as well. This is because the patient is usually unable to make his voice heard, whereas hospital staff interact daily with large numbers of family members.
In ensuring family-friendly operations in the ICU, it is advisable to look to improve five key areas of care:
-Communication and decision making. Regular communication between ICU staff and a patient’s family is essential for management of conflicts and addressing the patient’s family’s questions.
-Visiting hours. A major point of contention, and one on which hospital staff should be willing to give a little, is the amount of time that loved ones can visit patients in the ICU.
-Family presence during procedures. While physicians may feel they are “performing” in front of an “audience,” the ability to watch procedures as they are happening gives families much more confidence in the practice.
-Family presence during rounds. While family presence during rounds allows the family to directly ask questions, it is likely more effective to have them save their questions until after rounds.
-Family environment care. It is advisable to make the family’s stay as comfortable as possible. Some institutions have built family waiting rooms, in which there are televisions and wifi signals.
While adopting family-friendly policies in the ICU might seem a difficult task, it is really just in keeping with the general trend in medicine toward more patient-centered operations. Studies have shown that techniques similar to those mentioned here have had notable results in engendering greater patient satisfaction with service.
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FPs Can Apply for NHSC Loan Repayment Funds Now
Source: AAFP News Now
Date: 06/02/2009
New family physicians looking for some help with their educational loans now have a new opportunity...so long as they’re willing to perform some service in return.
On June 2, $300 million was allocated to the National Health Service Corps. Of that, $200 million is slated for the NHSC Loan Repayment Program. Physicians can now apply for loan repayment funds in exchange for service.
Recipients will be required to perform two years of service at a federally designated health professional shortage area. The loan repayment program offers to meet up to $50,000 for primary care physicians including osteopathic and allopathic physicians, so long as they perform two years of full-time clinical service at one of the sites. If they decide to stay on longer, additional repayment options are available.
The NHSC LRP program will include more than 7,000 sites, with more to be approved. Primary care physicians need not be employed at a site at the time of application, and administrators promise quick processing of applications.
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Payer & Reimbursement Issues
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HHS Rescinds Medicaid Regulations
Source: CMS Office of Public Affairs
Date: 06/29/2009
According to a recent announcement by HHS Secretary Kathleen Sebelius, three Medicaid regulations opposed by hospital administrations have been rescinded in part or in entirety, and a fourth will have its enforcement delayed.
The rules had previously met with resistance from hospitals, which claimed the rules would result in slashed funding for them. The rules were previously subject to congressional moratoria set to expire on July 1, 2009. In rescinding them, HHS Secretary Sebelius claimed that the rules could have adverse effects on children’s access to health care. Going further, Sebelius indicated a belief that the rescinding of the rules would allow for greater flexibility for states to serve Medicaid-eligible individuals. The rescinded rules are as follows:
-A final rule, published December 28, 2007, eliminating reimbursement for school-based administrative costs, including transportation costs, rescinded due to possible budgetary impact on schools offering Medicaid services as well as limiting their ability to offer Medicaid services.
-A November 7, 2008 rule limiting outpatient hospital and clinic service for Medicaid beneficiaries to outpatient hospital service. CMS determined that this would have a greater impact than previously thought.
-An interim final rule published December 4, 2007 had provisions rescinded restricting beneficiary access to case management services.
Additionally, a rule clarifying limitations on health care related tax programs has been delayed until June 30, 2010 so that CMS may review its impact in greater focus.
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Indiana Patients to Get Reminder: Pay Your Doctors
Source: American Medical News
Date: 06/04/2009
Indiana physicians looking to receive payment from patients will soon receive help from an unlikely sector: the Indiana state legislature and payers themselves.
A new law requires insurers to include a notice alerting patients receiving reimbursements for out-of-network care that they should use that money to pay their physicians. The law requires that the notice be included with any direct payments to patients to cover out-of-network claims.
Initially, State Medical Association representatives had hoped for the inclusion of a requirement for payers to honor assignment of benefits for out-of-network physicians, but this measure did not make it into the final bill. The new law will take effect after September 30, 2009.
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Credentialing, Licensure, Quality Management
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From NALTO: Risk Management for Locum Tenens Practitioners
Source: LocumLife
Date: 06/15/2009
A well-known perk of the locum life is the lack of having to deal with liability insurance and its assorted costs and hassles. It is common practice for locum tenens agencies to pick up the tab for practitioners’ insurance, but if you find yourself considering practice as a temporary physician, you’d do well to take a closer look at insurance. A recent article in LocumLife takes a look at some things you’ll want to keep an eye on regarding medical malpractice coverage.
Coverage for temporary physicians tends to come in two varieties: claims-made and occurrence coverage. “Claims-made” provides coverage for claims reported while a policy is in force, while “occurrence” covers physicians for life for claims reported during the policy’s coverage. Though most agencies offer claims-made, both types are suitable, presuming a reputable agency. A reputable agency will cover you under its group policy at a limit meeting the minimum state and hospital requirements for your assignment. Since the agency handles the paperwork, you’ll want a copy of the certificate of insurance for your personal files, as this will help you apply for licenses and medical staff privileges in later assignments.
No matter your coverage levels, it is best to exercise a good deal of caution in operating in a new clinical setting. It is advisable to seek out orientation from staff upon arrival to familiarize yourself with your new environment. Make sure to take care in ordering tests and procedures, and document everything. Go the extra mile or two in patient dealings and exercise caution in practicing in the new clinical setting. You are, in fact, watching out for yourself and making sure that agency-purchased insurance will not need to be used. If you’ve entered what you perceive to be a less than quality organization, notify your agency recruiter immediately. Additionally, report any untoward events immediately. It is best in a locum tenens engagement to utilize an ounce of prevention to avoid headaches later.
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The Time to Start Participating in the PQRI Is Now
Source: Urology Times
Date: 06/01/2009
The Centers for Medicare & Medicaid Services has recently been pushing harder for adoption of their Physician Quality Reporting Initiative. While reports of lack of payment for participation have occurred, an article in Urology Times claims that it is best for physicians to sign up for the program now, if only so as not to have to deal with it later.
The Physician Quality Reporting Initiative (PQRI) rewards participation by physicians with payments of up to 2% of all Medicare-allowable payments for the time they participate. Funding for the initiative was extended as part of the Medicare Improvements for Patients and Providers Act of 2008, which blocked conversion factor decreases for 2009 with the expectation that physicians would participate in PQRI.
Participation in PQRI is advisable for physicians for a number of reasons. First, physicians may participate without fear of an audit. If one makes a mistake in one’s reporting, there is no penalty. Additionally, participation is relatively easy, as most practices already do what Medicare is requesting, and the only additional step is reporting it to the agency. Finally, participation is advisable because this is the near-irreversible trend of the future. Private payer behaviors tend to follow Medicare over time, and adoption now can help your practice get a leg up on what’s coming.
In adopting PQRI, the authors advise checking whether Medicare receives your PQRI codes by reviewing your explanations of benefits. A charge of $0.01 or $0.00 should result in Medicare denying your claim. If you receive no denial from Medicare, Medicare is not receiving your claims, and you should straighten this out with your practice management system vendor. If you have electronic health records, it is advisable to see if your vendor offers any templates built to PQRI specifications.
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Can We Get Around Rationing When It Comes to Comparative Effectiveness Research?
Source: HealthLeaders Media
Date: 06/11/2009
The term “Comparative effectiveness research” has become a double-edged sword of late. Proponents of health care reform via government initiatives claim it will increase efficiencies, eliminating the use of outdated treatments and resulting in overall improved patient outcomes. Critics counter that it is bound to end in health care rationing.
A recent Brookings Institution symposium on implementing comparative effectiveness research hit upon the central concern of critics of comparative effectiveness research. Attendants held court on whether or not the research measures would lead to health care rationing. In what could be considered a bit of a rhetorical shell game, proponents proposed calling it “patient-centered outcomes research.”
The symposium brought together a number of influential figures in the health care reform debate. Critics of the research raised questions on how the policy would influence the delivery of treatments as well as prioritizing long-term versus short-term gains. Additionally, concerns were raised over whether the research would limit innovation. Proponents countered that measures would be undertaken to ensure a patient-centered program that brought physicians to the table in discussions and created safeguards to ensure physician flexibility in practice.
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Many Hospitals Cut Back on Infection-Control Efforts
Source: American Medical News
Date: 06/22/2009
Could the economic impact of the recession lead to sicker patients overall? If the Association for Professionals in Infection Control & Epidemiology is correct, that might very well be the case. The Association contends that the recession is causing hospitals to cut back in an area that must remain adequately funded: infection control.
It is estimated that hospital-associated infections add $20 billion to the nation’s health care costs yearly, killing an estimated 100,000 people. Multidrug-resistant organisms are a serious threat in hospitals. This threat is made all the worse by the recent financial impact on the health care sector. As a result of the recession, hospitals are cutting budgets wherever possible, including infection control.
Forty percent of infection control professionals report staffing or resource cuts in the last eighteen months. Among those reporting budget cuts, three out of four saw funding for educational efforts reduced, while more than half said overall budgets were reduced. Almost 40% report that cutbacks have reduced departmental ability to focus on infection prevention.
Infection prevention professionals contend that the budget cuts to their departments are shortsighted efforts on the part of hospital administrators and that the money saved from preventing a small number of hospital-acquired infections far exceeds the money saved by reducing infection prevention budgets. A number of additional studies back up this suggestion, with some putting the cost of care for methicillin-resistant Staphylococcus aureus at 40% higher than for a similar infection susceptible to antibiotics.
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University of Houston Team Working on Home Patient Monitoring Technology
Source: Healthcare IT News
Date: 06/29/2009
Could your Blackberry help you remotely monitor a troublesome, wandering, or critically ill patient? If a team of University of Houston researchers has their say, that might well be the future of patient monitoring.
A team of researchers at the University of Houston’s College of Technology, in partnership with the Methodist Hospital Research Institute, has developed a new wireless health-monitoring system. The system is built from off-the-shelf technology, meaning it could be installed throughout a home for around $1,000.
Patients are monitored through the use of sensors, which they wear in areas specific to the reasons they are being monitored. Thus, a dementia patient at risk for flight would wear a sensor on, say, an item of clothing. A person whose vital signs are being monitored, then, would wear a sensor on his skin. The sensors communicate with the installed health-monitoring system, which is connected to the Internet and just a push notification away from a caregiver’s smartphone or PDA. The system is designed to be simple and thus easily installed by caregivers.
The designers contend that this sort of system will relieve medical providers of some of the burden of care. It is believed that, with the monitoring system in place, unnecessary checkups will be eliminated, allowing practitioners to continue serving other patients and improving the quality of care by alerting providers when there is a problem.
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Small Hospitals at a Crossroads
Source: Trustee Magazine
Date: 06/01/2009
In the late 1990s, administrators at a small Wisconsin hospital decided to have their institution take a sizable leap forward technologically. Ten years later, while administrators at similar and larger hospitals are struggling to adopt EHRs in a rapid fashion, this hospital is ahead of the curve, with all clinical notes, lab work, and prescription details entered through a computerized system. It may be a bit late to get ahead of the curve, but small hospitals still have a big choice to make when it comes to health care IT adoption. An article in Trustee Magazine examines the pitfalls and rewards awaiting hospital administrators looking to upgrade their IT infrastructure.
Small hospitals, by definition, have lower budgets and fewer staff and sometimes face resistance from staff reluctant to adopt new technology standards. Nonetheless, the question, according to Trustee Magazine, is not whether to make the technological leap, but when. In deciding, small hospital trustees should be sure to assess the risks of not making the upgrade. Penalties in the form of lowered Medicare payments will begin to be assessed for noncompliant hospitals beginning in 2015.
The switch is a bit easier said than done, though. A North Dakota survey of rural hospitals found that 35 out of 37 employed three or fewer IT staffers, with seven not employing any at all. In looking to get funding for IT, the article recommends looking first to state and local health agencies for grants or other funds. It may also be advisable to upgrade in stages, though this is an option with a closing window of opportunity, as Medicare adoption deadlines are imminent. It’s also advisable for board members to take an active role in explaining the EHR upgrade process to community members, detailing the costs to the institution if they do not upgrade as well as informing them of the likely benefits. The technological leap is not easy, but it is necessary. The right attitude, combined with cooperation and steady guidance from the hospital leadership, will result in as smooth a transition as possible.
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Physician Practice Management
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Dissolving a Practice Takes More Than Closing the Door
Source: American Medical News
Date: 06/15/2009
All good things must come to an end; but if the good thing is your practice, you need to be sure you’ve covered all bases before shutting the doors that one last time. An article from American Medical News lays out some things to be aware of when dissolving a practice.
Practice dissolutions tend to have two major areas of concern: patients and practice assets. With regard to patients, their welfare should be a primary concern in dissolving the practice. Safekeeping of patient medical records is the responsibility of the medical staff. Additionally, it is common for states to have laws mandating notification of practice closure for patients, typically sixty days in advance. These notices should be in the form of a letter stating when the practice will be closing, where patient records will be stored, and how records can be transferred to other physicians. Additionally, you may be required to retain patient medical records, though it is best to consult your state’s laws when determining this.
As for divvying up practice assets, much of the work may already be covered under practice contracts. But, if not, something will have to be done with the exam tables and equipment and all the other physical aspects of a practice. Arrangements should be made to pass on possession of physical aspects or to sell them off. With regard to accounts receivable, post-dissolution collections should be hashed out among partners before dissolution. The practice bank account should remain open until the settlement or write-off of all accounts occurs.
Beyond these issues, dissolving partners will want to make sure that property and equipment leases, maintenance contracts, and all sorts of employee and service agreements have been properly settled before parting ways. It is a good idea to consult your state’s laws regarding these and other facets of practice administration. These sorts of things do not go quickly, but with diligent application, you’ll find this business done before you know it.
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How to Talk to Your Patients about Health and Wellness
Source: Medical Economics
Date: 06/05/2009
A recent study found a marked improvement in the health, activity, and cholesterol levels of patients who were coached in health and wellness versus a control group who received solely standard checkups. What’s more, with wellness being one of the buzzwords of the effort to reform the American health system, much in the way of funding is available for physicians who emphasize prevention and wellness for patients. So how do you talk to your patients about wellness as a concept? An article in Medical Economics details some tips.
First, physicians need to be more than informers; they need to be motivators of wellness. Practice motivational interviewing with patients. Motivational interviewing is a manner of engaging patients by involving them in the creation of their own management plans. Patients making their own plans are more likely to stick to them. When something goes wrong, talk it over with them. When things are going right, encourage them to continue to do what will contribute to their health.
Next, develop a wellness system. Wellness should be valued throughout your practice. Patient habits that adversely contribute to wellness should be recognized by staff during a visit, and efforts should be made at all ends to nudge patients toward wellness-enhancing behaviors. Ensure that patients have your full attention and do not rush them through interviews and checkups, as this makes them more likely to take their own wellness seriously.
Following these hints will help you integrate wellness into your practice style. When billing, be sure to file the correct codes for reimbursement. CPT codes 99401-99412 cover much that would be classified as wellness instruction. Also, be certain to adhere to limitations on these codes.
Properly executed, an emphasis on wellness can result in improved patient outcomes, better word of mouth for your practice, and more referrals; all of which can positively impact your bottom line.
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Is Your Practice Insured Against Employee Theft?
Source: Physicians News Digest
Date: 06/05/2009
Over the course of ten years, the business manager of an ophthalmology office stole $783,000 from the practice, caught only when the practice’s bank noticed irregularities in their accounts. Could the same thing happen to your practice? If so, would you be prepared and able to absorb or deflect the monetary damages? An article in Physicians News Digest explores your options with regard to insuring yourself against employee theft.
Employee theft is something practices tend not to think about in a monetary sense. Many presume they are covered against thieving employees so long as they maintain stock of their prescription closet. Even if you’ve screened your employees, it is still a good idea to invest in Employee Dishonesty Coverage. This coverage protects employers from economic damages resulting from employee theft of funds. This is coverage that generally is not included in standard malpractice insurance.
When Employee Dishonesty Coverage is purchased, the issuer will typically give recommendations for loss control, thereby helping the insured to prevent theft in the first place. These measures often include internal controls such as tightened checks and balances and greater oversight. Additionally, the insurer may recommend separation of duties, so as to keep one person from having too much control over a practice’s finances. Upon becoming insured, the practice will be subject to a number of regulations. Most companies will have a notification clause, under which you are required to notify the insurer of theft within a certain time frame. Other similar clauses will likely be present in any contract. It is best to honor them, as you can be sure the insurance company will.
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Stop Bounced Checks
Source: Physicians Practice
Date: 06/01/2009
Your practice is dedicated to cutting expenses and getting the most out of your reimbursements, but employers and payers are increasingly pushing the burden of payment onto patients; so more and more of your bottom line is dependent on how well you collect payment from patients. So how do you make sure you’re getting payment from increasingly financially stressed patients? An article in Physicians Practice takes a look at how to avoid bounced checks and the sizable financial impact that they can have on your practice.
The bad check cycle goes something like the following. Your practice gets a check and deposits it. Your bank sends the check to a clearinghouse, which then sends the check to the patient’s bank. If the funds aren’t there, the check is bounced back. If this happens once more, the check comes back to you and your practice is responsible for collection. To avoid this, it is best not to accept post-dated checks and to have clearly communicated collection policies for patients and staff. Additionally, the use of electronic check services is recommended. A number of options are available with this route:
-Check conversion/e-deposits. These allow you to treat a check like a debit or credit card, allowing for quicker processing and less likelihood of a bounced check.
-Check guarantees. This pushes collection responsibility from your practice to a check processing company. In the event of a bad check, your practice is paid and the processing company takes action against the check writer.
-Check verification. This functions as a sort of watch list for bad check writers. Patients with a history of bad checks are flagged and your likelihood of accepting a bad check is decreased.
While these services may entail additional costs for your practice, they are likely to pay for themselves in avoided fees if your practice runs across a lot of bad checks.
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How Doctors Can Spot Lies or Head Them Off
Source: Los Angeles Times
Date: 06/08/2009
The patient says he’s been taking his meds like he’s supposed to, but his symptoms say he’s been skipping at least a few. Do you call him a liar? And why is he lying in the first place? An article in the Los Angeles Times examines how doctors can spot lies and how to keep patients from lying in the first place.
It’s generally agreed that the doctor-patient relationship shouldn’t be “don’t ask, don’t tell.” Doctors need to ask about sensitive topics and they need to trust that their patients are being truthful in answering. To help identify a fibbing patient, experts recommend looking for micro-expressions, fleeting reactions that flash across the face when someone is telling something other than the truth or concealing emotions. A number of resources are available to teach physicians how to recognize the micro-expression signals of lying, including a site run by the professor who is the inspiration for Fox’s “Lie to Me” series. Experts contend that anyone can learn these signals within an hour or so.
But better than calling your patient a liar and teasing out the truth is just getting the truth the first time. That, experts contend, requires a healthy rapport with a patient. Patients must be comfortable telling their doctors the truth. That requires encouragement from doctors in the form of asking the right questions at the right time. Experts recommend approaching questions in an open, positive phrasing. Instead of castigating a patient for not taking medication, find a positive aspect of whatever they have told you and use that to build toward encouraging them to follow their medical schedule. Approaches such as this can improve the doctor-patient relationship, cutting down on the need to keep an eye on their “tells” rather than their symptoms.
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