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By J&C Research Associates
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Career Satisfaction: Looking Inward and Outward
What gives physicians the greatest career satisfaction? Practicing medicine in a
specialty that matches their personality make-up is one important facet of
career satisfaction. In this month’s edition, we showcase the results of our
Extended DISC survey offered to physicians in major medical specialties. The
results discuss the association of key personality traits with doctors working
in similar medical fields. We will continue this fascinating analysis in coming
months. Specifically, we will focus on the benefits of hospital administrators’
using the DISC results to acquire a better understanding of how personality
traits linked with medical specialties provide important insights related to
physician recruitment and retention.
On a personal level, some physicians have
experienced tremendous professional satisfaction in “looking outside” their own
world of professional involvement and contributing their medical skills in a
charitable, humanitarian way.
This month we feature a Special Report entitled
“Medical Missions—Challenges and Rewards” that discusses the growing interest
that an increasing number of locum tenens physicians have in volunteering their
clinical expertise to treat patients in medically underserved areas. Coupled
with this is a first-person account of a Jackson & Coker executive who
participated in two medical missions to Honduras sponsored by Jackson Healthcare
Charities and Predisan, a Christian organization that provides faith-based
medical care to residents of Honduras.
In the words of Ed McEachern, “I feel as
individuals we all gained more than we gave to Hondurans who appreciated the
visits by our medical brigade in November and April.” His fascinating story will
inspire any clinician who has considered volunteer medical service.
If you’re
interested in volunteering your service or otherwise contributing to this
humanitarian effort, you can obtain more information at these websites:
www.predisan.org or www.medicalmissions.org. Cordially,
Calvin Bruce
Managing Editor
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Jackson & Coker is committed to caring for the medically underserved by helping promote volunteer opportunities for physicians, CRNAs, and other health professionals. Assisting Jackson Healthcare Charities, J&C sponsors “medical brigades” to Honduras to perform surgeries and dispense critical medical care to residents of all ages. Future medical missions will take the team of volunteers back to Honduras, to China and possibly other areas around the globe.
These volunteer opportunities are open to medical practitioners of all personal faiths who can commit at least one week of time and service. Our staff will coordinate travel and other details of each trip.
A first-person account of a recent medical brigade can be found here. For more information concerning medical volunteerism, log on to www.predisan.org or www.medicalmissions.org, or phone Ed McEachern at 800-272-2707, ext. 3030. | |
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Readers’ Forum: Discussions in Healthcare
There are many timely issues related to the health care industry. In addition to
the topics covered in our regular newsletter content, a new feature will address
important matters in a reader-interactive format. We invite you to participate
regularly in our Readers’ Forum and voice your views on lively discussion topics
such as “Revamping the Health Care System.” We welcome suggestions of topics
that would enhance our ongoing discussions and appeal to a broad segment of the
health care community.
Award-winning Hospital Reduces Annual Staffing Costs by $10 Million
Source: Healthcare Finance News
Date: 04/03/2009
The private, non-profit Southwest General Health Center in Middleburg Heights, Ohio is a 354-bed facility with over 2,500 employees. In 2007, the Center’s administrators found they were exceeding their budget for total labor costs and adopted workforce management software and labor analytics tools. By the end of 2008, the hospital had saved $10 million in labor costs.
The Emergency Department by itself was running $25,000 over each pay period, but analyses showed that using patient volume data to guide ED staffing had created a gap between actual staffing costs and budgeted costs. By bringing the two into alignment, over-scheduling and more accurate budgeting was possible.
Managing finite labor is hard in an intense environment—hospitals need to be able to match labor sources to workloads in an efficient way. By standardizing metrics, providing clear and actionable information, and guiding executive leadership to manage personnel, the software helped Southwest lower its salary composition from 39% of revenue in 2005 to 35% in 2008. The hospital was named by HealthGrades as one of the 2009 “America’s Best 100 Hospitals” for the third year in a row and cited by Thomson Reuters as a 100 Top Hospital and 100 Top Cardiovascular Hospital. The facility has won accolades for its ability to deliver quality care at a low cost.
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Shortage of Doctors an Obstacle to Obama Goals
Source: New York Times
Date: 04/26/2009
President Obama campaigned on the promise of change in numerous aspects of American life, including the health care arena. The new president has, in his first few months in office, put forward sizeable initiatives regarding the remaking of the American health care system, but these proposals are running up against the reality of the modern American health care market. An article in The New York Times explores the difficulties facing those who would remake America’s health care system, explaining how the results may not turn out to be exactly what the administration was hoping for in determining legislative priorities.
Some sizeable obstacles to the president’s agenda arise from the physician shortage that currently exists in the health care workplace and is expected to worsen in the coming years. Obama’s agenda centers on extending health care coverage to a large portion of the 47 million Americans who currently lack it, while at the same time working to bring down health care costs. Part of the plan hinges on cost-saving measures yielded from prevention of serious conditions through greater access to primary care physicians. This, however, is undercut by a shortage of primary care physicians in both the current market and in training.
Additionally, proposals to increase Medicare payments to primary care providers—presumably with the goal of enticing more to take up primary care—have touched off fights in Congress, as specialist groups contend that such measures will invariably result in fewer payments going to specialists.
The administration claims it has plans to increase enrollments in medical schools and residency training programs and will encourage the use of nurse practitioners and other physician extenders, though even these plans could have the unintended consequence of driving up the costs of health care while at the same time making care more accessible.
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Recession Now Hits Jobs in Health Care
Source: The Wall Street Journal
Date: 04/12/2009
Think employment in health care is a sure bet? Think again. Recent U.S. Department of Labor figures have shown that the health care sector has been experiencing weaker job growth since the recession began in December 2007 – an unusual trend for the sector given that job growth in the health care industry has outpaced all other sectors since 1990.
A number of hospitals have taken severe hits from the economic downtown, as fewer people go without health insurance or elective procedures, and states cut budgets. According to government sources, in February 2009, the number of layoffs for hospitals was double what it was in 2008. Health insurers and pharmaceutical companies have also been adversely affected. To give a general picture of the employment situation in health care, here are a couple of recent examples:
-Beth Israel Deaconess Medical Center in Boston, MA has announced 140 job cuts, salary freezes, and reductions in vacation allowances and retirement contributions.
-Heritage Hospital in Tarboro, NC has asked staff to voluntarily reduce hours.
-The Mayo Clinic in Rochester, MN has frozen salaries for doctors and senior administrators, reduced travel and overtime expenses, and reduced temporary staff.
-Johnson & Johnson is planning to lay off 900 employees.
According to the article, the downturn in employment in health care is a “temporary break in the industry pattern.” Optimists suggest that employment in the industry will pick up once the recession ends and that health care will once again be a fundamental part in fueling the U.S. economy. One can only hope that will be the case.
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Institute of Medicine Calls for Doctors to Stop Taking Gifts from Drug Makers
Source: New York Times
Date: 04/28/2009
Doctors receive too much in the way of money, gifts and free drug samples from pharmaceutical companies and this constitutes a grave conflict of interest—this according to a recent report put out by the National Academy of Sciences’ Institute of Medicine.
The report, which calls on Congress to require that drug makers publicly report all payments made to doctors, echoes many of the findings of a similar report released last year by the Association of American Medical Colleges. The report offers an indictment of the most common methods of interaction between doctors, medical schools, hospitals, and drug makers. The report claims that these contacts create conflicts of interest, threatening institutional integrity as well as the public trust.
By way of free drug samples, free food, free medical refresher courses, and payments for marketing lectures, drug companies disperse billions of dollars in pursuit of doctors. A 2007 study found three quarters of doctors accepting such goods and services from drug makers. As a solution, the report recommends, among other actions, ending industry influence over continuing medical education courses. Administrators in medical schools contend that subsidies for such courses are necessary to keep doctors apace of the latest medical developments, though a number of institutions, including the American Psychiatric Association, have indicated intentions to phase out industry financing for refresher courses.
The report cuts to the heart of the issue of drug makers’ influence in patient care. Experts contend that medical centers and companies will likely heed the recommendations and implement them.
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Bill Would Expand Rural Physician Tax Credit
Source: WTVY (Dothan, AL)
Date: 03/20/2009
Legislation supported by the Alabama Rural Action Commission (ARAC) would expand current incentives for physicians to begin practicing in rural Alabama. The legislation phases in an increase in the rural physician income tax credit from a maximum of $5,000 annually to a maximum of $8,000 annually by 2012. The bill also phases in an increase in the number of years that a physician can claim the tax credit from five years to eight years over the same three-year period.
According to the article, many of Alabama’s most rural areas have a severe shortage of physicians. Gerald Dial, Executive Director of ARAC, is quoted as saying, “We all understand that our citizens need to be healthy in order to be able to reach their full potential. Physicians are a vital part of any rural community and this bill is a much needed, common sense step to improving the health and quality of life in rural Alabama.”
An ARAC-led health committee recommended legislation increasing the rural physician tax credit to help Alabama be more competitive with other states in recruiting and retaining physicians and to reduce the challenges that rural communities face with physician recruitment.
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Study: Doc’s Decisions Drive Health Costs
Source: Medical Economics
Date: 04/17/2009
From all corners, one hears tell of the rising cost of health care. Equally from all corners, one hears explanations as to the reason Americans spend more on health care than any other industrialized nation. But a new study published by researchers at Dartmouth Medical School indicates that the high price of health care is attributable to… doctors themselves?
The study, published in the New England Journal of Medicine, found that Medicare spending rose 3.5% on the whole from 1992 to 2006. There were, however, significant variations among regions of the country. In 2006, the average expenditure per enrollee was $8,304, but these expenditures ranged from $5,311 in Hawaii to $9,564 in New York.
The study found that physicians in higher-spending regions were more likely than their counterparts in lower-spending regions to refer patients to subspecialists and to admit patients with end-stage congestive heart failure to intensive care. Additionally, higher-spending region physicians were 30% less likely to discuss palliative care with patients and families.
The study authors attribute the cost of medicine, then, to how physicians “respond to the availability of technology, capital and other resources” when it comes to fee-for-service payment systems. In higher-spending regions, there are typically more resources available, these resources are used more frequently, and they wind up costing more to the system on the whole.
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Help Is Sought for West Virginia Health System
Source: New York Times
Date: 04/15/2009
West Virginia’s Governor Joe Manchin is under pressure from community health care advocates to sign into law a bill that would appropriate $6 million from the state budget in order to address what are called critical flaws in a deteriorating health care system.
West Virginia’s mental health care system has been categorized as the worst in the country, a designation that spurred action by the state’s House and Senate to pass a bill known as the Mental Health Stabilization Act of 2009 as an initial step toward ameliorating the state’s health care provision woes. The bill has encountered some objections from the State Department of Health and Human Resources, which objects to a provision in the bill directing money toward privately run regional mental health centers. Representatives from the department claim that that provision amounts to an earmark to subsidize private mental health care providers at a time when the budget for overall mental health care provision is stretched thin.
Currently, the state spends $162 million per year on mental health care, though mental health care advocacy groups estimate that more than $100 million has been removed from the state mental health care budget over the last fifteen years. This, they claim, has resulted in overloads at state mental facilities and hospitals as well as an increased load on all mental health care providers.
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Pharma Support of Medical Societies Raises Conflict-of-Interest Concerns
Source: American Medical News
Date: 04/13/2009
Public outcry over ties between physicians and pharmaceutical companies is widespread, and the news media has made the most of the story. Thanks to this pressure, it may not be surprising that the American Psychiatric Association announced in March that it will phase out $1.5 million in pharmaceutical funding to remove the danger of bias. At the same time, the American College of Cardiology declined almost half a million dollars in industry-funded goodies—branded tote bags, lanyards, and badges— at its annual scientific session.
Physician organizations have also become increasingly wary of potential conflicts of interest. An April 1st report in the Journal of the American Medical Association argues that organizations should aim for zero dollars of industry funding in the long term. In the short term, associations should immediately reduce funding to under 25% of their budgets.
Medical societies play a vital role in the education of physicians and the drafting of guidelines for clinical care. It is their responsibility to reassure patients and the public in general that the organization isn’t improperly influenced by pharmaceutical industry funding.
“It doesn’t matter whether there is, in fact, a quid pro quo,” said Steven Nissen, MD, former ACC president and chair of the cardiovascular medicine department at the Cleveland Clinic’s main campus. “When professional medical societies accept money from industry, it creates an appearance of influence. And that appearance undermines the most important thing we own in medicine, and that’s the trust of patients.”
With continued public scrutiny, including a bipartisan Senate bill requiring doctors to post payments from industry over $100 to a public website, medical associations will need to tighten standards and remove even the possibility of undue influence.
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Strategic Planning Begins With the Basics
Source: Health Leaders Media
Date: 04/30/2009
With the freezing of the credit markets and the larger economic downturn, 2009 is certain to be a challenging year economically for hospitals and practices. While strategic planning is generally a more long-term goal for practices, an article in Health Leaders Media argues that the current economic climate demands such planning in the short term as well in order to ensure that basic administrative and billing procedures are operating efficiently for practices.
Until recently, it was common for medical offices to rely on lines of credit for long-term and short-term needs. With the seizing up of the credit markets, it is essential that practice administrators ensure they have avenues for cash flow if the practice needs it. The article recommends developing a closer relationship between your practice and your bank to ensure that the lines of credit your practice depends upon are reliable and not subject to drastic alteration in the face of a change in ownership or other such events.
The article also recommends preparation for forthcoming changes to the insurance industry. The coming year may see much in the way of increased reliance on health savings accounts and other such coverage options. It is likely that your patients will not know their way around these policies as much as they should, so it is imperative that your billing staff be educated in them. Otherwise, you could leave money on the table or be stuck holding the bill. Also, practices are advised to take the following measures to shore up operations in the midst of financial uncertainty:
-Tighten up your billing department and processes to better coordinate deductibles, copays, verification, collections, and other aspects of the payment process. Collect payment as early as possible, and allow for all payment methods.
-Evaluate staffing levels to root out overlaps and redundancies. Also evaluate the feasibility of alternative compensation methods instead of salary raises.
-Make sure you’re getting the most for your dollar from vendor services.
-Look at provider productivity. Can you use physician extenders to fill roles and see additional patients?
-With regards to information technology, are there opportunities to achieve greater efficiency through automation?
While the economic climate may be daunting, it doesn’t have to spell tough times for your practice. With a level head, hard work, and a tough, realistic look at your practice’s operations, it is still possible to function at a high level of efficiency and productivity in a difficult economic environment.
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3 Personality Types You Don’t Want on Your Staff
Source: Physicians Practice
Date: 05/01/2009
A problem employee is certainly a drag on productivity overall, and every office has had one at some time or another. Getting rid of these workers can prove a problem in itself; so the better solution seems to be not to hire them in the first place. An article in Physicians Practice details three types of employees you’ll want to look out for and how to avoid hiring them.
The article recommends looking beyond traditional human resources staffing questions. It has been common, for example, to ask prospective employees about actions they would take in a given situation. This opens the door to fakers who know what answer interviewers are looking for as well as people who have a higher opinion of their own work habits than is justifiable. Instead, interviewers should ask applicants about actions they’ve already taken in past situations. When they detail previous work experiences, future bad employees are more likely to display behaviors that should raise red flags, including criticism, disdain, and blame.
The article warns to look out for three personality types in particular, as they are guaranteed workplace culture killers.
-The Office Martyr—With an over-inflated sense of his accomplishments and worth to the job, this colleague continually reminds people how underappreciated he is, constantly seeking approval and recognition. If they paint a picture in which they shouldered most of the load at their old job, you’ll want to steer clear.
-The Not-My-Job-er—For this person, “not in my job description” is a clarion call. To identify prospective hires in this category, ask applicants about times when they’ve asked for additional responsibility. If you have an applicant who seems to be constantly shifting blame from himself, you’re probably best advised to steer clear of hiring this individual.
-The Territorialist—Easy to spot, this is someone who won’t share information or control with others. To ferret out territorialists, ask probing questions about conflicts of responsibility in previous jobs and be wary of those unable to describe their past work in the context of the company overall.
These are not the only personality types that can present problems in the workplace, but they are typically ones that make it extremely difficult to manage a cohesive, supportive staff.
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Employment & Compensation
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CEO Compensation Now under the Microscope
Source: Trustee Magazine
Date: 04/01/2009
“CEO” might be the least popular three-letter combination a person could have following their name at this point. Across the nation, people are eyeing executives suspiciously, looking to see if their performance merits what they assume is a sizeable compensation package. Hospitals should, in this time of crisis, ensure that their executives are compensated in a manner that takes into account the institution’s financial footing and future. An article in the April issue of Trustee Magazine examines the situation and gives advice on executive compensation in the midst of crisis.
A recent study by the IRS evaluated compensation and community benefits of not-for-profit hospitals, finding that 14% of not-for-profit hospitals shoulder the majority of the burden of uncompensated care. While the study found executive pay at such institutions to be within a reasonable range—averaging around $490,000—a number of hospitals displayed much higher salaries, with executive compensation averaging $1.4 million annually. Though critics charge that the study is flawed, it is indicative of closer attention being paid to hospitals and compensation in the face of belt-tightening all around. Experts and executives tend to agree that it is necessary now to ensure that executive pay is tied to organizational performance.
While there is no sure-fire way of predicting what proper compensation will be in the coming years, a few guidelines are available for institutions looking to ensure a compensation structure that sends the right message to executives, employees, and the public.
-Strike a balance between attractive compensation for executives and maintenance of your organization’s financial health.
-Form an independent body to oversee compensation plans. This is generally required by the IRS for non-profit hospitals. This grouping should include representatives from the finance committee as well as other trustees who will not personally benefit from the package.
-Consider bringing in outside consultants for comparability studies to benchmark your organization against peers.
-Make sure your compensation committee, in deciding on compensation packages, takes into account the total value of the package, the elements making up the package and their amounts, and how each element fits in the organization’s larger goals and financial outlook.
-Maintain an open dialogue and sense of trust between your board and your CEO, as this will lead to higher performance.
-Construct performance incentives that include balanced portfolios of expectations, focusing on financial goals, safety, quality, and other desired goals.
Additionally, experts recommend keeping the number of metrics and determining factors as low as reasonably possible. Overloading compensation packages with determining metrics can result in executives losing focus as they try to cover all bases. Lastly, the strongest test is whether you can come out of the boardroom and proudly tell your organization’s constituents of the package you’ve approved. If you can come out of the boardroom and comfortably explain who got what and why, then your process and resultant package are likely adequate.
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Another Way to Seal the Deal
Source: H&HN Magazine
Date: 04/17/2009
What do physicians look for when choosing a place to work? Increasingly, the answer includes the clinical technology that the hospital offers. Nobody wants to deal with paper records or outdated film images from the 1970s. Savvy hospitals recognize that their IT portfolios are becoming key tools for standing out in the competition to attract new recruits, especially those accustomed to state-of-the-art facilities.
A hospital’s technology system provides practical benefits for physicians. “Electronic medical records and other digital innovations allow physicians [to] work more efficiently and access medical records from home, which helps them avoid off-hour return trips to hospitals,” according to Kurt Mosely, senior vice president of a physician staffing agency.
Digital imaging and electronic medical records (EMRs) are “almost a must,” especially in emergency care, where speed and accuracy are essential. In addition, physician portals allow physicians to log into EMRs after hours, and nonclinical medical service applications perform billing and administrative functions, which would otherwise drain time and energy. These technologies can lower a hospital’s cost of operation and give physicians the opportunity to set their own hours and lifestyle.
Technology can also aid employee retention: thanks to relaxed regulations, hospitals may subsidize up to 85 percent of physicians’ purchase and use of electronic medical records systems. The up-front costs should be balanced by the month-to-month efficiency savings.
The article points out that the latest gadgets are not automatically beneficial. Hospitals must “apply the technology to make a process better.” In many cases, IT training is just as important for medical staff. Trend-setting hospitals have even hired preceptors to train new recruits in using EMRs and other technologies.
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Integrating Existing Physicians into Your Employed Network
Source: Healthcare Strategy Group
Date: 02/01/2009
As the trend of physician employment by hospitals continues, numerous organizations are finding themselves approached by physicians hoping to add their practices to the hospital’s network. Care is necessary in bringing in these physicians, however, as they may have a different understanding of the market value of their practices, on one hand, and the routine that work in a hospital entails, on the other. Nonetheless, with enough planning and communication, these transitions can be made much easier on all parties. An article from Healthcare Strategy Group discusses some things necessary to keep in mind when negotiating a practice acquisition.
It is advisable for a hospital to limit the market valuation to a practice’s hard assets, patient charts, and accounts receivable, avoiding intangible assets that are hard to define and may not be recouped. Although physicians will likely disagree with the lower offer, it is important to emphasize that the practice will also gain intangible assets and be more sustainable.
Furthermore, hospitals looking to acquire a practice should:
-Be selective in targeting practices that are worth investigating.
-Avoid practices with large financial liabilities.
-Match compensations to physician productivity.
-Set clear expectations and protocols for all operations.
-Maintain staff and physician involvement in the running of the practice before, during, and after the acquisition.
-Communicate the role the practice will assume in the hospital with regards to larger organizational goals.
-Double-check for hidden pitfalls/liabilities.
-Develop an operating proforma to project the practice’s results for five years out.
The increased pressure on hospitals to build physician networks is no excuse for poorly executed acquisitions. By following a few simple guidelines, your organization can build healthy relationships with an expanded network of physician employees.
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Tailor Your Search
Source: Unique Opportunities
Date: 04/01/2009
Residents and fellows typically report that after graduating from medical school, they feel “prepared to handle patients but unprepared to confront job markets and the complicated process of landing the right job.” This is likely a result of many young physicians reporting that they receive little to no job counseling in medical school. A recent article in Unique Opportunities provides a substantial account of how young doctors should approach the complicated job search process.
An essential first step, according to recruiting professionals, is to develop a list of “non-negotiable” features the new position must offer. For some, this could be a matter of geographical preference, while others may be determined to have access to certain technologies for which they have been trained.
Overall, the most important factors to consider typically fall into one of five categories: setting, culture, location, money, and access to technology. These are the elements that have the most bearing when you ask yourself, “Will I be happy here?” Setting refers to the structure of the employing organization (e.g. private practice, academic medical center) and its effect on your job responsibilities, while culture refers to the way the employees interact with each other and approach their own work.
Location, like money, requires little explanation as a factor, but it is important for specialists in particular to keep in mind that location is something they may have to be flexible on since the medical services provided can differ greatly from one area to the next. Professional staffers, for their part, also consider how well an applicant “fits” into the community with regard to extracurricular activities, geographic preferences, and family plans.
Additional advice provided by recruiters is to be aware of the tendency to be drawn to familiar environments (not a bad inclination by any means) and to apply for too many positions, making the final decision more difficult (four to six interviews is a good target). Ultimately, by applying some basic guidelines, young physicians can focus on the positive opportunities afforded by the job search and be more confident in their decisions.
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Do Restrictions on Residents’ Work Hours Harm Patient Care?
Source: Medical Economics
Date: 03/06/2009
Hopefully you wouldn’t get behind the wheel of your car with a blood alcohol level of .05%, but should a doctor be allowed to function on just a few hours of sleep, which has been shown to have virtually the same mentally impairing effect? An article in the March issue of Medical Economics contends that this is exactly the sort of situation being brought about by restrictions on resident work hour limits, which the author claims actually have a negative overall effect on patient care.
The movement to restrict the work hours of medical residents stems largely from the Libby Zion case, in which a patient presented to the emergency room with vague symptoms only to die while in care. When it was revealed that the resident caring for her had been on duty for 17 hours, the resulting uproar eventually yielded work hour limitations for residents. The reasoning in this case was that sleeplessness results in increased likelihood of medical error. The author contends, though, that the pat description of the Zion case that is usually presented leaves out an important fact: the residents on call did not have proper physician supervision. Since it is standard now for residents to have attendings supervising them, the author argues that the work hour limits don’t help things, but rather actually hurt overall care.
The reasoning behind this conclusion is that, with resident hours restricted to a maximum of 48 per week, a greater burden is placed on physicians and physician extenders. That is: someone has to work those hours. This, coupled with the physician shortage, results in overloaded physicians who will likely suffer the same sleep deprivation—with its accompanying deleterious effects on judgment and awareness—either while supervising residents or while covering the hours that residents would otherwise be working. In effect, the risk is passed from the first line of defense to the last. Furthermore, the author argues that the work week restrictions can’t help but raise a generation of doctors with a shift-mentality, viewing their jobs as discrete time commitments to which they are beholden rather than the ongoing professional calling that medicine really is supposed to be.
There are no easy solutions, the author contends, but the medical world needs to come to a realization that simply shifting the burden of sleeplessness isn’t the way to handle the problem either.
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Layoffs on the Rise, Litigation, Too
Source: Health Leaders Media
Date: 04/13/2009
In today’s recession, many hospitals are looking to reduce inefficiencies and streamline staff. However, executives must be careful about how layoffs are carried out, or they may find themselves in court. According to data from the Equal Employment Opportunity Commission (EEOC), lawsuits for discrimination are at their highest levels in the Commission’s 44-year history. Age discrimination suits are up by 29%, retaliation claims up by 23%, sex discrimination up by 14%, and racial discrimination up by 11% from the previous year.
Janine Yancey, president of an HR compliance consulting firm, says executives must be careful with all communications about layoffs. Employees often feel unfairly treated if the justification is ill-defined, especially if vague terms like “culture” or “youthful energy” are seen as providing cover for age or racial discrimination. “It depends on how you define the culture,” Yancey says. “If the culture is a bunch of white males, sorry but you’re not allowed to do that anymore.”
A few suggestions for companies planning layoffs to defend their actions:
-Develop clear criteria for layoff selection. Salary can be a factor, but it should not be the sole criterion because it generally weighs towards older workers.
-Evaluate the hospital’s “core competencies” and target divisions that are not considered essential. In tight economic times, it’s harder to justify maintaining certain departments or organizational teams, and a reduction-in-force is unavoidable.
-Check the lists of targeted employees for disproportional impacts, especially if certain groups seem to be overly affected.
-Hire an attorney and/or employment consultant to examine layoff lists before you take action.
To some extent, layoffs are unavoidable among hospitals and health care organizations struggling with the current economic downturn. When layoffs are in view, foresight dictates taking precautions to preclude possible litigation following issuance of the proverbial pink slip.
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How to Avoid Malpractice Suits
Source: Medical Economics
Date: 04/17/2009
It goes without saying that nobody—lawyers excluded—likes a malpractice suit. The patient, of course, feels he’s been wronged in some manner. The doctor is taken away from practice to attend court hearings. The financial risk? Well, in 2007, nearly 11,500 medical malpractice claims were paid in the United States, and the cost of defending a claim averaged around $30,000 regardless of the outcome. An article in Medical Economics claims physicians can avoid malpractice suits through translating doctors’ orders into the legal realm.
-Return calls with your cell phone. This helps you avoid the allegation that you did not return a patient’s call in a timely manner by creating a record of the call.
-Document what is said in communications. If you ignore the creation of a paper trail, you take your practice’s financial well-being into your own hands. All communications with patients should be submitted to a written record.
-Guarantee patient access to lab and radiology results within a specified timeframe. When patients are told they will hear from you regarding results, they’re likely to assume no news is good news if you don’t call.
-Document what you did not do. If there is a specific reason for forgoing a treatment, document it carefully.
-Think twice before sending a patient to collections. If you send a patient to collections over a negligible amount, and the patient had an undesirable outcome, you’ve just opened your practice up to risk of a malpractice suit, if only through the ill will a collections call engenders.
-Don’t speak ill of others. The competitive nature of medicine makes it easy to snipe at other practitioners, but you’d be well served to avoid this temptation.
-Accept patients who badmouth their previous doctors at your peril. Everyone’s vulnerable to flattery to some extent; but if your patient flatters you at the expense of denigrating previous doctors, an alarm should go off in your head.
-Never alter the record. Alteration of records after being served with a lawsuit is a huge no-no. If you’re documenting before service of papers, that’s open to explanation. If you’re documenting after being served papers, that’s an excuse and is perceived in a suspicious light in court.
Following these steps will not eliminate the possibility of your facing a malpractice lawsuit at some point in time. However, observing these common-sense guidelines will certainly minimize the overall risk.
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Court Approves Doctors’ Suit over Ranking Program
Source: American Medical News
Date: 04/27/2009
Massachusetts doctors fighting to halt a ranking program mandated in 2006 by the Group Insurance Commission earned a victory when a Suffolk County Superior Court judge allowed their lawsuit. The doctors are suing two health plans participating in the tiering program known as the Clinical Performance Improvement Initiative.
The Initiative seeks to improve quality and restrain costs by holding doctors to performance metrics, but physicians believe the methodology of the rankings is flawed and results in serious errors and higher payment rates for patients in addition to damaged physician reputations. Representatives from the Massachusetts Medical Society contend that no evidence exists suggesting that the program will achieve its stated goals of improving quality of care and altering cost trends.
American Medical Association policy states that “rating systems should be transparent and based on evidence-based quality measures” rather than cost and also urges health plans to “allow physicians to review the data behind such ratings and have the ability to appeal them.”
The medical plaintiffs are asking the court to either cease the use of the ranking program or initiate a requirement among administrators to adhere to specific standards including the “disclosure of the ranking methods, physician input, appeals processes and independent oversight.” Critics of the suit contend that the program rests upon nationally recognized measures and attempts to rectify problems that make current health care practices unsustainable.
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Surgical Specialties and Locum Tenens
Source: LocumLife
Date: 04/15/2009
Within the surgery specialty, the shortage of physicians is predicted to be acute. The American College of Surgeons counts the number of physicians nationwide with surgery expertise at 4,500 for fourteen subspecialties. For general surgery, the subspecialty has seen a decline in the past 25 years by as much as 25% per capita, with some studies putting the shortage of general surgeons at around 1,300 as early as next year. By 2050, some studies have the shortage of general surgeons reaching 6,000. Similar shortages are expected for orthopedic surgery as well as other critical surgical fields. To counter the effects of this specialist shortage and cover the growing need for surgeons, a number of institutions are turning to locum tenens physicians to fill the gap.
The increasing use of locum tenens surgeons grows out of the needs of acute care hospitals, ambulatory surgical centers, and private practices, among other institutions. The services of locum tenens professionals are especially needed in rural areas, which tend to have longer recruiting processes for permanent staff. At the same time, though, opportunities for locum tenens providers are always available in metropolitan and suburban areas as well, as these areas tend to need to maintain a certain level of surgical staff to retain their trauma designations.
A large number of surgical specialists have undertaken the locum tenens lifestyle over the years. The locum tenens profession allows for greater autonomy and control over a physician’s personal and professional life. Physicians develop relationships across practices and sometimes develop recurrent locum opportunities.
In entering the locum practice, physicians should ensure that they are able to quickly adjust to new settings regularly, as this is at the core of the locum tenens lifestyle. Some physicians recommend bringing your own “basics”—needle holders, pickups, scissors, retractors, etc.—to a new assignment. Equally important is the knowledge that one is working under the sponsorship of a reputable locum tenens company. If you are considering starting up a locum tenens stint, contact the National Association of Locum Tenens Organizations (www.nalto.org) for lists of reputable companies and additional information regarding the locum lifestyle. The lifestyle is suited to virtually any physician with a flexible attitude and the ability to function well in a team setting. Surgeons with this ability could fill a critical need in numerous communities while at the same time exploring and rekindling their passion for practicing medicine.
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Beyond Parity: Primary Care Physicians’ Perspectives On Access to Mental Health Care
Source: Health Affairs
Date: 04/14/2009
In 2004, two out of three primary care physicians reported they could not get outpatient mental health services for patients. This rate was twice as high as rates reported for any other services. The inability rose from shortages of mental health care providers, barriers in patient health plans, and lack of coverage for mental health care.
A study published in Health Affairs found that the probability of having mental health access problems for patients varied depending on physician practice, health system, and policy factors. Using data from a nationally representative survey of physicians, the study examined the proportion of primary care physicians reporting obstacles to obtaining outpatient mental health services for patients, the reasons for those problems, and the factors—policy, patient characteristics, practice characteristics, health system factors—that figure into the difficulty of obtaining such services.
The study drew on data from the 2004-2005 Community Tracking Study (CTS) Physician Survey with a sample of about 6,600 nonfederal physicians who spend at least twenty hours per week in patient care. Among the findings of the study:
-Primary care physicians have far more difficulty obtaining mental health services for patients than they reported for other common services.
-Six of ten primary care physicians cited a lack of--or inadequate amount of--insurance coverage as a primary reason for the lack of access to mental health care.
-The number of charity-care and Medicaid patients in a practice also had an effect on access to mental health services. PCPs with high numbers of charity-care patients were more likely to get outpatient mental health services for patients.
-The supply of psychiatrists in the community also came to bear on mental health services access. In counties with eight or more psychiatrists per 100,000, providers were 12% less likely to report service shortages. Counties with high numbers of psychiatrists, though, were more likely to encounter coverage barriers for mental health services.
It is hoped that data from this study will prompt health care policy makers to recognize the importance of making quality mental health care available to patients of primary care physicians across the country.
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How to Make Primary Care Better
Source: The Wall Street Journal
Date: 01/21/2009
This editorial is written by Benjamin Brewer, M.D., who comments on the importance of primary care in the ongoing national discussion on health care reform.
Good primary care can reduce costs and improve patient outcomes, yet this area is woefully neglected by the American health system. “We spend twice as much as many other developed countries on health care, yet have worse quality,” Brewer says. Successful health care reform will require a re-thinking of the way that primary care is provided and funded.
Brewer argues that the biggest hurdle is the current payment incentives. “Services that earn [him] the least are often the ones patients value most, such as e-mail messaging, phone advice, and calling in prescriptions to avoid an ER visit.” Unfortunately, Medicare, Medicaid, and other insurers are reluctant to pay for services outside of an office visit. Instead, they provide incentives for primary care doctors to see as many patients as possible, which is sometimes reflected in poor quality of patient care.
Currently, primary care in the United States lacks adequate funding. An effective system requires “ready access, a provider who can be the main source of care for most needs, coordinated and comprehensive care.” Brewer makes several suggestions: lower payments to hospitals for surgical care, radiology, and other, expensive services, moving that money to primary care; provide incentives for community-based care, and increase the use of non-physicians in routine procedures.
The discussion of medical costs and benefits might be uncomfortable, he says, but an adequately funded system of primary care is the key to the health care reform our country really needs.
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A Steady Growth in CAM Services
Source: H&HN Magazine
Date: 03/31/2009
For six years, the Complementary and Alternative Medicine Survey of Hospitals has tracked the prevalence of complementary and alternative medicine use and support in the nation’s hospitals. The survey also keeps track of institutions’ reasons behind their use of such medicines. While there have been no massive spikes in usage throughout the survey’s history, a review of the past years reveals that the growth of complementary and alternative medicine use has been steady and marked, with its prevalence more than doubling since 1998.
In 1998, the Annual Survey of Hospitals marked complementary and alternative medicine (CAM) use in hospitals at about 7.9 percent. Health Forum’s most recent survey marks CAM prevalence at 19.8 percent in 2006, more than double in eight years. This jump is largely attributable to the decline in physician resistance to CAM. Physician attitudes opposing CAM declined from 50 percent in 2003 to 41 percent in 2007. Additionally, physician requests for CAM services have been on the rise in the same period of time. As a result, more hospitals are making efforts to include such treatments as part of their offerings.
The rise isn’t without its pitfalls, though. In light of the current economic climate, budgetary concerns arising from the use of CAM pose a sizeable obstacle to further adoption. Still, 53 percent of hospitals with CAM programs report support from senior management on the launch of such programs, and 55 percent report ongoing support from management.
The adoption of CAM services is largely driven from patient demand for such services. Eighty-five percent of organizations report patient demand as a primary motivating factor. Additionally, the survey found that CAM treatments have made advances with regards to perceptions of their clinical effectiveness, with 67 percent of respondents indicating they were clinically effective.
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Specialty Facilities Don’t Hurt General Hospitals: Study
Source: ModernHealthcare.com
Date: 04/23/2009
A study released recently claims to refute industry concerns that specialty hospitals would pull profitable patients and services from general hospitals and cause a negative impact on the bottom lines of general institutions that are already financially stressed.
The study, conducted by the Center for Studying Health System Change and funded in part by a grant from the Robert Wood Johnson Foundation Physician Faculty Scholars Program, was based upon more than forty interviews with leaders, staff, and observers of the health care industry in the Indianapolis, Phoenix, and Little Rock health care markets.
It has long been the contention of community hospital officials that specialty clinics poach profitable patients and procedures such as cardiac and orthopedic care from other hospitals, leaving them with the uninsured and more expensive, less profitable procedures. Since these clinics do not often provide community services such as emergency rooms, they do not bear the financial burden that is borne by non-specialty clinics.
In the markets analyzed by researchers, it was found that fears of specialty clinics negatively impacting hospital bottom lines were unfounded. General hospitals in the survey reported little change in patient acuity due to competition with specialty competitors. Those hospitals reporting changes in patient acuity generally attributed such change to the rising numbers of the uninsured. In markets where the two types of hospitals existed side by side, though, general hospitals did report greater difficulty in recruiting staff and maintaining patient referrals and service volumes. Competition was shown to have a greater impact on general hospitals than on safety-net hospitals.
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Coordination of Care by Primary Care Practices: Strategies, Lessons and Implications
Source: Center for Studying Health System Change
Date: 04/30/2009
While everyone seems to know that the health care delivery system in the United States is not exceptional at the coordination of patient care, it also seems that no one has a panacea to improve the coordination of patient care.
A recent study from the Center for Studying Health System Change that was based on interviews with experts and physicians across 36 physician practices found no consensus on coordination among health care providers. The difficulty in coordination was attributed to a variety of factors arising from patients, physicians, and the health care market. Still, the study did find “cross-cutting lessons” like the value of physician commitment to continuity of care.
Study participants noted that the existing fee-for-service system does not reimburse for continuity of care efforts. The study also identified a number of individual measures physicians use to ensure continuity of care, including formalized agreements between primary care providers and specialists regarding referrals and consultations, and the authors contend that, if aligned with proper compensation incentives, the strategies identified could very well increase patient service quality and overall satisfaction. Properly funded and disseminated, these practices could help cover the existing holes in the continuity of American health care.
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Payer & Reimbursement Issues
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Self-Insured Companies Going After Doctors to Recover “Overpaid” Claims
Source: American Medical News
Date: 04/13/2009
Health Research Insights (HRI)--a firm that specializes in identifying and recovering medical claims overpayments on behalf of self-insured employers--has stirred up quite a bit of trouble in recent months, intimidating physicians in Georgia and Tennessee to pay up for upcoding patient claims.
Since late 2008, thousands of doctors in the two states have received collection letters from HRI accusing them of overpayment. The Indiana State Medical Association also received a warning from HRI saying that it will start collection efforts in the state. According to one targeted Georgia doctor, the letter warned him to “immediately settle this issue” or send complete records proving he did not incorrectly bill the patient for the visits in question.
Per HRI, health care plans regulated by the Employee Retirement Income Security Act (ERISA)--namely those plans offered by self-insured employers--are not bound by the same legal constraints as other health care plans. In particular, the statute of limitations for ERISA claims is much less straightforward. As a result of this ambiguity, HRI has attempted to reclaim payment for visits dating as far back as 2005.
Health care attorneys and ERISA legal experts, however, suggest that HRI is simply bluffing and that doctors should try to shift the “burden of proof” back onto HRI. State medical associations are not taking this issue lightly; the Medical Association of Georgia has ordered HRI to temporarily stop collections and the Tennessee Medical Association has contacted federal officials. The American Medical Association is also in the physicians’ corner, working with state medical associations to investigate HRI and counter any of its unwarranted activities.
HRI has stated it will continue to keep up its collection efforts, and until the legality of its operations is confirmed, doctors can continue to expect a good fight.
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Adoption of Consumer-Driven Health Plans Accelerated by Recession
Source: MSN Money
Date: 04/13/2009
Consumer-driven health plan (CDHP) enrollment, already expanding at a rapid pace, is expected to grow even more quickly in 2009 as employers, faced with higher premium increases, look for savings in health care coverage wherever they can be found—this according to new reports from HealthLeaders-InterStudy, a provider of managed care market intelligence.
The term CDHP is in reference to health insurance plans allowing members to use personal health savings accounts, health reimbursement arrangements, or other similar payment products to pay routine health care expenses directly. Enrollees are protected from catastrophic medical expenses by high-deductible health insurance policies. Analysts have seen increases in CDHP enrollment rates across the board, from early-adopter states to states just hit by the recession.
Reports also indicate that the individual CDHP market is growing. This likely comes as unemployed citizens look for affordable health insurance solutions. According to reports from Health Plan Analysis, we can expect to see employers continue to use account-based and high-deductible options as budgets continue to be strained and premiums are expected to continue to rise. It is expected that the federal COBRA subsidy—which includes a 65% subsidy on the cost of COBRA premiums for up to nine months—will have the effect of reducing demand for at least individual CDHPs, but group plan enrollment is expected to continue to rise no matter the impact of COBRA adjustments.
According to other recently announced studies, wellness and pharmaceutical benefits will figure greatly into the future spread of CDHPs, as the plans typically cover only generic medications and low-cost options, if at all. Subsequently, COBRA coverage is highly preferable to individual CDHPs, at least as far as the pharmaceutical industry is concerned.
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Medicare Funds 14 Communities to Reduce Hospital Re-admission Rates
Source: Healthcare Finance News
Date: 04/14/2009
The Centers for Medicare & Medicaid Services (CMS) recently launched the Care Transitions Project--a program designed to reduce or eliminate unnecessary hospital re-admissions. With studies showing that almost one out of every five patients is re-admitted within a month and that over three-quarters of those re-admissions could be prevented, the program is a much needed attempt to solve a costly problem.
The Care Transitions Project helps patients, caregivers, and other providers prevent unnecessary re-admission by working on transitions from hospital to home, providing skilled nursing care and extending it to home-based health care, and actively creating a sustainable and replicable plan that other communities will be able to adopt in the future.
Dr. Barry Straube of the CMS points out that, “Rather than focusing on one global problem and trying to apply a one-size-fits-all solution across the country, Care Transitions experts will look in their own backyards to learn why hospital re-admissions occur locally and how patients transition between health care settings.”
This community-centered approach is organized using state Quality Improvement Organizations (QIOs). The QIOs work within CMS’ quality care program to help providers, consumers, and stakeholder groups work together on delivery systems to ensure that Medicare beneficiaries get high-quality and high-value health care.
The fourteen communities selected to participate in the project are: Providence, R.I.; the Upper Capital Region of New York; western Pennsylvania; southwestern New Jersey; Metro Atlanta East; Miami; Tuscaloosa, Ala.; Evansville, Ind.; the Greater Lansing, Mich. Area; Omaha, Neb.; Baton Rouge, La.; northwest Denver; Harlingen, Texas; and Whatcom County, Wash.
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Credentialing, Licensure, Quality Management
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New Standards Focus on Lifelong Learning for Maintenance of Certification
Source: Urology Times
Date: 04/16/2009
Citing the need for physicians to respond to the needs of the public and at the same time keep up with the growing field of physician performance measurement, the American Board of Medical Specialties--which oversees physician certification in the United States through its member boards--announced the adoption of a new set of standards with the goal of enhancing physician qualification principles.
The new standards outline and set timelines for official adoption of new Maintenance of Certification program elements. These include documentation of physicians meeting CME and self-assessment requirements; evidence of participation in practice-based assessment and quality improvement every two to five years; completion of a patient safety self-assessment program during each Maintenance of Certification cycle; and an assessment of communication skills.
The changes come following the launch of the ABMS 2008-2011 Enhanced Public Trust Initiative--which aims to bring increased commitment to health care quality and physician accountability, while attempting to enhance the image of the Maintenance of Certification in the eyes of the public, physicians, and the board enterprise.
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‘Getting Health IT Right’ in the Federal Stimulus Package
Source: iHealthBeat.org
Date: 03/31/2009
Health care information technology has, for some time, been near the forefront of the health care reform debate. Proponents claim the technology has the power to revolutionize the way health care is transacted in this country, while detractors say IT in itself is not enough. While the debate has raged, little in the way of actual policy has emerged from Congress. Until the passage of the recent stimulus package, the Office of the National Coordinator for Health IT had a budget of $61.3 million. With the bill’s passage, $2 billion becomes available for that office, and $17 billion is pledged for wider health care IT implementations. An article on iHealthBeat.org examines where the debate stands now in the face of massive funding.
Those urging caution warn that the widespread adoption of health care IT is not an end in itself. In fact, they argue that unintended and unexpected effects could end up worsening health care delivery if systems are not properly implemented. Concurring, supporters and interested parties in health care IT claim that clear objectives need to be set out before the deployment of technology. All sides agree that implementing a system just to implement a system is not the way to go. “Getting it right” would involve specific and measurable goals for the investments, assurance of the security of health data, use of information to make better decisions, and the adoption of a phased strategy of implementation.
Of concern to many in the health care industry is the definition of the term “meaningful use,” upon which hinges much in the way of funding for practices looking to upgrade their technology. Some urge having a “strong and escalating but predictable definition” of the term, so that practices know what to expect and the money does not go to waste. Additionally, cost is a large barrier to physician acceptance, as a single physician might have to spend upwards of $100,000 to upgrade to EHRs according to some estimates. Some recommend greater cooperation between health care workers and hospitals to overcome the cost barriers to EHR adoption. Physician resistance can be overcome if doctors are provided with support through means such as regional health information technology centers.
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Peer Review Protection Statutes Take on New Meaning
Source: Health Leaders Media
Date: 04/30/2009
The Tennessee Court of Appeals recently ruled that, so long as a peer review decision was reached in good faith, hospitals and not just physicians are eligible for immunity in cases involving physician negligence. Some believe the ruling leaves open the possibility of a new interpretation of peer review protection legislation.
For most states, laws concerning peer review provide confidentiality and legal immunity for participants, who are usually professionals raising concerns about competence or testimonial reliability in their colleagues. The Tennessee court ruling concerns a case in which a patient sued both a plastic surgeon and his affiliated medical center for malpractice. The plaintiff sued the hospital itself for negligent credentialing, with the claim that the hospital should have recognized the physician’s incompetence and revoked his credentials. The court’s ruling held that the qualified immunity defense is available for hospitals in cases where the institutions are sued for credentialing decisions made by peer review committees.
The opinion is subject to appeal on the part of the plaintiff, whose attorneys contend that the statute regarding peer review is unconstitutional and that granting immunity to hospitals in credentialing lawsuits goes against the original intent of the statute.
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Medication Errors Could Be Cut: Experts
Source: Forbes.com
Date: 04/26/2009
Medication errors are estimated to affect at least 1.5 million Americans every year, at a cost of up to $177 billion. Two new reports out from researchers at Brigham and Women’s Hospital and the University of North Carolina claim that these errors are avoidable if hospitals and pharmacists work to reduce the factors that lead to errors.
The first report is based on the use of a computer system, which tracked patient medications upon admission and compared these records with patient medications upon discharge. The report followed 322 patients from two hospitals, comparing the computer accounts of medications against tracking performed by doctors, nurses, and pharmacists. The computer-tracked patients averaged 1.05 medication errors per patient, while the human-tracked patients averaged 1.44 errors per patient. The computer-tracked patients also had fewer errors with the potential to cause serious harm.
Another report found that pharmacist, doctor, and patient communication significantly decreased the occurrence of medical errors in patients with high blood pressure. The study examined 800 patients, using a computer program to identify adverse drug reactions. Patients in the experimental group received regular feedback and advice from pharmacists on the patients’ medication regimen, as did the patients’ physicians. As a possible result, the study found a 34% lower risk of any event in these patients.
The teams behind the two studies both claim they illustrate the potential to significantly decrease the incidence of medical errors. When computer systems are introduced to track medication and staff are acclimated to such systems, adverse reaction incidence rates drop. The same is the case when pharmacists are more involved and communicative with doctors and patients. The study authors contend that these are viable methods of saving lives and reducing costs all around.
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Association Between Hospital-Reported Leapfrog Safe Practices Scores and Inpatient Mortality
Source: JAMA
Date: 04/01/2009
The Leapfrog Group provides information regarding hospital safety and quality to large companies that purchase health care. The Leapfrog Hospital Survey, administered to volunteering institutions by the Leapfrog Group, is its means of measuring safety and quality of care. Since its inception, the survey has grown in assessment from three initiatives—computerized physician order entry, staffing of ICUs by trained intensivists, and evidence-based referrals for high-mortality surgeries—to include a fourth—Safe Practices—which allows hospitals to report efforts toward implementing the recommendations of the National Quality Forum’s Safe Practices for Better Healthcare. Approximately 1100 urban hospitals have completed the Safe Practices Survey (SPS) n recent years, but no effort has been made to study the correlation of survey responses with measures of interest to healthcare consumers and policymakers.
An article in the Journal of the American Medical Association aimed to examine the connection between scores on the Leapfrog survey and inpatient mortality, finding there to be little or no correlation between the two.
The study was conducted using data supplied by the Leapfrog Group itself. The study authors examined discharge data for all urban US hospitals completing the 2006 safe practices initiative and identifiable in the Nationwide Inpatient Sample. Researchers ran hierarchical logistic regressions to determine the relationship between SPS scores and inpatient mortality, adjusting for discharge volume and teaching status as well.
The study found no correlation between an institution’s SPS score and its observed inpatient mortality rate. That is: hospitals scoring better on Leapfrog’s survey did not necessarily display overall better patient care with regards to mortality.
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Evidence-Based Medicine Examined
Source: Physicians Practice
Date: 04/01/2009
It takes around seventeen years for new treatments to make their way into routine patient care, even after they’ve been proven to be more effective than the current standard. As a result, only half of patients today are having their common diseases treated with the latest accepted standards. The protocols in many practices wind up incomplete and obsolete. An article in Physicians Practice contends the problem isn’t a failure on the part of the industry to spread the word of a new treatment, but rather an overflow of information, which results in modern physicians winding up adrift in a sea of “vitally important information.”
The average primary care physician would have to read about ninety journals regularly to keep up with the latest developments in treatments. Since nobody’s got the time for forty articles a day, the article posits evidence-based medicine as a solution to the modern information overload conundrum. The idea behind the term is to lay out a foundation for treating patients that is based upon the latest proven research.
Evidence-based medicine allows physicians to go beyond using just their own clinical knowledge and to rely more heavily upon the consensus knowledge of the medical community on the whole. Proponents contend that it is an enhancement for a physician’s standard practice rather than a replacement, but critics call the system a “cookbook.”
The method is based on a logical progression of steps in which a physician, upon recording patient symptoms, formulates a specific clinical question based on the particular patient problem, searches the current literature for relevant information, evaluates the existing evidence in the medical community, and based on that decides a course of action.
In implementing evidence-based practices, experts recommend that practices take advantage of existing technology. Of particular note are electronic medical records and various online tools, which can be quite helpful in setting up evidence-based practices in the face of massive patient rolls. In all, experts recommend that practices keep in mind that evidence-based medicine is a tool—a collaborative tool that can greatly enhance your ability to provide patients with the latest, safest treatments--but a tool, nonetheless. The process is not a replacement for physician expertise, and physicians would be well served to continue to hone their own talents instead of relying solely on a single tool.
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E-Prescribing Sees Growth, But Action Still Required
Source: Healthcare IT News
Date: 04/22/2009
According to the National Progress Report on E-Prescribing—an annual report released by Surescripts—electronic prescribing has, from 2006 to 2008, undergone significant growth with regards to adoption.
Surescripts’ report pegs the number of e-prescribers in the United States at 103,000 in 2008. This is up substantially from 19,000 in 2006. This adds up to more than 134 million e-prescribing messages exchanged between prescribers, pharmacists, and payers. Surescripts’ report credits this growth to increased national attention for e-prescribing, national programs offering assistance for adopters, and the adoption of e-prescribing by key payers like Medicaid.
The study’s authors contend that, while the results show solid growth, further action is needed on the part of policymakers to ensure continued adoption, with goals including a tie-in of e-prescribing to the “meaningful use” clause of the recent stimulus package, support for the technology by organizations involved in all levels of a pharmaceutical transaction, and a suite of incentives for adoption by smaller medical practices.
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Brother, Can You Fund an EHR?
Source: Health Leaders Media
Date: 04/09/2009
In these tough economic times, many Americans are looking to President Obama’s $787 billion American Recovery and Reinvestment Act as a sign of recovery. The health care industry, to which $147 billion has been allotted, has been particularly reassured about the $19 billion to support the adoption of electronic health records (EHRs). However, before breathing a sigh of relief, consider this: $19 billion doesn’t come without strings attached and may even exacerbate the already constricting financial situation of many health care providers.
The $19 billion allotted for the implementation of EHRs is not to be issued as a “front-out grant” to health care providers, but as a reimbursement which will not be issued until 2011. Since health care providers need to pay upfront for the expenses associated with this major IT overhaul, this inevitably raises the question: how are hospitals expected to pay when they are already in a financial straitjacket?
The credit situation of hospitals throughout the U.S. is dire. According to a recent survey by the Thomson Reuters’ Center for Health Care Improvement, about half of all hospitals in the country are “operating in the red” and reimbursement growth rates from Medicare, Medicaid, and private insurance have significantly declined. Small facilities, too, are having an especially difficult time with getting cash flow, as many cannot afford to run the risk of a variable interest rate.
So, what’s the solution? According to some indications, lowering interest rates could encourage health care providers to seek out loans for the massive EHR projects, which must be implemented by 2015 in order to be eligible to receive Medicare payments. In the meantime, hospitals need to dig deep into their pockets to find a way to shell out the cash.
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“Meaningful Use” Focus Probed
Source: HealthDataManagement.com
Date: 04/30/2009
Though nobody knows exactly what they are supposed to mean yet, two words in particular stand to have a significant effect on American health care in the coming years. An article from HealthDataManagement.com takes a look at two of the most important words yet to be discussed thoroughly in the coming health care system reforms: “meaningful use.”
The term matters as much as it does because it is the determining factor in whether or not hospitals and group practices will qualify for Medicare and Medicaid financial incentives for implementing electronic health records systems. Such systems, under the guidelines of the Department of Health and Human Services, will need to be put to meaningful use by their hospitals in order for those hospitals to begin receiving financial incentives in 2011. While the DHS guidelines are as yet forthcoming, a number of groups have stepped forward with their own suggestions on what exactly should constitute meaningful use in the final guidelines.
One such group, New York-based think tank the Markle Foundation, puts forward a definition that focuses on ensuring the provider use “‘clinically relevant electronic information about the patient to improve medication management and coordination of care.’” The Markle Foundation purports that the meaningful use definition needs to “optimize achievability” for providers and focus on patient care. Markle’s report calls for standard information types and inclusion of extant standards. Above all, the report calls on the federal government to ensure that its requirements are structured so as to be implementable in a timely manner without putting undue pressure on organizations to adopt unwieldy software upgrades. Supporters of the report include representatives of technology vendors, health care providers, payers, and professional associations.
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Military E-Health Record Plan Gives Open Source a Boost
Source: iHealthBeat.org
Date: 04/16/2009
Open source technology, touted by proponents as a low-cost alternative to traditional software vendors, may get a chance to shine on the national stage. The Obama administration recently announced that it would use open source solutions for the military’s forthcoming national health records system. If the program is a success, it could portend well for the open source movement on the whole, possibly saving the nation a large amount of money in the process.
“Open source” is a catchall phrase covering software and hardware that is open to redesign and improvement by any within the community of users. This is in contrast to proprietary offerings from vendors, who tend to keep the source codes for their software secret and unchangeable. Proponents claim that an open source system is the only way to ensure interoperability in a truly national health care records system.
The open source community received word of the Obama administration’s decision on military use of open source solutions with a measure of cautious optimism. The move follows a number of outreach and information efforts put forth by the open source community to raise awareness of the efficacy and cost-effectiveness of their offerings. Proponents say they are taking a wait-and-see approach to ascertain whether the Obama administration plans to simply use one open source solution or if this is part of a larger plan to implement such solutions on a national scale. Currently, the feasibility of open source solutions for health care records is slated for a study to be completed by October 2010.
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Physician Practice Management
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How to Sell Your Medical Practice for Millions
Source: Physicians News
Date: 04/08/2009
When faced with the possibility of selling a practice, many physicians balk. They feel they won’t get any significant value by selling unless they have younger partners ready to buy them out. So how can physicians turn the sale of a practice into an opportunity rather than a burden? A few clear lessons stand out:
-Plan thoroughly and plan early: As you begin your practice, start funding a buy-out vehicle 10, 20, or even 30 years before retirement. It’s important to fund and plan a buyout over time.
-Consider using non-traditional retirement plans to fund the buyout: Pensions, 401(k)s, SEP-IRAs and other traditional retirement plans are familiar to most physicians, but alternative plans such as non-qualified deferred compensation or “split-dollar” plans can make all the difference when it comes to a buyout at retirement. Non-qualified plans can only be offered to a few employees (staff physicians or partner physicians, for example), and typically require you to put a certain dollar amount or percentage of income into the plan each year. The plan grows over time and as older physicians retire, they are entitled to a percentage of the total assets in addition to their pension.
-Consider a captive insurance company-funded buyout: Practices typically use CICs to manage risk, taxes, and asset protection. Thanks to beneficial tax treatments, CICs can allow physicians to build large amounts of low-tax reserves. With a built-in buyout formula in the stock agreements of the CIC, it can serve as an additional source of funds for doctors ready to retire.
In essence, safeguarding your financial future doesn’t have to be about “selling” your medical practice. By planning ahead and employing a few of these techniques, you can ensure a solid retirement.
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How to Make a Good First Impression with Patients
Source: Urology Times
Date: 04/15/2009
First impressions matter in other aspects of your life: business meetings, dates, and so forth. But they also matter when you first meet with a patient. An article in Urology Times gives some tips on ensuring that your practice makes a strong impression upon new patients, and a good one at that.
The impression patients get upon visiting your practice plays heavily into how they’ll perceive it in the future. The more positive the impression, the more likely you are to have repeat patients who spread favorable word of your practice among others. The following are just a few touch points you’ll want to ensure so that patients come away with a positive impression of your practice.
-If your office environment looks rundown, patients will think you operate a rundown practice, and that’s likely to color their impression of their visit.
-Dead plants and ancient magazines in the reception area are a sign of neglect. The reception area is the first thing patients see upon entering, and the effect should be calming and comforting.
-If the restroom in your practice looks like a gas station bathroom, you’re in trouble. Patients particularly take note of such things as they begin to form a judgment about returning.
-A telephone call scheduling an appointment is often the first contact a patient will have with your practice; so it’s best to make sure that it is a pleasant interaction.
-Your staff members are your ambassadors, spending more time with patients than you will, in all likelihood. Thus, they should be trained in courtesy and etiquette, and in displaying caring and compassion to every patient.
-While you may be most comfortable in casual clothing or a scrub suit, studies have shown that the white coat inspires patient confidence and ease of communication.
-Pamphlets and printouts should be available to patients regarding their conditions. These educational handouts should be crisp, clean, and easy to read.
-The stationery with which you communicate with patients reflects directly on how they perceive your practice. The same goes for business cards. Make a positive impression with tasteful, professional stationery, business cards, and invoice notices.
-Everyone’s on the web nowadays. Your practice should be, as well. Make sure your web page is easy to find and navigate. Additionally, ensure that all content is current and useful to your patients.
-Patients expect to hear from you when you say they can expect to hear from you.
In dealing with patients, you should protect your first impression just as strongly as you would your professional reputation, as the first impression is the first step toward building such a reputation. Making sure your practice is presentable in these areas will take you a good amount of the way toward making sure your patients leave that first visit with a glowing impression of your practice.
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Customer Loyalty
Source: H&HN Magazine
Date: 04/01/2009
In these tough times, hospitals are sure to be deluged with advice from economic and business consultants with complicated strategies and cost-cutting measures meant to help them weather the current economic climate. An article in the April issue of H&HN Magazine, though, contends that the easiest—and maybe most effective—measure for hospitals to follow right now is a simple, customer service-oriented strategy: put a focus on customer loyalty.
For the short term, reductions in staff, expenses, and the like may result in a more palatable bottom line; but these are not, in fact, measures that will result in long-term fiscal stability. On the other hand, an average 80% of patients have consistently laid claim to a hospital as their “own.” Additionally, loyalty-related reasons—having always gone to a particular hospital; having a strong image of personalized care; a doctor’s recommendation; overall positive reputation; a friend or relative as employee; memorable staff experiences—constitute more than half of the top ten reasons consumers prefer particular hospitals.
An institution should do everything it can to ensure that consumers identify that institution as “their” hospital. Patients having a positive experience at a hospital are more likely to return for future services and enhance the facility’s reputation by word of mouth. Loyal doctors admit more patients to hospitals. Loyal employees are more likely to provide positive experiences to patients.
Administrators shouldn’t forget to account for the well-educated nature of the modern health care consumer as well. Consumers know more about hospitals than administrators would think, and they believe they know more about which area hospitals provide the best care. So they seek the advice of friends, family, and physicians for their health care services. Also, consumers increasingly turn to the Internet for information. All of these are avenues by which, if you have a loyal patient base, favorable word of your institution can spread.
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The Power of Public Relations
Source: H&HN Magazine
Date: 04/28/2009
It’s no secret that the modern hospital faces challenging times. Executives face declining revenues, soaring costs, and weighty financial commitments, all the while struggling to decide on essential programs and services and the correct balance of funding across an institution. In response to these circumstances, an article in H&HN Magazine cautions that care should be taken in making changes to program budgets. Sound financial stewardship doesn’t mean cutting items that don’t directly affect patient care. In fact, preservation of some of these items can actually help you in the long run.
The article cites public relations as an example of an item that might seem like it could be cut, but should not be touched. Management of perception and influence over employer and consumer purchasing allows hospitals to distinguish themselves among peers.
Public relations departments, the article argues, allow hospitals to educate the public in tough times. Customers become more selective about their health care choices, and it is incumbent upon organizations to get their brand out there and build support. Additionally, the PR department can help solidify support among employees in times of salary freezes and benefits restructuring.
Public relations departments are also the most cost-effective way of message dissemination, as advertising in all its forms is generally more expensive than is a public relations initiative. As such, administrations should ensure that their PR departments are strategically driven and directly tied to larger organizational objectives. Properly executed, public relations work will provide a better return on dollars that would have been spent on other marketing forms.
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Understanding ‘Own-Occupation’ Disability Insurance
Source: Physicians News
Date: 04/14/2009
When selecting an individual disability insurance policy, it is essential for physicians to properly educate themselves about the differences between contracts. An article in Physicians News explores the particulars of the three best levels of coverage for physicians.
-True Own-Occupation with medical specialty protection language—This option covers you in the event that you are unable to perform the material and substantial duties of your medical specialty due to sickness or injury. “Your occupation” is understood to be the one you were performing at the time of your injury or sickness. This option allows physicians the ability to continue to work in the medical field and earn an income even though they do not get to work in their previous specialty.
-True Own-Occupation without medical specialty protection language—This option is essentially the same as the preceding one except that it does not cover you if your sickness or injury forces you to abandon your specialty but allows you to continue working in the medical field. The benefit continues to be paid if the beneficiary takes up work in a non-medical field.
-Modified Own-Occupation—This contract pays a benefit in the event the disabled person cannot perform specific occupational duties in their field but does not pay out if that person continues to work in any field.
In choosing between these options, it is advisable to weigh what matters to you. Medical specialty language allows you to ensure the protection of your training and education in the medical field in the event an injury prevents you from practicing your specialty. Some physicians may deem this unnecessary. The choice is really dependent upon specialty and individual taste.
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Rethinking Disability
Source: The New Physician
Date: 04/01/2009
According to a recent article in The New Physician, the professional path for physicians with disabilities is “difficult and sometimes paved with discrimination” and roadblocks.
One difficulty lies in the system of medical schools being individually responsible for defining the “technical standards, reasonable accommodations, and educational objectives” that produce so-called “undifferentiated” graduates. The author believes that the variation that flows from this system can “result in acceptance and accommodation of a student with a disability at one school but not another.” In anticipation of this problem, many medical schools require accepted applicants to agree that they can meet the “technical standards” without reasonable accommodations. Furthermore, if an accepted applicant does have a disability, it must be identified at this point in the process, after which the school decides whether reasonable accommodations can be offered.
According to Dr. Joel A. DeLisa, chairman of the Department of Physical Medicine and Rehabilitation at the University of Medicine and Dentistry of New Jersey, the preoccupation with other types of diversity among medical schools results in disability being pushed out of the spotlight. And while graduating medical school with a disability is difficult enough, similar problems persist for these doctors during residency and as working physicians.
With the goal of helping medical schools reassess and improve their policies regarding the disabled, DeLisa has made numerous recommendations. Most prominently, a paper published in the American Journal of Physical Medicine and Rehabilitation pointed out the need to gather accurate statistics regarding medical students and physicians with disabilities. Further, DeLisa encourages disabled students and physicians to document their experiences in the hopes that this could lead to the development of solution models.
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