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Spirituality and Health: The Art of Compassionate Medicine
By Christina M. Puchalski, M.D., FACP.
Dr. Puchalski currently serves as the Executive Director of The George Washington Institute for Spirituality and Health and also Professor of Medicine and Health Sciences at The George Washington University School of Medicine and Health Sciences. |
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The Role of Spirituality in Medical Practice
Volume I, Number 6 of the Jackson & Coker Industry Report focused on healthcare providers’ use of complementary and alternative medicine. A major emphasis in the special report and guest feature article in that issue was recognition that body, mind and spirit are integrated and that interplay must be appreciated by caregivers who adhere to some facet of “holistic medicine.”
This issue includes a special report on “Spirituality and Medicine.” It examines the study of spirituality in medical education, the correlation of health outcomes, positive and negative coping mechanisms, and striking a balance between patients’ spiritual needs and physicians’ adherence to scientific methodology in diagnosing and treating illness.
We’re also featuring a guest article entitled “Spirituality and Health: The Art of Compassionate Medicine” (originally printed in Hospital Physician in 2001) by Dr. Christina Puchalski, a distinguished professor who has devoted considerable study to exploring the relationship of spirituality and health. The implications of her insightful research for medical education are particularly enlightening.
Other articles of interest in this edition include: “The Future of Healthcare,” “Cross Generational Recruitment and Retention,” “Playing Hardball with Payers,” ‘Health Reform Can Cut Errors,” and “Developing a REAL Marketing Strategy,” among others.
Our intent is to offer content that is informative and stimulating to all segments of our expansive readership—now numbering over 200,000 monthly.
Cordially,
Calvin Bruce
Managing Editor
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Risk Management Tip of the Month: Be sure to track and review results of all lab studies ordered.
"Risk Management Tip of the Month supplied by PRMS, Inc., Manager of The Psychiatrists' Program" www.psychprogram.com.
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Physician Shortages Threaten Service Line Development
Source:
Healthcare Strategy GroupHealthcare Strategy Group
Date:
03/03/2010
Which specialties are being impacted the most by the physician shortage? A new report from Healthcare Strategy Group takes a look at the numbers, finding that the physician shortage is having multiple effects on the recruitment and compensation of physicians, even leading to difficulties in developing and maintaining service lines.
Recruitment costs and salaries are on the rise for a number of specialties that are in short supply. Cardiovascular services, neurosciences, orthopedics: four out of the top seven shortages were in specialties connected to those service lines.
Cardiology services are in particular demand due to the aging of the population and, ironically, the success rate of the specialty, which leads to more and more chronic patients in need of service. In 2009, there were 752 graduating residents and fellows in cardiology, while there were 3,300 openings advertised. As a result, hospital employment is on the rise.
In orthopedic surgery, 3,002 openings existed for 629 graduates. In 2009 there were more than a thousand openings in this specialty left unfilled. Neurology fared little better, with the graduating resident supply able to fill less than a quarter of openings.
Hospitals looking to overcome these shortages are increasing physician pay, but experts also contend that there are other methods of addressing the challenge. They recommend service line strategic plans, co-management deals, hospital employment, incubator models, and generous call packages as means of attracting needed talent to institutions.
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Many Health Professionals Buying iPad, but Its Effect on Healthcare Still in Question
Source:
HealthLeaders Media
Date:
04/05/2010
For media consumption purposes, the iPad might be an okay computer, but will it work as a medical information tool? A number of early-adopting physicians happen to think so; but it remains to be seen whether the device will be able to fully integrate into medical practice, or whether it’s just a flash in the pan.
Apple released its newest digital consumer item in early April of this year to much adulation and attention from not just the technology media, but the wider media on the whole. The touchscreen device–bigger than a smartphone, but smaller than a laptop–has programmers and professionals of various industries trying to find ways to expand its use to areas beyond media consumption. In the medical field, a number of early adopters are picking up the device for personal use, but also hoping it will have some impact on the way they deliver care.
With the right sort of EMR implementation, the iPad–along with other tablet computing solutions from HP, Google, and Microsoft–could prove to be a physician’s best friend: a handy, capable digital repository of any kind of patient information from charts to images to patient history. For that reason, EMR software companies are quickly moving to push out offerings for Apple’s tablet, which is handier to perform certain tasks than a smartphone due to its larger screen and greater processing power.
As of yet, organizations and physicians are just feeling out where the device can fit into their workflows. But don’t be surprised in the future, though, if you’re going over a patient’s MRI images on a handheld touchscreen computer.
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Brides Turn to Doctors to Help Them Look Better for Big Day
Source:
American Medical News
Date:
03/22/2010
The wedding day is, of course, a huge day, and a costly one at that. Americans spent $59 billion on weddings in 2008. More than a quarter of a billion dollars was spent on weight loss services before weddings, showing that Americans want a perfect body for that special day and don’t care if it hurts their wallets. So is there an ethical issue to consider when they turn to physicians to make themselves glamorous for that special day?
Exact figures on pre-wedding medical services aren’t available, but there are definitely physicians who dedicate resources to recruiting patients interested in them. Some physicians pitch their services at bridal expos, while others even host bridal expos within their clinics. One Florida plastic surgeon claims that these sorts of events put his practice directly in front of its target demographic. Few of these physicians would qualify this market as a big part of their practices, but they admit that it’s definitely a solid contributor to their bottom lines.
This practice raises ethical concerns among experts who worry that physicians trying to capitalize on wedding anxiety may be pushing unnecessary, and under normal circumstances, unwanted procedures. Others raise concerns that the practice trivializes physician professionalism. Physicians engaging in this market counter that more effective marketing doesn’t adversely affect their professionalism.
And, as if surgery before marriage wasn’t enough, some physicians claim they’re receiving even more business from another group of people hoping to look their best: the recently divorced.
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The Future of Healthcare
Source:
Physicians Practice
Date:
04/04/2010
The pace of technological advance is moving the world of medical practice into uncharted territory. Already, professionals are at work rethinking the traditional reimbursement model, finding ways to make payment for other services work. Instead of in-office visits, you’re likely to find your practice billing payers for teleconferencing with patients, or giving opinions via email. Online visits–likely to increase in the future–improve access to care for people in rural and underserved areas while allowing physicians to control their schedules in an innovative manner. Also, payers are increasingly willing to pay for group visits, which allow for greater efficiency in treatment and at the same time gives patients a built-in support group.
In the future, we’re also likely to see the rise of the hybrid concierge practice, in which practices can extend concierge services to those patients that desire them, while keeping other patients in the practice loop, allowing for greater flexibility and a degree of freedom from the payer model that is sure to appeal to practices. In the future, the physician is likely to take on more of a coordinating role. The coming years are likely to see specialist tasks done more by generalists, while non-physicians take on generalist tasks. Some worry that this may eventually lead to a marginalization of the physician in the medical workplace, but only the future will tell how this all ends up.
EHRs, e-prescribing, patient registries: these are just the beginning. As personalized medicine moves to the fore, you’re going to need an EHR capable of storing and presenting information in an accessible way, and technology by which to access that EHR system.
And, of course, one can’t leave the payment system on the whole out of the equation. The recent health care reform bill ensures that the payment system will undergo a period of change. One likely outcome is an increase in the rate at which doctors opt for hospital employment. Integrated health systems are more able to bear the cost of technological implementation; so the fate of the private practice model is in question.
While we’re likely to see some form of these predictions coming true, no one actually knows where the field will end up in ten or fifteen years’ time. What is certain, though, is that you need to think creatively about the way you deliver care. A certain amount of flexibility will be necessary to navigate the health care landscape of the future; but if you’re open to change, your practice will find itself on strong footing no matter what the coming years bring.
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Pfizer Details Payments to Doctors and Researchers
Source:
The New York Times
Date:
03/31/2010
Pharma is coming clean about contributions to physicians, nurse practitioners, and academic medical centers. Critics, though, maintain a healthy level of skepticism, as one of the world’s largest pharmaceutical companies starts putting its dealings online.
Pfizer, the world’s largest drug maker, recently announced that it had paid about $20 million to 4,500 medical professionals over the last six months of 2009. This money was dispersed as payment for consulting and speaking on Pfizer’s behalf. The pharma giant also paid $15.3 million to 250 academic medical centers and research groups for clinical trials over the same period. The disclosure is the first of its kind to include clinical trial payments, even though it doesn’t disclose payments outside the United States.
The disclosure comes as the pharmaceutical industry tries to get ahead of a rising public sentiment toward greater transparency in pharmaceutical funding of the medical industry. Pfizer recently settled a federal investigation involving illegal promotion of drugs for off-label uses for $2.3 billion, the largest criminal fine of any type in the nation’s history. Pfizer representatives claim that the recent revelations are part of a larger “march to disclosure” started in 2002.
The figures on doctor payments are available online at a company-generated website. The site is searchable by doctor name, but critics contend the data isn’t easily analyzable or downloadable. Other critics claim that the data may be incomplete. These critics call for an independent auditing process to accompany these disclosures
A survey of more than 3,000 physicians conducted in 2007 across six specialties found that 94 percent had some relationship with drug companies, receiving free meals and pay for consulting, speaking, or enrolling patients in clinical trials.
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Cost Consciousness in Patient Care–What Is Medical Education’s Responsibility
Source:
The New England Journal of Medicine
Date:
03/31/2010
Cost is the elephant in the room. America spends more on health care than any other developed nation and receives fewer benefits from that money. Of course, most involved parties have put forward some idea of how to control costs, but are we overlooking a very simple solution? Could spiraling health care costs be brought under more control by simply teaching medical students to be more cost aware?
Numerous attempts have been made over the years to engage physicians in addressing costs controls. In the 1970s, some tried academic detailing, wherein pharmacists would inform doctors of cost-effective prescribing patterns. This strategy proved unsuccessful. Later attempts at administrative solutions were poorly received by both physicians and patients.
There is the argument now, though, that the very manner in which physicians are educated leads to an unhealthy mindset regarding cost. The inpatient education system exposes young doctors to patients for the first time in what is one of the most expensive of medical settings, the hospital room. This–in combination with a philosophy that each patient must receive the best possible benefit at all times and cultural values that stress the “high knowledge” of medicine over real-world concerns such as cost cutting–leads to a culture in which it is impossible to get doctors to envision cost effective practice.
The alternative? It starts with informed-consent conversations with patients that realistically break down the potential benefits and risks of a procedure, establishing a sense of value, not just cost. Next, it is necessary to abandon the mindset that the physician is the advocate for maximum benefit for each and every patient. Value-based decisions are made all the time in medicine; so why should cost be any different? Finally, medical students should be educated in such a manner that they have the opportunity to develop and use cost-conscious strategies for patient care. A new, cost-aware medical industry will be impossible if we aren’t educating future physicians to take cost into account.
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To Help Pay for Reforms, Medicare Fraud Ripe for Plucking, Top South Florida Prosecutors Say
Source:
The Palm Beach Post
Date:
03/31/2010
Florida: America’s retirement home, tourist destination, and...Medicare fraud capital of the country? Such is the case according to federal investigators, who are likely to turn a cautious eye to the Sunshine State in an effort to eliminate $500 billion in waste and fraud from Medicare over the next ten years.
Fraud and waste reduction figures greatly in Democratic efforts to pay for the recently passed health insurance reform law, and Miami in particular has proven to be a hotbed of Medicare fraud. Federal investigators claim that Miami, in particular, accounts for more than half of the money paid out by Medicare for home health care services nationwide, despite having only two percent of patients receiving such care.
Digging just under the surface, investigators have uncovered nonexistent companies billing for services, homeless people selling the use of their names to criminals, and crooked referral schemes among physicians and registered nurses.
Experts contend that the problem arises from the manner in which Medicare is dispersed. Medicare typically pays out a claim quickly and only inspects for fraud afterward. Some contend that Medicare needs to be more proactive in seeking out fraudulent claims before dispersing funds. This would likely necessitate alternate identification methods for Medicare beneficiaries beyond the current Social Security number. While such a move would create some difficulties and could require heavy investments up front, if the result is to save several hundred billion in reduced fraud, fraud tracking, and litigation, it may be time to take a closer look at this option. In the meantime, at the least, the government’s intensified efforts to recoup fraudulent claims could still result in significant savings for taxpayers.
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Cross Generational Recruitment & Retention: It’s Still All About Communication
Source:
Journal of the Association of Staff Physician Recruiters
Date:
01/01/2010
The job of the modern staff recruiter involves interacting with candidates from across five generations. That’s a wide span, reaching from Howdy Doody to MTV and beyond. What’s more, each generation tends to have its own particulars in how it likes to communicate and be recruited. These days, limiting your marketing and recruitment efforts to too small an area means you’re going to miss out on a number of candidates; so it’s best for recruiters to cast a wide net.
Of course, the latest trend is social networking: Facebook, Twitter, and so on. What’s necessary to keep in mind, though, is that while these networks can connect you to potential recruits in ways never before possible, they only connect you to those recruits who are actually actively involved in those networks. If a recruit only checks a network once a month, but the recruiter posts information three times a week, the recruiter is wasting effort and is likely better served posting within their company’s intranet, a practice that can get medical staff spreading the word within their own circles of colleagues. Recruiters should also look to make use of alumni associations, as older generations are keener on using these as job search tools.
While some recruits might be hooked on e-mail, and others might not be able to go five minutes without looking at their Blackberry, it’s essential to remember that not everyone is fully invested in the digital culture. Some people will still prefer face-to-face meetings or phone calls at home. The key is to tailor your approach to the individual and be persistent.
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Boost Morale by Asking Workers What’s Bugging Them
Source:
American Medical News
Date:
03/01/2010
Nursing staff been a bit snippy lately? Or maybe the administrative staff’s lost that gleam in their eyes? If your staff morale seems to be low, and you just can’t figure out why, why not try... asking them?
A survey conducted by the Conference Board found that only 45.3 percent of those who were employed in any sector are satisfied with their jobs. Among health care workers, a CareerBuilder survey found that one in five reported low morale. If you’re thinking your workforce is the exception, and you don’t have facts to back that up, then you might be deluding yourself. Even if you’re paying competitively, employee morale can still be low for reasons you wouldn’t even consider.
In order to avoid morale issues or keep them from escalating, talk to your staff. It can be as simple as asking “How are things today?” or as involved as holding employee meetings. If you do hold meetings, you might find out things you hadn’t even suspected, such as negative behavior by one of your administrators, or the lack of proper coat storing facilities. These sound like small things, but it’s the little things–like a proper coat rack or an employee-of-the-month parking space–that matter when one’s been in a job for years on end.
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Aligning Physician Incentives with Hospital Objectives
Source:
H&HN Magazine
Date:
03/29/2010
Improving patient outcomes should be about as simple as paying physicians for following best practices, no? Unfortunately, it’s not that simple. Hospital initiatives to give physicians a financial stake in patient outcomes by incentivizing quality improvement practices run the risk of violating regulatory measures aimed at combating kickbacks and anti-competitive practices. But there is hope: a number of recent regulatory moves show that the government is, indeed, looking at ways for hospitals to more easily give doctors a greater stake in quality of care.
One common method of improving quality of care involves the practice of “gainsharing.” Under such an arrangement, a hospital pays physicians a portion of the savings attributable to the physician’s quality improvement efforts: hand washing, checklist following, and so on. This arrangement, though, can run afoul of prohibitions in the Civil Money Penalties provisions as well as the Anti-Kickback Statute. A gainsharing agreement can, though, maintain compliance with the law, so long as it involves hospitals aligning incentives with physicians to achieve savings that are not in violation of the aforementioned provisions.
Pay-for-performance programs are another method of improving quality. In the case that a hospital is participating with an insurance company’s pay-for-performance initiative, such a hospital might well qualify to share a percentage of any bonus compensation with physicians as a means of incentivizing quality improvement measures.
Both of these methods run the risk of violating government regulations if improperly implemented. Recent moves by CMS, however, indicate that the government is softening its stance on these and similar methods in an effort to combat rising costs. In its 2009 Proposed Physician Fee Schedule, CMS had a regulation that made space for gainsharing and pay-for-performance arrangements. While the proposed regulations were eventually withdrawn, the agency did solicit further public comment on additional matters relating to shared savings and pay-for-performance. It is likely, then, that the future will see some sort of special carve-out in the regulatory space for just this sort of measure.
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Private Practice Physicians Make More Than Those In Academic Practices
Source:
Healthcare Finance News
Date:
04/05/2010
Academic physicians continue to see their earnings lag behind those of their private practice peers. This assessment is according to new figures out from the Medical Group Management Association.
MGMA’s report–“Academic Practice Compensation and Production Survey for Faculty and Management: 2010 Report Based on 2009 Data”–found that compensation for primary and specialty care groups in academic practice increased less than three percent in 2009. This represents a slowing in growth from 2008 to 2009. Additionally, the study showed that academic practice compensation has consistently lagged behind private practice compensation from 1999 to 2009. The study authors attribute this to the greater proportion of patient care revenue in private practice, as well as the lower reimbursement potential for teaching and research activities.
The study also found wide variance in the level of payment increases for assorted specialties within academic practice. Cardiologists saw 7.29 percent increases in compensation, while neurologists saw a decrease of 2.52 percent. Ophthalmologists saw a 9.35 percent rise, and median care for primary physicians increased in three of four geographic sections. Study authors attribute the fluctuations to location, faculty rank, and productivity.
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The “Medical Occupation” Definition of Disability: Don’t Believe the Hype
Source:
Physicians News
Date:
04/09/2010
Thanks to a new product now offered by a well-known insurer, physicians have more options when it comes to long-term disability coverage and the type of work disabled doctors are permitted to do and still receive benefits. While having more options is generally a good thing, the author of a recent article in Physicians News worries that doctors may not fully understand what this new insurance offering would require of them should they become disabled. For starters, it’s important to outline the most important differences between the product, which as being sold as “Medical Occupation” insurance, and “own-occupation” insurance as it is commonly sold.
The standard in medical disability insurance is “own-occupation” disability. According to the author, the main benefit of this type of coverage is that in the event of “total disability,” meaning that you are unable to perform the “material and substantial” duties of your occupation due to illness or injury, you are entitled to full disability payments even if you decide to pursue a career in another field. The choice is fairly straightforward for disabled physicians under this policy: if you want to receive disbursements from the policy, you must stop working in the medical field; but outside of that, you are free to do what you want and receive full benefits.
The gap in coverage that “Medical Occupation” insurance seeks to fill is when disabled doctors wish to continue working in medicine in some capacity but need disability benefits as well to make up for their reduced income. The insurer claims this opportunity is particularly relevant because many disabilities in the field do not qualify as total disability and thus are not or should not be covered by own-occupation policies. The author of the article portrays this claim as misleading as it pertains to payouts from the typical own-occupation insurer.
Furthermore, the author wishes to make clear that the options for disabled physicians covered by a “Medical Occupation” policy are to continue working in medicine for a reduced salary and partial benefits or to cease working entirely (in any occupation) and receive full benefits. It is the opinion of the author that it is unfair to keep doctors from both receiving benefits for the loss of a job in which so much was invested and trying their hand at gainful and satisfying employment until they are ready to retire. It is this third option that is expressly prohibited in the new coverage product.
While the article has a definite bias, one of the most important messages is that it is essential for physicians considering a disability policy to do their homework and examine the particulars of payouts and requirements. The last thing you need in the unfortunate event you need to make use of your policy is to learn you do not have the coverage you thought you did.
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You the Physician: Your Own Worst Enemy
Source:
Medical Economics
Date:
03/19/2010
When malpractice attorneys let slip a few tricks of the trade, the things they say might well surprise you. For instance, if you find yourself on the losing end of a lawsuit, you might want to look in the mirror for the person to blame. That’s right: when it comes to losing lawsuits, you may find as a physician that you do it to yourself.
Juries love doctors. Really, they do... at least more than lawyers. And malpractice attorneys admit that physicians generally have the upper hand in malpractice suits. So how do they turn the tables? They get a helping hand from physician arrogance and ego. If you have a hard time thinking you’re in the wrong, you might be heading for legal defeat. And with medical malpractice claims costing $3.6 billion dollars in 2008, arrogance is a luxury you can’t afford in the court room.
So how do you avoid a lawsuit? First off: if you’re thinking about altering medical files to clarify or fill in gaps after a suit has been filed... don’t. Malpractice lawyers are experts in detecting post facto alterations, using an array of technologies and tactics from handwriting experts to infrared spectroscopy. And you won’t just suffer the consequences in trial: record alterations are reported to a number of professional organizations and licensing boards, which could affect your privileges and even your licensure.
Next: treat every case seriously. Even if you think the case is a joke with no grounds, it isn’t. Despite what you may hear reported in the media, attorneys don’t commonly take up “frivolous” cases, as a typical case costs tens of thousands of dollars to properly prosecute. Attorneys pick cases they know–through experience–are likely to sway juries. They also say that a number of cases wouldn’t even get off the ground if physicians took more time to talk to–not talk down to–their patients. If you’re leaving questions unanswered, if you’re not apologizing for things that go wrong, then you’re possibly leaving the door open for litigation.
So, when you’re heading into a malpractice case, lose the attitude, and come prepared. If you’re unable to answer what appear to be basic questions about the particulars of a patient’s treatment, or if you admit ignorance of key aspects of the case, you’re not exactly helping yourself to dispel notions of negligence. Finally, cases are most often lost in deposition rather than trial; so treat all aspects of the case with the humility a court of law deserves. You might just save yourself in the end.
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Mo. High Court Narrows Medical Malpractice Limits
Source:
BusinessWeek
Date:
03/24/2010
The scope of medical malpractice reform law in the state of Missouri was narrowed recently in a State Supreme Court decision that might portend a wider rollback of the state’s recently adopted malpractice laws.
The case centers around two St. Louis residents and the suit they brought against a physician and the Metro Heart Group of St. Louis. The suit alleges negligence as the cause for one patient contracting a staph infection following the implantation of a pacemaker in 2004.
In 2005, the state of Missouri enacted a malpractice reform lawsuit that lowered the cap for non-economic damages in lawsuits to $350,000 per lawsuit for any case filed after August of 2005. When the plaintiffs filed suit in 2006, a jury awarded them more than $2.5 million in damages, more than half of which was non-economic damages. A trial judge later reduced the non-economic damages total under the cap imposed by the 2005 law.
Under the Court’s recent decision, though, the damages have been reinstated to the plaintiffs. The Court argues that the Missouri Constitution’s prohibition on retroactive laws means the state’s malpractice limits cannot apply to lawsuits based upon injuries that took place before the lawsuit took effect.
Adding to the potential impact on the state’s system are two concurring opinions by justices that claim the jury award portion of the law should be stricken for violating a person’s right to equal-protection. Experts maintain, though, that the law will likely stay in place until another patient takes up the issue and brings it before the court.
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Judge Invalidates Human Gene Patent
Source:
The New York Times
Date:
03/29/2010
The personalized medicine industry was shaken up recently with a decision by a federal judge that could cast doubt upon the validity of patents covering thousands of human genes. Patient advocates and civil liberties activists call the decision a triumph for human rights, while critics maintain it represents a serious affront to the progress of medical technologies.
The decision centers on the BRCA1 and BRCA2 genes, which have been linked to breast and ovarian cancer. Myriad Genetics holds the patents on those genes along with the University of Utah Research Foundation. The plaintiffs in the case argue that the genes are unpatentable, in that they are products of nature, and the patents stifle research, innovation, and testing options, due to the price Myriad charged for the genetic tests to determine likelihood of developing the diseases.
Myriad and other patentholders argue that the process of isolating the DNA from the body transforms it and that that is what they patent. Such patents have been granted for decades, with the Supreme Court upholding a patent on living animals in 1980. This decision, though, casts doubt on the validity of those patents.
About 20 percent of human genes have been patented, and much of the structure of the modern biotechnology sector is built upon the intellectual property rights such patents secure. Biotechnology industry representatives caution that the prices made possible by the extant patent system constitute the main incentive for biotechnology researchers to look into curing the sorts of diseases their patented developments treat. Without them, they contend, this research will likely fall to universities and the federal government, which could slow the pace of discovery.
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State Looks to Protect Volunteer Docs from Malpractice Suits
Source:
HealthLeaders Media
Date:
04/01/2010
Are malpractice laws regarding volunteering of physician aid services keeping physicians from helping out California’s poorest residents? That’s the assertion that’s driving a new piece of legislation, which seeks to protect California physicians when they’re providing aid under the auspices of the state.
In California, a physician who is sued for providing care as a volunteer isn’t covered under her own current medical malpractice coverage unless she purchased an expanded policy. These policies can run in price into the thousands of dollars. California is one of only seven states in which this is the case. Some experts on the subject contend that the state would have a much higher rate of physician volunteerism were the state to enact some sort of volunteer malpractice protections.
Experts contend that the malpractice issue will have a sizable impact, in that there are actually very few instances of litigation for volunteer services, but the fear of possible action keeps many physicians away.
A bill introduced recently, though, would have the state provide medical malpractice insurance to physicians and surgeons providing unpaid services to the state. Under the bill, the volunteering physician would become an employee of the state for the duration of the services provided. Other states have adopted models granting immunity except in cases of gross negligence, and still others purchase professional liability insurance for physicians or reimburse them for their premiums.
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Lawyer Repellant
Source:
Physicians Practice
Date:
03/03/2010
Steering clear of the courtroom isn’t just as simple as good practice. Your practice needs a procedural structure in place to make sure you’re operating in the safest manner possible, both for the good of your patients and the legal health of your practice.
The first thing to consider is communication. If you’re not properly relating information to patients in a timely manner, you could be setting yourself up for a summons. But it’s not just relating lab results: your practice will need to set expectations for patients. If an iodine shot is going to leave skin discoloration, or if a surgery will affect a patient’s athletic performance, relate these things in a manner the patient can clearly understand. Also try to provide patients with pamphlets before they leave, where applicable. Finally, if something does go wrong, speak plainly with patients about their case and show empathy throughout the process.
It’s also good practice to document everything you can: correspondence, orders... everything. Make sure that a log is kept of all patient contacts. You may even want to consider getting a voice recording system for practice phone lines. That way an audio record exists of all patient contacts. Take time to look at your whole documentation process. Note and address any gaps that could endanger patients or the practice, whether they involve in-lab tracing, information handling, or patient contacts. It’s also helpful to keep up-to-date documentation of your and your partners’ job competency: conduct fitness-for-duty evaluations at certain ages. These and other checks should be built into practice policy, so as to be evenly applied.
Of course, having all these ideas down on paper doesn’t in itself protect you from liability. You’ll have to make sure your practice fully comprehends the new policies and their importance to the practice’s legal health. And, finally, if you’ve implemented these cautionary measures and some patients still seem like a liability, don’t be afraid to sever ties with them. If a patient seems unable to get along with physicians, that is a patient that’s more likely to sue. Medical practice is a consensual relationship, and you shouldn’t be afraid to cut ties with a patient that endangers the well-being of your practice.
Above all, practice good medicine: doing the right thing for patients is the best way to steer clear of the courthouse.
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CVS to Double In-Store Clinics After Health-Care Law
Source:
Bloomberg.com
Date:
04/13/2010
The recently passed health insurance reform law is likely to result in a massive influx of newly insured patients. The oncoming wave of patients is expected to overload the already suffering primary care system, but some aid is coming from a relatively unexpected provider: the retail clinic.
CVS Caremark Corp., the nation’s largest prescription drug provider, has announced that it will double the number of in-store medical clinics it operates within five years. Executives for the company note the recent health care legislation’s role in expanding insurance access as a motivating factor in the decision to expand their clinic offerings.
CVS doesn’t make money off the clinics, but hopes to reduce their costs to the point that they break even. As such, the clinics will serve as a sort of no-cost traffic attractor for CVS stores. The company–the largest retail clinic operator in the country–operates about 500 clinics in 25 states, though right now they are busiest around flu season. Currently, the clinics focus on acute care: earaches, strep throat testing, and so on. Plans exist, though, to build on previous service expansions to include chronic illness care services.
CVS isn’t the only retailer looking to expand its clinic offerings. Walgreen Co. and Wal-Mart have both recently announced plans to expand their retail clinic presence.
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Direct Admissions: VIP Treatment or Risky Business?
Source:
Today’s Hospitalist
Date:
02/03/2010
Direct admissions can constitute a problem for hospitalists. While they help referring physicians ensure that patients are not subject to lengthy triage in emergency departments, it is also often the case that hospitals have to end up dealing with issues other than those for which the patient was admitted. Nonetheless, direct admissions can be an important market differentiator and driver of revenues for hospitals; so hospitalists are now more commonly being coerced or encouraged through incentives to find ways to accommodate more direct admissions at a minimal cost to the hospital.
Some organizations are taking steps to develop formal policies for direct admissions. One institution has a policy that demands eligible patients be in the primary care office when the doctor calls; that the doctor’s diagnosis is fairly certain; and that the patient is not critically ill or unstable. These sorts of regulations are helping institutions cut down on improper direct admissions. Another key factor in the decision of whether or not to admit is the hospitalist’s familiarity with the referring physician and/or patient. Referring physicians that have established trust with a hospitalist are less likely to request admission for uncertain conditions or to misrepresent the facts of a case to gain immediate admission for their patient.
Groups aiming to facilitate direct admissions sometimes keep a hospitalist on call in each hospital. Referring physicians are patched through to on-call hospitalists, to ease the transition process. Groups like this also tend to have safety nets built into their admissions policies. In such a policy, direct admits are flagged in the ED. They then see the admitting hospitalist in that designated area, who performs diagnostic tests. Patients found to have vitals outside of an acceptable range are then transferred to emergency physicians. The result is that direct admissions make it through the admission process more quickly than they would in the regular ED queue, but improper admissions don’t necessarily clog up the system for others. Thus, a workable balance can be achieved in which upwards of 50% of direct admissions requests are accommodated while still giving hospitalists leeway to avoid the most problematic cases and possibly earn a bonus for their troubles.
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Cancer Research by U.S. Disorganized, Underfunded, Study Says
Source:
BusinessWeek
Date:
04/15/2010
Why is it that four out of ten late-stage trials in the government’s cancer research network are abandoned before completion? A new study from the Institute of Medicine says that work within the network, which is an important alternative to the research funded by private pharmaceutical companies, has become too complex and inefficient and that the network is approaching a crisis state.
Cancer–at more than half a million deaths per year–is second only to heart disease in the number of Americans it kills. The nation’s leader in cancer research, the National Cancer Institute, conducts cancer treatment trials on some 25,000 patients each year through the Clinical Trials Cooperative Group Program at a cost of $145 million. The system, though, according to the authors of the most recent analysis, is near a crisis point, leading many important trials to simply fall apart.
As this group has made vital contributions to the knowledge base for cancer treatment, the Institute of Medicine recommends sizable changes that the NCI needs to implement to turn things around. Among the changes they call for are the consolidation of administrative operations, streamlined oversight of clinical trials, a more efficient trial design process, and better incentives for investigators to initiate trials. In some ways, this task may seem akin to starting over, but the relationships and means of communication developed through the network remain intact--at least for now; hence, the reference to a crisis. If changes are not made soon, the network may start to deteriorate, affecting the quality of cancer research available to the public at every step along the way.
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New Medical Imaging Technique Is Studied
Source:
UPI.com
Date:
04/15/2010
Lasers and nanotechnology continue to reshape the possibilities of medical treatment. The newest possible advance comes from experimenters in Indiana, who claim that they’ve developed a technique that could lead to earlier disease detection and treatment.
Researchers at Purdue University have pioneered an imaging technique in which gold and silver alloy nanoparticles injected into the bloodstream are detected by “near-infrared laser pulses” and used for imaging.
The new technique, researchers say, avoids the problem of background fluorescence caused by different laser wavelengths, producing clearer images that can aid in disease detection. The different wavelength also results in less heat damage to tissue, and the team responsible for developing the nanoparticles claims the radiation technique could be used to deliver time-released anti-cancer drugs, marking a promising new development in cancer research.
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Payer & Reimbursement Issues
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New AMA Tool to Help Doctors Correct Managed Care Contracts
Source:
Healthcare Finance News
Date:
03/17/2010
Unsatisfied with the contract your managed care partner is trying to push onto you? The American Medical Association has your back, as they’ve recently debuted a tool that helps even the odds in negotiating with payers.
In negotiating payment contracts, physicians are decidedly at a disadvantage with payers. Large health insurers have market power and leverage that allows them to dictate terms to physicians. To counter this, the AMA has developed a National Managed Care Contract—that is, a model contract for physicians to use—and an accompanying database that provides up-to-date information on insurance statutes. These two items are meant to give physicians a best practice base in negotiating contracts with payers.
The AMA says the NMCC and its database covers most physician concerns with contract negotiations, including business arrangements following the signing of a contract. Furthermore, the tool can help in providing alternative language support for contract negotiations, ensuring compliance with state legal requirements, clarifying contract issues, assisting legislative reform efforts, and monitoring state and federal legislative trends.
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Medicare Physician Payment Cuts Delayed (Again)
Source:
Physicians News
Date:
04/16/2010
Physicians concerned about the pending 21% cuts in Medicare reimbursement can breathe more easily--for all of the next several weeks, that is. Medicare reimbursement reductions have been forestalled at least through the end of May. Sizable cuts to Medicare reimbursements have been scheduled to go into effect for some years now, but Congress again has approved legislation that delays the payment reduction through the end of May.
Starting April 1, 21% payment cuts in Medicare reductions were scheduled to take effect. Even by then, Congress had not approved a fix to the payment cuts; so CMS agreed to delay processing claims until April 15, in hopes that Congress would pass a suitable measure. The measure passed pushes back the implementation of the cuts until May 31.
While this is a short respite, don’t look for Congress to pass any actual sweeping solution to the cuts any time soon. The AAFP’s president, Lori Heim, notes the proper overhaul’s $209B bill is politically difficult, though AMA presiden,t, J. James Rohack, points out that delays only make the needed changes significantly more expensive than they would be with quick action.
With the recent passage of health insurance reform, it is unlikely that a permanent fix for the sustainable growth rate will be passed. Instead, experts expect another temporary fix to be undertaken come June 1.
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Playing Hardball with Payers
Source:
Physicians Practice
Date:
04/04/2010
Got a meeting with a payer coming up? Don’t dread the day: effective preparation can put you in a better bargaining position. Simply by taking a closer look at your practice’s functioning, you can turn the tables on insurance companies and get the pay your service merits.
Before a meeting, you’ll want to confer with all of your staff: clinical, front office, business office, physicians–the whole lot. Have each participant in your office grade the payers you work with on an “A to F” basis, with space for comments. The results will give you a picture of which payers are the most troublesome for your practice. They’ll also tell you where you’re losing money. These can be valuable bargaining chips in negotiations. If, say, one payer consistently monopolizes your billing staff’s time with denials and paperwork, you can bring this up in the meeting: if they’re more expensive to work with; then shouldn’t you be getting reimbursed more?
Also, don’t be afraid to let payers know how they stack up to their competitors. Go into negotiations armed with your own payer report card as well as those of popular publications. If your results match what others are saying, this can help you out as well.
Furthermore, don’t be afraid to inform payers that you know your patient base. Significant numbers of employees of a large organization, senior management of a local employer: these can serve as leverage in negotiations.
You’ll also want to enter negotiations armed with the percent of revenues attributable to that payer, the number of competitors to your practice in the payer’s network, and the denial rate for the payer. If you’re more important to them than they are to you, then you can make them pay you like they should. Also have on hand the average Days in A/R for the payer and notes on any pre-authorization hurdles. You’re likely to squeeze better service out of them on these matters if negotiations go well.
When it comes to dollars and cents, the payers are likely to want to fight you every step of the way. So go into negotiations properly armed, and you’re likely to come out the victor.
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Credentialing, Licensure, Quality Management
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Health Reform Can Cut Errors
Source:
Albany Times Union
Date:
04/01/2010
Patient safety and care quality are talked about a lot these days, but a less often discussed element of the recently passed health care bill aims to do something tangible to increase quality of care: it’s hitting lower quality institutions on their bottom line.
Hospital-acquired infections account for thousands of deaths, illnesses, and injuries in this country every year. In 2008, CMS ceased payment for a list of infections it deemed completely preventable. The result was an industry-wide shift toward prevention of these infections, a result brought about because of the overwhelming importance of Medicare within the current hospital system. Now the government is trying to engender the same behaviors on a wider scale. Beginning in 2012, hospitals meeting or exceeding stroke, heart attack, and infection performance standards will receive higher Medicare payments; while institutions performing below average for pneumonia, heart failure, and other conditions will have their payments reduced.
In 2014, the list will expand to include other conditions. Additionally, each hospital’s quality profile will be published and made publicly available on the Internet. Insurers will be required to have contracts with medical providers that include actions centering on reducing readmissions and using best practices. Medicare patients account for about half of all inpatients across the nation; so the impact of these and other changes is expected to be sizable.
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State Medical Boards Disciplined More Doctors in 2009
Source:
ModernHealthcare.com
Date:
04/01/2010
In a trend that’s lasted a decade, the number of disciplinary actions filed against physicians increased 6.4 percent from 2008 to 2009. At the same time, though, the disciplinary boards filing these actions are increasingly suffering financial strains.
In 2009, state medical boards filed 5,721 disciplinary actions against physicians, a 6.4 percent increase over the previous year. This figure comes from the Summary of Board Actions report from the Federation of State Medical Boards. The Federation maintains a disciplinary alert system, in which reports from one member board trigger alerts that are disseminated to all others.
The Federation also maintains a Composite Action Index, which is a weighted average of actions taken against physicians practicing in a state as well as all physicians licensed within a state. The Index serves as a barometer of sorts to measure changes in disciplinary action levels. Recent years have seen improvements in the Index, as boards have been more stringently enforcing regulations, but such progress is coming under stress due to budgetary limitations. Most medical boards are funded by dedicated revenues from licensing fees. Strained state budgets, though, are leading to medical board funding reductions and even the appropriation of those funding fees. Experts contend that the boards’ critical role in public protection is at risk if they are not sufficiently funded.
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Hospital-Acquired Infections Continue to Plague Patients
Source:
FierceHealthcare
Date:
04/14/2010
“Quality improvement” is an inescapable phrase these days, and with good reason: reductions in adverse hospital events are expected to put a measurable dent in the nation’s health care costs. But new research figures show that, over the past decade, hospital-acquired infections have increased in frequency, and the potential consequences for hospitals are likely to be costly.
A study out from the federal Agency for Healthcare Research and Quality (AHRQ) looked at incidence rates for five common hospital-acquired infections. For three out of the five infections–post-operative sepsis, post-operative catheter-associated urinary tract infections, and selected infections due to medical care–the study found increases of 8%, 3.6%, and 1.6%, respectively. The number of bloodstream infections associated with central venous catheter placements was unchanged, while the rate in post-operative pneumonia was found to have dropped by 12%.
Additional figures from the 2009 Leapfrog Hospital Survey found that hospital quality needs significant improvement. Government and regulatory officials, of course, reacted with disappointment to these figures, indicating that they show hospitals still missing the mark when it comes to patient safety and care quality improvement. Officials did note that the recently passed health insurance reform bill does contain measures meant to rein in this sort of quality lapse. Beginning in 2015, hospitals with high infection rates will begin to suffer federal penalties in reimbursement for failure to achieve higher care quality standards.
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Feds Give Maryland’s Health Care Quality Mixed Reviews
Source:
Southern Maryland Headline News
Date:
04/14/2010
The newest edition of the National Healthcare Quality Report is out, ranking states top to bottom in the overall and particular qualities of their health care delivery. And where does the Free State rank? The results aren’t good, but Maryland’s defenders claim it’s not exactly the state’s fault.
Every year since 2003, the National Healthcare Quality Report has provided a look at the quality of care across the country. The report gauges overall health care quality as well as how a state manages particular afflictions, such as breast cancer, pneumonia, and HIV. Most states had mixed results this year, and Maryland was no different.
The state excelled in breast cancer screening and in-home care, but performed below average on pneumonia treatment and HIV-related deaths. Defenders of the state allege that the “all-payer rate” system–in place since the 1970s to keep hospital reimbursement rates equal and combat discrepancies in quality of care–is the main factor driving Maryland’s positive marks. The negative marks for the state they attribute to deficiencies in funding.
Others, though, claim Maryland’s system is too expensive, needing upgrades in Medicaid reimbursement among other areas.
The state was even or slightly below average for pediatric coordinated care and dialysis patient registration for kidney transplant waiting lists. Overall, the state ranked about the same in 2009 as it did in 2008, though a look back at previous rankings shows a decline in health care quality from 2006 to 2008. It is interesting to note, as Anne Kasper of the Maryland Women’s Coalition for Health Care Reform points out, that Maryland is one of the wealthier states in the union, yet provides subpar care in so many areas. According to Kasper, what the state needs now is a better vision for how health care services are provided to its residents.
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FCC Mobile Network Plan Could Revolutionize Health Care
Source:
BusinessWeek
Date:
03/31/2010
Could a wireless connection help you and your patients keep better tabs on their health and progress? That’s the thinking behind a recent federal initiative that’s looking to secure a slice of the mobile spectrum for miniature monitoring kits that might eventually have you taking a patient’s vital signs without them leaving their homes.
The technology is the medical body area network (MBAN), and it consists of sensors that monitor all required functions, aggregate the results, and transmit them to another location for evaluation. Hospitals are beginning to use them to monitor patients in-facility, but they can, with improvements in technology, be used in a home setting. The possibility even exists for patients to use consumer electronics such as the Nintendo Wii to interface with their hospitals and transmit vital signs.
Right now, plans are underway for the FCC to open up a portion of the wireless spectrum for use by these technologies. The spectrum under investigation is right next to the spectrum used for existing Bluetooth devices–think mobile headsets and earpieces–a convenience that may eventually reduce costs due to common device components.
The MBAN networks are already under development, and could see additional devices springing up: for instance, bracelets and bandages that monitor and transmit vital signs, or blood monitoring tools to detect infections.
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E-Prescribing Growing, but Most Practices Still Don’t Use It
Source:
American Medical News
Date:
03/15/2010
Considering adopting an e-prescribing solution? You’d be joining a growing number of physicians looking to bring such a technology into practice. And a new study out from the Weill Cornell Medical College shows that e-prescribing might not just make your practice more productive; it could also improve patient outcomes, leaving you with fitter, healthier patients.
E-prescribing has seen an uptick in use in recent years, but the technology still is only used by about one in four office-based doctors. Recent figures released by Surescripts–the nation’s largest e-prescribing network–show that electronic prescriptions accounted for about 18% of prescriptions by the end of last year. This was up from 6% at the beginning of the year. In total, 190 million out of 1.6 billion prescriptions were filed electronically.
Most physicians sending prescriptions electronically are doing so with an application in their EMRs. While many EMRs may not have been incentive-certified for e-prescribing in 2009, an increasing number are becoming so. Experts expect higher adoption rates for the technology in the coming years, with some contending that the practice is only held back by DEA rules requiring controlled substance prescriptions be written on paper.
Reports also show that physicians are more and more aware of the benefits of e-prescribing, a fact that likely impacts the sizable gains in adoption the technology is making. Surescripts representatives note that their study findings indicate that physicians are finding out about the benefits of e-prescribing, which include increased safety, lower costs, and increased efficiency.
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Will EHRs Ever Work Together?
Source:
Physicians Practice
Date:
04/04/2010
Electronic health record systems are supposed to greatly improve communication among hospitals, insurers, patients, and practices. But, with the preponderance of offerings and vendors out there, how is the industry ever going to come together to make sure all the different technologies can talk to each other?
In a perfectly interoperable world, EHRs would autopopulate with lab data, hospital discharge notes, and pharmacy histories; but the tech environment that surrounds us is far from perfect. As of right now, the EHR landscape is exceedingly fragmented, with competing architectures within specialties, from practice to practice, and so on. Add to that the fact that virtually all instruments generate some sort of loggable information now, and you’ve got a recipe for confusion.
It’s not all gloom and doom on the interoperability front, though. Leaders in the field are hard at work on data communication standards, while some are working toward the adoption of Health Information Exchanges. These regional cooperatives would serve as communication networks for the sending and receiving of health information within a particular region.
We’re still quite a ways off from the utopian digital health care workplace envisioned by some politicians and executives, but we’ll get there slowly and surely. One way you can start preparing for the future is to make sure that any EHR you purchase has the ability to operate with Continuity of Care Documents and Continuity of Care Records. These two standards are indicative of the sort of jockeying for supremacy that’s going on throughout the industry, but it’s not clear which one will win out yet; so it’s likely best to have both in your system.
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State AGs Stepping Up HITECH Enforcement
Source:
HealthLeaders Media
Date:
03/30/2010
The fight to keep patient electronic health records secure might be moving a little bit closer to home for everyone. State attorneys general are increasingly likely to become active in state efforts to enforce compliance with the Health Information Technology for Economic and Clinical Health (HITECH) Act.
The biggest recent case of a possible health information breach involves Health Net of Connecticut, Inc., which failed to secure private information for 446,000 Connecticut members and failed to give those members adequate warning of a possible security breach. As a result, the Attorney General of the State of Connecticut announced a lawsuit against Health Net. Under the HITECH Act, state attorneys general have new powers to pursue lawsuits against health care organizations for noncompliance with HIPAA regulations.
Another recent case involves a 160-bed facility in Derby, CT, in which a formerly employed radiologist maintained access to patient imaging and contact data long after his termination, which he used to make unsolicited contacts with patients when working at another facility. Hospital administrators have notified HHS, those affected patients, and the media, and are complying with their obligations under HIPAA; but the state Attorney General has still commenced an investigation of the matter.
Experts claim that the HITECH Act’s inclusion of state attorneys general in enforcement efforts raises the possibility of discovering breaches to levels previously unattainable with simply federal enforcement. Some envision state attorneys general as a sort of “first responder” for security breaches, bringing enforcement efforts much closer to the local level.
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Will Medical Schools Join 3-Year Degree Trend?
Source:
USA Today
Date:
03/25/2010
Texas Tech University is gearing up to start graduating new M.D.s in three years–not four. The institution will be joining a small cadre of other universities offering such early completion options for students. But the move doesn’t come without criticism.
Texas Tech’s move comes as the Carnegie Endowment for the Advancement of Teaching is getting ready to recommend that all medical schools consider offering three-year programs. Proponents claim that the move will save students money and at the same time possibly aid the ailing primary care industry: the thinking being that the lack of a fourth year dedicated to narrow electives will make students more likely to adopt a primary care role.
In the Texas Tech program, the first year would be largely the same as it is now, but there would be no summer break. Instead, students would take a single course in family medicine that is usually reserved for the second year. The second year is largely the same as in the four-year program, but students would have a clinical experience in family medicine. The third and final year would include regular rotations, with the slot reserved for family medicine rotations now dedicated to intensive care, neurology, and geriatrics.
Proponents claim the program would knock about $13,000 off the cost of medical education for Texas residents, and the school already has a few in its entering class that are interested in the program. Skeptics, though, caution that three years aren’t enough to determine what field of medicine one wants to enter, and thus the fourth year is a necessary component in choosing a satisfactory career path in medicine.
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Physician Practice Management
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Selling Your Practice? Here’s How to Prep It
Source:
American Medical News
Date:
03/15/2010
Is it time to say goodbye to your old company? Unfortunately, selling a practice takes a bit more effort than just putting out a “For Sale” ad. To get the best price, though, there are a number of strategies you can put to use in attracting buyers.
First, you’re going to want to start this whole process about two years before any prospective sell date, preferably even three years. This allows you the time to get your financial records in order, set realistic price expectations, plan a transition, and spruce up your practice to make it a better sell. You’ll need to organize your financial records in such a manner that they make sense to any party that might have to look through them. Any personal expenses charged to the practice should be taken out.
Next, you’ll want to spruce up your practice. The premises: make them shine. Discard clutter, expired medications, and broken equipment. Do some landscaping. Modernize the decor. You’ll want to keep in mind that it’s not really “your” practice any more. Update equipment within reason, but don’t sink too much money into EMRs and such, as a buyer may not adopt your system.
When it comes to setting a price, you’ll want to keep in mind that this isn’t the 90s, when practice prices were high. Practices are going now for fair rates. Selling to a doctor is a matter of determining what is a fair market value for hard assets and expected accounts. Selling to a hospital involves self-referral and anti-kickback regulations; so you’ll need to be more careful in this regard. Numerous services exist, though, to help you properly value your practice and services. Make use of them.
When it comes time to spread the word of your sale, keep your staff in mind. Don’t generate fear among your staff or prompt flight within your patient base too soon. That is: spread the word of your interest in a sale among a select network. Still, always look to involve more than one party. Lining up multiple bidders increases the likelihood that you’ll maximize your selling price.
In the final transaction, you’ll need to discuss details of the transition and the handling of patients. If you’re staying, that’s easier: the patients can stay with you while ownership switches hands. If you’re leaving, though, you’ll need to inform patients with adequate time for them to make other arrangements. It’s not just as simple as walking out the door. The process isn’t easy; but if you follow these steps, you’ll find it goes much more smoothly than it would otherwise.
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Understanding Scope of Practice
Source:
Physicians Practice
Date:
04/04/2010
The state of modern practice being what it is, you’ve no doubt considered bringing on a midlevel professional to help lighten the load. You’re not alone, as midlevel providers are increasingly vital in the health care team. Their services allow physicians to get back to the business of medicine without cutting corners on patient care, practice offerings, and patient satisfaction. But, if you’re looking to incorporate midlevels into your practice, it’s best to know where they’ll best fit in and what their scope of practice involves.
Midlevels typically come in two varieties: nurse practitioners and physician assistants. They’ve got different educational backgrounds and different areas of expertis;, so it’s essential to know which one best fits your practice needs.
Nurse practitioners are independent practitioners certified to diagnose and treat chronic conditions and acute conditions. They can, without physician supervision, prescribe medicine, update charts, manage patients, and provide counseling. They tend to specialize in family practice, acute care, family health, oncology, mental health, and related fields.
Physician assistants are intended for coordination of care. They require some physician supervision in all 50 states, though the level of supervision varies from state to state. PAs and supervising physicians must be in constant dialogue about their patients, but that doesn’t mean physical proximity. PAs are trained in the medical model much in the same way as physicians, but with a much shorter educational period. They tend to work in family and general medicine, surgery, internal medicine, and emergency medicine.
Integrating NPs and PAs can even serve as a catalyst for changing around the structure of your practice. If you’re adopting the medical home model, you could develop “pod teams,” in which PAs and NPs work with practice nurses and medical assistants under the guidance of one physician. Such schemes are in practice in a number of organizations that are seeing success around the country.
Patients are becoming increasingly comfortable with getting service from a midlevel, though there is still progress to be made. The trend, though, is almost irreversibly toward greater integration of midlevel providers; and, if your practice finds a way to bring them into the process, you’ll likely experience quite a boost in performance.
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Insurance Preauthorizations: How to Make the Process Less Painful
Source:
American Medical News
Date:
04/05/2010
Does the insurance preauthorization process have you climbing up the walls? Fret not, for experts contend that there are process adjustments your practice can make that will ease the ordeal of dealing with payer preauthorizations. When it comes to easing your insurer-caused headaches, the answer is process, process, process, according to preauthorization experts. You can automate the preauthorization process, taking advantage of electronic submission options typically provided by payers, or you can modify your existing policies to streamline the whole effort. If an insurer offers an online option for preauthorizations, that is likely the best route to take, as it will result in direct submissions to the payer’s own system, lessening the risk of any misunderstandings. If electronic methods are not an option, go step-by-step through your process to find inefficiencies. Set up a reference tool–with the policies and procedures of various insurers–for staff to look at when they have questions. Also, consider beginning the preauthorization process before a patient leaves the office. The necessary information will be fresh in everyone’s mind, decreasing the likelihood of mistakes. If you can’t shave time and effort off the process, you may want to consider attempting to further monetize the effort you put forward on preauthorizations. In your negotiations with payers, have figures detailing the time and effort spent on following their procedures. Inform them that you feel you’re not being properly reimbursed for the amount of work you put into dealing with them. It may not work, but you have a better chance than if you hadn’t tried at all. One option you might want to avoid is having your patients complete the preauthorization process themselves. A number of practices have tried this, only to find that the patients call in with innumerable questions. In effect, your staff winds up doing the work without actually doing the work, and this may actually be prohibited within insurer contracts.
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Developing a REAL Marketing Strategy
Source:
Healthcare Strategy Group
Date:
03/03/2010
If your hospital has brought in employed physicians, you likely did so with the goal of having them drive inpatient volume. If the volume they’re generating isn’t sufficient, that could lead to problems with physician retention. Your hospital can combat this by taking a sober look at your marketing strategy, as a proper strategy is indispensable in modern hospital operations.
Your plan in looking at marketing will be to increase the profitable volume in the hospital on the whole as well as your practices. You’ll first want to get a clear idea of what exactly marketing is for your institution. It’s not just ads and physician directories, though those are important aspects. You’ll also want to take a look at patient origin, analyzing the way it impacts current and future payer mix. If you can effectively position your organization as opening up access to a more profitable payer mix, you’ll be more likely to draw the physicians you’re interested in.
Next, it’s time for a review of your network’s referral process management. Take a close look at in-network referral. If physicians are referring out of network, look to see if you’re making it easy for them to refer in-network. Does your organization have a common EHR? This drastically streamlines the referral process. Check on practice relationships with local hospitalists, as unassigned patients can bring in more referrals for your practices. Develop relationships with hospitalists to draw in these patients.
Finally, look at every possible competitive advantage you can offer. Take them and push them into your marketing strategy. Put the weight of your organization behind each physician practice and let potential partners know you do such in all marketing outreaches.
It’s not an easy process, but times such as these don’t call for easy answers. In the race to acquire talent and partnerships, your organization can’t afford to have its marketing lagging behind the competition.
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