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Interview with Corbin Wilson, Executive Director and President, JPS Physician Group, Fort Worth
Thomas McKeever, Jackson Healthcare’s National Sales Director
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Challenges Facing Health Care Executives
This month’s focus is on health care executive leadership. Our articles selection includes a recent Hospitals & Health Networks piece entitled “The New Health Care CEO.” The article describes all the plates the contemporary CEO has to juggle simultaneously: key personnel matters, the business side of health care, the practice of medicine--as well as strategic planning, crisis management and corporate communication.
The Special Report is entitled “The Evolving Role of Physician Executives. It examines the motivations physicians have to move into their medical organizations’ C-suites, what is required in terms of advanced degrees and certification, the different roles and responsibilities entailed, the cost advantages of training physicians for executive leadership, and what it takes to succeed.
Also featured in this edition is an interview with Corbin Wilson, JD, who serves as the Executive Director and President of the JPS Physician Group. His legal background provides him a unique perspective in weighing the complex and critical issues that confront the contemporary health care executive, a role that he finds both challenging and extremely rewarding.
We trust that the insights provided in these writings will shed a different light on what health care executives face day-to-day in effectively managing hospitals and other health care organizations.
Cordially,
Calvin Bruce
Managing Editor
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Risk Management Tip of the Month: Never alter a patient record. The general advice for correcting an entry in a paper record is to draw a single line through the mistake (so it remains legible), mark it “error,” initial, and date it (with the date the correction was made).
"Risk Management Tip of the Month supplied by PRMS, Inc., Manager of The Psychiatrists' Program" www.psychprogram.com.
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Careful–There’s a Baby in That Bathwater
Source:
H&HN Magazine
Date:
06/01/2010
It’s easy to focus on the negative aspects of our health care system: spiraling costs, incomplete coverage, insufficient provider supply; but what things are we getting right in this country? Before the effects of the health care bill and other measures begin to totally reshape the industry, it might not be such a bad idea to check out what’s worth keeping in the American model.
The American system, by any number of international measures, doesn’t compare favorably with most of its industrialized peers and is particularly susceptible to manipulation by special interests. With that said, the American system does lead the world in cutting-edge research–from gene therapy to nanotechnology and stem cells. The American system also leads the way in care innovation. We perform more outpatient surgeries and have done much to pioneer telemedicine and minimally invasive surgery. Furthermore, the U.S. leads the way in efforts to improve patient safety, and our system places a strong emphasis on patients’ rights. From alternative medicine to niche medical activism, Americans will agitate and organize to see their medical rights honored. This acceptance of, and heeding of the rights of, the patient is one of the major gifts the American system has given the world.
But one of the most important aspects of the American system is the people—the hard-working, compassionate people that stay late and work overtime. The professionals that don’t allow ideologies or prejudices to stand in the way of patient care. They are the most indispensable aspect of the American system and it is important to remember that regardless of what policy changes will bring about, they are still the ones that will care for us at the end of the day.
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Physicians Ask Patients: What Is This Visit Worth?
Source:
American Medical News
Date:
05/24/2010
Imagine there were no insurance companies. It’s easy if you try. No paperwork or challenged claims. Imagine all the patients paying what they can. Could you run a business on the proceeds from that? A number of physicians tried just that–allowing patients to pay what they could–for a day, with surprising results.
The idea started out on a practice management listserv. A number of primary care physicians were lamenting the regular undervaluing of primary care services. Some of them decided to eschew insurance payments for a day, letting their patients pay only what they could afford and thought the visit was worth.
Cutting to the chase, none of the physicians collected enough to base a business model off that system, but they did spend a day free from insurance paperwork, collections and co-pays. Patients paid via cash, check, or credit card. Largely, the physicians saw uninsured patients, who likely otherwise wouldn’t have been able to afford treatment.
And the final impact of the little experiment? Physicians found that it was easier to talk with patients about money and special payment arrangements that patients typically don’t know or ask about. As an added bonus, some practices received a boost in the form of media coverage; the sort of exposure that can only boost one’s standing in a community.
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Could ‘Too Much Transparency’ Lead to Higher Health Prices?
Source:
The Wall Street Journal
Date:
05/07/2010
It’s argued that increased transparency in health care pricing will lead to more informed, and thus more cost-effective, choices on the part of consumers. But is this really the case? An entry at The Wall Street Journal takes a look at the issue.
Transparency in medical pricing is a hot topic lately, with three bills currently in committee in the House of Representatives to increase transparency for hospitals, ambulatory surgical centers, pharmacies, and vendors as well as encourage complete disclosure by insurance plans.
So how could this be a bad thing? The answer lies in a 2008 Congressional Budget Office report. The report covers the benefits of transparency, but it also points out a possible flaw in increasing transparency. It turns out that providers in concentrated markets might–due to increased transparency–be able to view the prices their competitors charge, and then raise their own accordingly. Later remarks by the former CBO Director raised the point that transparency doesn’t matter for people covered by insurance, as they don’t typically have the option of shopping around. Also, transparency matters little in the case of emergencies and in those cases that disproportionately impact spending in this country.
It’s a contentious issue that is sure to produce fireworks. As of yet, no political party has been willing to bring a transparency bill to the floor.
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Do MCAT Scores Predict Med School, Licensing Exam Results?
Source:
The Wall Street Journal
Date:
05/27/2010
Ever wonder about the predictive power of MCAT scores? What’s the likelihood that someone performing well on the MCAT will go on to perform well in medical school and on the licensing exam? You’re not alone, and–thanks to researchers at Jefferson Medical College–you’ve got an answer.
JMC researchers were looking at the effectiveness of MCAT revisions at strengthening the test’s predictive abilities. They looked at data from 7,900 of their own students from 1970 to 2005, covering 36 graduating classes.
Their findings? MCAT scores are “moderately” correlated with medical school performance and USMLE scores. Additionally, they found that previous alterations to the MCAT have been ineffective at improving the predictive value of the exam. In light of forthcoming revamps to the test–which aim to improve its predictive value–the results cast doubt on the ability of such alterations to accomplish their goal.
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Medical Office Buildings: Time to Sell?
Source:
American Medical News
Date:
05/24/2010
With the health care industry undergoing its own substantial period of turmoil, maybe you’re not too keen on the idea of dealing with upkeep on your office building. If you’re looking to sell, there’s good news: your medical office building could fetch a healthy sum thanks to deep-pocketed investors.
At the 2010 Medical Office Buildings & Healthcare Facilities Conference, a number of presentations focused on the desire of investors to put their money into stable holdings, with medical facilities being near the top of the list. Medical office buildings didn’t lose as much value as other real properties in the recent recession, and now sell at an average of $230 per square foot, a 1 percent increase over the past year, compared to nearly 40 percent declines for other office types.
Within the medical facilities market, investors are most interested in large buildings on hospital campuses, but also look at smaller off-campus buildings as favorable holdings since outpatient services continue to grow. Commenters admit that interest in medical facilities will likely decrease among investors once other areas of the market pick up again. Still, for right now, the sector is hot, and selling your building could net you a particularly nice profit.
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Government Loans to Docs May Raise Health Costs
Source:
Physicians News
Date:
05/26/2010
Nowadays, it seems that if the government does something to rein in health care costs, it is almost certain to raise them. The latest example is a federal plan to give physicians, dentists, and other providers more than $2.5 billion in loans to modernize equipment and expand space and services. Some experts contend, though, that the loans could actually lead to higher health care costs.
About 5,000 providers across the nation have received government-backed loans in order to expand facilities. These loans were 90 percent guaranteed by the government, with associated costs either reduced or waived.
Experts from the Center for Health Policy Research warn, though, that the increased capabilities and space of those getting loans will add to the health bill. Simply put, the increased resources make it more likely that those resources will, in the future, be used wastefully. Physicians counter, though, that the increased capacity and capabilities will result in improved outcomes for patients.
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Legislation Has Some Physical Therapists Out of Joint
Source:
Chicago Tribune
Date:
05/28/2010
An Illinois law awaiting the governor’s signature is causing friction between the state’s physicians and physical therapists. The issue of contention is whether physicians should be allowed to employ physical therapists at their practices. Under current law, the legality of such employment is questionable, but the law in front of the governor right now would officially legalize the practice. One side claims the law will ease integration of services among health care providers, while the other maintains that it allows a serious conflict of interest to exist in which doctors could profit by recommending unnecessary physical therapy services.
The Illinois Physical Therapy Association opposes the bill and the practice of therapist hiring, claiming that the practice leads to fee-splitting as physicians receive payment for work done by physical therapists. The Illinois State Medical Society argues to the contrary, contending that doctors are legitimate employers and don’t receive direct kickbacks for referrals. Regardless, opponents of the law point out that studies show patterns of increasing referrals when doctors benefit financially from them.
Physician-employed therapists account for about 400 of the 9,000 licensed physical therapists in Illinois. If the legislation is signed into law, it could have a negative impact on the number of free-operating physical therapy clinics if more physician practices take the opportunity to bring therapists in-house.
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Queens Crunched by Hospital Closures
Source:
The Wall Street Journal
Date:
05/24/2010
Seventeen-hour waits and double-capacity patient loads: no, it’s not a field hospital in a war zone or third-world country. This is the situation in New York Hospital Queens, a facility dealing with the impact of the closure of neighboring hospitals.
Queens has seen three hospitals close in the past two years. Each closure has compounded the patient load woes of the remaining institutions. Add to that the growing elderly and immigrant populations as well as cuts in state funding, and Queens hospitals are near the limit. Professionals in the area describe the situation as a verifiable crisis, pointing to a swine flu outbreak last spring that saw hospitals setting up tents and trailers outside to deal with patient loads.
The overcrowding situation is even causing patients to head out of the borough to seek care. Queens hospitals are seeing especially heavy loads in their psychiatric departments, which have seen loads more than double following the closing of other care facilities.
Perhaps worst of all, despite the backed up ambulances and long wait times, the problem looks to be worsening. New York Hospital Queens is opening an additional 80 beds this month, but there is no guarantee that this will come anywhere close to meeting the burgeoning demand.
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Bar Codes Used to Track Surgical Instruments
Source:
Health.mil
Date:
06/01/2010
Tracking surgical tools in military medical facilities just got a little easier. This thanks to a research project from the 81st Medical Group Hospital in Mississippi.
The project, sponsored by the Office of the Air Force Surgeon General, tracks surgical instruments using automated identification and data collection technologies.
The goal of the project is to help assistants assembling surgical trays to know when the tray is complete, depending on the procedure to be performed, and whether any of the items have passed their expiration date. This information is tracked through bar codes etched into the surgical instruments. Once the trays are assembled, RFID tags are affixed so the trays can be located when needed.
The project is currently in the proof-of-concept stage.
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The New Health Care CEO
Source:
H&HN Magazine
Date:
05/05/2010
As the health care delivery industry continues to undergo change, so too does the role of the health care CEO shift. Modern CEOs head up large corporations functioning as integrated health care delivery systems, often incorporating hospitals, outpatient centers, primary care, community health care, and just about every facet of the health care world.
The modern health care CEO needs to be able to manage not only personnel, the business of health care, and the practice of health care, but also strategic planning, crisis management, and communications.
Human resources and communications are especially important aspects of the CEO’s job. The modern CEO has to communicate a vision for the organization and make sure that physicians buy into that vision. Increasing physician employment means that more attention must be paid to physician desires. Physicians will want leaders that can identify with where they’re coming from. Any CEO looking to implement changes–payment schedule shifts, call hour changes–will have to demonstrate clearly how the changes will benefit the organization and its physicians.
CEOs also need to spend time and energy in the community, building the organization’s brand. For this reason, it is essential to have a government relations department doing solid work and a board of directors that bring specific skill sets to the table for the betterment of the organization. The future of health care organizations is, almost inevitably, bigger and more complex. It will take a specific kind of leader to ably steer a health care organization through the years ahead.
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Does My Practice Have Enough Support Staff?
Source:
iPractice
Date:
05/05/2010
Support staff are essential for efficient practice functioning. But how do you know if your staffing levels are sufficient for the number of physicians in your practice? iPractice takes a look.
The easiest way to determine adequate staffing levels is to figure out your practice’s support staff ratio: the number of staff relative to full-time equivalent physicians in the group. Take the number of full-time support staff–combining part-timers to add up to a 40-hour workweek–and divide that by the number of FTE physicians.
Compare the figure you get to benchmarking figures from sites such as iPractice in order to get an idea of how your practice compares. If you’re below the average, you might want to consider bringing on additional staff to improve patient flow and care. If you’re higher than average, your first instinct might be to reach for the pink slips, but reconsider, as cutting staff can also lower productivity.
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Employment & Compensation
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MGMA Report Shows Increase in Physician Placement, Pay
Source:
Modern Healthcare
Date:
06/03/2010
Hospital-owned practices are turning to higher starting compensation packages in order to recruit physicians—this according to the Medical Group Management Association’s latest study.
The study was conducted in conjunction with the National Association of Physician Recruiters. It takes into account information from 4,100 physicians and more than 1,500 physicians hired out of residency.
According to the study, nearly two out of three established physicians and half of new physicians were placed in hospital-owned practices. The study found higher guaranteed incomes among hospital-owned practices, with primary care physicians receiving a median income of $164,000, about ten percent more than their peers in other practices. The median income for specialists at hospital-owned practices was $240,000, compared to $230,000 for specialists at other practices. The study also found that the gap between primary care and specialist compensation is shrinking.
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A Look at Hospitalist Benefits
Source:
Today’s Hospitalist
Date:
05/05/2010
If you’re considering the hospitalist specialty, the comparative lack of paid time off might be a negative factor to you. A closer look at the real benefits for hospitalists, though, might change your perception of the perks of the specialty.
Today’s Hospitalist conducted a survey among readers, asking what the typical benefits were for hospitalists. Among those responding, 45 percent indicated they get no paid time off at all; instead, fitting vacation and down time into their already scheduled days off.
While 45 percent of respondents receive no paid time off, more than a third of respondents receive three weeks or more paid time off. Hospitalists at teaching hospitals typically receive about two weeks of paid time off, about three days more than their community-based peers. Pediatric hospitalists also get nearly five days more of paid leave than other hospitalists.
The survey also found that just under half of respondents get time off for CME activities, with pediatric hospitalists receiving the most time off. Additionally, 81 percent of respondents get a stipend for CME expenses. Other common benefits included personal health, dental, life, and disability insurance; 401k contributions; and pension plans. Finally, one in six respondents are part of some sort of profit sharing arrangement.
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Long-Distance Locums: Taking That First Step Away From Home
Source:
LocumLife
Date:
04/15/2010
The locum tenens lifestyle offers many attractive options to physicians: variety of practice, locale, and assorted other factors. Some physicians, though, might hesitate to take up the itinerant practice style for fear that it will keep them away from their families. Distance concerns are no reason to hold off from locum practice, as there are a number of ways you can use your travel to actually deepen your family ties. LocumLife has the details.
Your locum tenens agency will be able to provide you with a number of tips on arranging your home life to deal with distance assignments. Before heading out, discuss your assignment with your family. Let them know where you’re working, when you’re working, and how to contact you. Also be sure to schedule your assignments so as to allow attendance at special events such as weddings and graduations.
If your spouse is staying at home, he or she can play a special role in coordinating your assignments. Your spouse can wind up handling scheduling details, alerting your agency to upcoming events that will require your presence. Make sure to share your agency and facility contact information with your family to ensure smooth operations on both ends.
If you are at risk for emergency situations, you may want to stay away from more remote assignments, as you won’t be as able to quickly return home to be with family. Keep family first, and your agency and host hospitals will understand completely. Agencies maintain contingency plans for getting you back home quickly while ensuring continuity of coverage at facilities.
Above all, take the initiative in keeping up with your family. Use technology for regular calls or video chats if possible. It’s not the same as face-to-face contact, but regular contact will keep your family ties strong.
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Liability Damages May Be Limited by Ohio Ruling
Source:
American Medical News
Date:
05/24/2010
What impact could a car crash in Ohio have on medical liability laws in that same state? A surprisingly significant one, it turns out, as the Ohio Supreme Court has handed down a ruling impacting medical liability throughout the state.
The ruling stems from a personal injury lawsuit filed in 2005. The plaintiff in the suit wanted compensation for his total medical bills, while the defendant argued she was only liable for the amount the defendant’s insurance company had paid for, since the rest was written off. The Supreme Court eventually ruled in favor of the defendant, allowing the defendant to present records of insurance payments for the plaintiff’s medical care and argue that only the payments actually made can appropriately be considered for compensatory damages.
In medical liability terms, this means that the calculation of damages in Ohio can now be based on the amounts actually paid out by insurance companies. This could serve as a relief to Ohio physicians wary of continually inflating liability insurance costs. Plaintiff representatives claim that the ruling unfairly shifts financial burdens to the patients, and that the ruling could eventually come to hurt doctors if payers start to claim that the discounted total amounts to fair market value.
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Managed Care Firms Sue to Stop Federal Parity Law
Source:
Psychiatric News
Date:
05/07/2010
Equality of coverage, equality of access: that was the aim of the “Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.” But the legislation is under fire from managed behavioral health care organizations, who seek to halt the implementation of the law.
The law, signed by President Bush in October 2008, had strong support from the American Psychiatric Association. The aim of the legislation was to put mental health on the same footing with regard to coverage as physical health. The MBHOs’ suit challenging the law contends that MBHOs should be able to impose management strategies not imposed on medical and surgical services while remaining in compliance with the law. Until the issue is decided, they are seeking to block the implementation of the law, while the APA and others seek to push ahead and make sure it goes into effect.
Specifically, the suit relates to a requirement of a single deductible for both mental health and medical conditions and another requirement prohibiting “‘nonquantitative’” treatment limitations.
While this is the first real regulation regarding mental health coverage, the stiff challenge from the managed care firms demonstrates that there is still much work to be done in ensuring parity of coverage for these services.
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Hospitals Want More from Their Hospitalists. Will Your Group Survive?
Source:
Today’s Hospitalist
Date:
05/05/2010
It’s not quite “do more with less,” but when your hospital’s directors want your hospitalist group to steadily improve on extant savings, the pressure to generate additional value can be quite intense. Adding to that pressure, many hospitals are turning to consultants and reorganizers to increase the value derived from their hospitalist groups. Along the way, management shakeups are not uncommon.
As new care models arise, administrators are constantly on the lookout to find ways to bring about cost savings and quality improvements using these models. Payers are putting money behind these methods, and hospitals need physician partners to successfully implement them. In this regard, the success of many hospitalist groups has been a double-edge sword. When hospitals realize the importance of hospitalist groups to organizational functioning, they often look to squeeze more value out of the group; and, to do that, they typically try to exert more control.
With so much riding on the success of a hospitalist program, it’s understandable then that some hospitals walk away from underperforming programs or call in consultants for reorganization.
So what sort of value does this kind of shifting about bring? Well, the exact model of a group is less important than, say, the way the group executes its assigned tasks. Hospitalist groups should be well-aligned with overall institutional goals, functioning as a team that helps the institution succeed, typically on cost saving goals. To make sure this is the case, you can expect to see scrutiny of hospitalist programs continually on the rise.
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EM Fellowships for FPs: Bane or Boon?
Source:
Emergency Medicine News
Date:
05/05/2010
Emergency medicine is feeling the effects of an acute physician shortage. In fact, a study released last year claimed that emergency physicians are only serving about 55 percent of the current market, and with the current training system in place, the disparity is not going to get better any time soon. So what, then, can be done to make sure that more people have access to emergency care when they need it?
One proposed solution is to provide an accelerated training program that will allow physicians practicing in other fields to switch to emergency medicine. The American Academy of Family Practice, for example, has developed a program to fund special one-year residencies so that family practitioners interested in moving into emergency medicine will have at least some relevant training. The assumption is that the current situation in emergency medicine is untenable, and if doctors are going to start switching from other fields to emergency medicine, it’s better to have some training mechanism in place than none at all.
Others, however, believe that the shortage of emergency physicians is overstated, as midlevel assistants have allowed EPs to become more productive in recent years. Furthermore, some in the emergency field are simply unwilling to compromise when it comes to physician training and, regardless of whether there’s a better solution available, think that proposals such as the AAFP’s one-year residency program will only hurt the field by diluting the quality of care.
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Reinvention of Depression Instruments by Primary Care Clinicians
Source:
Annals of Family Medicine
Date:
06/01/2010
Primary care clinicians are quite often the first line of detection for depression in the medical community, as they typically have more access to a wider array of patients. But are they properly utilizing the tools at their disposal to identify depressed patients? A study in the Annals of Family Medicine has a surprising answer.
The study looked at 70 primary care clinicians–family physicians, general internists, and nurse practitioners–in individual interviews and focus groups. Investigators took notes on office practice environments as well.
The investigators found that clinicians occasionally used the depression instruments in which they had been trained, but they didn’t routinely use them to aid depression diagnosis or management. Instead, the instruments were used as a tool of emphasis when a clinician believed they would encounter resistance from a patient. Clinicians’ available time, presence or lack of objective evidence of depression, and patient familiarity: all these were found to have an effect on the use of these instruments.
The researchers concluded that, while clinicians make use of depression screening instruments, they adapt the use of them to real-world circumstances. In practice, these instruments–instead of screening, diagnosing, and aiding in the management of depression–are used to suggest, tell, or convince patients to accept diagnoses.
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EPs Push Back Against ABEM MoC
Source:
Emergency Medicine News
Date:
06/06/2010
The American Board of Emergency Medicine’s new Maintenance of Certification requirements are encountering stiff resistance from emergency physicians across the nation. Are the new requirements, which have become well established in many other specialties, an important step in improving practice quality, or will they just result in unnecessary paperwork for EPs who wish to go through the MoC process?
Part 4 of ABEM’s Maintenance of Certification program is the one drawing the criticism. This part requires a Communications Professional Activity, under which EPs must evaluate their communications with patients every ten years by conducting some form of survey. Also, Part 4 calls for a Patient Care Practice Improvement Activity, in which physicians self-assess their treatments of patients and how they compare to evidence-based guidelines, outlining adjustments to make as needed.
Emergency physicians are resisting the policy, claiming that, while regular testing may help them improve their quality of care, they will receive little tangible benefit in return for their time beyond a tax write-off and a certificate. They argue for the inclusion of continuing education credits as a part of the regular recertification. ABEM representatives empathize with physicians and claim that work is being done to better integrate MoC activities with other common continuing education requirements. ABEM also reiterates that self-assessments like those outlined in Part 4 are necessary to ensure quality improvement and have proven successful in other specialties after similarly rocky starts.
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Payer & Reimbursement Issues
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Cash Flow Becomes Problem With ‘Medicare Meltdown’
Source:
Fort Worth Business Press
Date:
05/17/2010
Medicare: dealing with it is no picnic, but could it be worse? According to an article in the Forth Worth Business Press, physicians across the nation are facing the prospect of a “Medicare meltdown”... and, yes, that’s about as bad as it sounds.
The problem arises from the increasingly unreliable nature of the government insurance program. Since 1998, with the introduction of the Sustainable Growth Rate, Medicare reimbursement rates have been forecast to be reduced. Every year, though, Congress delays the cuts for up to a year. The most recent cuts would have lopped 21.3 percent off payments to physicians. This perennial kicking of the can down the road makes it hard for practices to do any long-term planning such as adding physicians or purchasing equipment.
Some physicians note that the program used to be reliable, with physicians making enough off Medicare and private payers to take on charity cases or offer discounted rates. Medicare rates as they currently are mean that physicians take a loss handling Medicare patients.
As it stands, though, the problem is unlikely to be fixed. A real fix to the system could cost as much as a quarter of a trillion dollars, which makes it an unlikely prospect for either political party to advocate. Still, the fact remains that a reckoning must come some day on this vital program, because short-term fixes can only hold for so long before the system begins to fall apart.
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Nimble Payment Models
Source:
Managed Healthcare Executive
Date:
04/01/2010
As far as sources for prognostication on issues facing the health care world, one could do a lot worse than the former acting head of the Centers for Medicare & Medicaid Services, who helped increase CMS oversight, reduced fraud, and launched much of the agency’s electronic initiative. So what does the future hold for managed care? Managed Healthcare Executive has the interview.
Kerry Weems has a keen eye for the challenges facing the American health care system. His advice to managed care: get ready to fight. Look for rate conflicts from the federal to the state level all over. Take a look at non-traditional populations for capitation, and bring them under capitation first by gaining the trust of state legislatures and population advocates. Weems also calls for the elimination of the sustainable growth rate, instead calling for physicians to be paid based on a value metric that is in use in some managed care companies.
Weems claims that Medicaid is unsustainable and should be largely handed over to the states; and he also sees cost increasingly shifting to consumers. Also, he says Medicare should move more quickly toward quality initiatives in order to contain costs. In terms of reducing fraud, Weems actually calls for Medicare to be less predictable, as fraud depends largely on the predictable element of Medicare payment.
Weems is currently senior vice president and general manager of health solutions with consulting firm Vangent Inc.
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The Effect of Different Attribution Rules on Individual Physician Cost Profiles
Source:
Annals of Internal Medicine
Date:
05/18/2010
Health plan cost profiling is not a perfect science, and yet it is one that has a big impact on a physician’s relationship with insurers. In a recent study by the RAND Corporation, researchers analyzed data from a large group of patients’ treatment records in order to test the extent to which a physician’s cost profile can vary depending on the formula a payer uses to apportion treatment episodes among several physicians a patient has seen.
As part of the study, the researchers created twelve alternative cost attribution formulas and applied them one by one, in addition to what they refer to as the industry default model. After applying each formula, or model, the cost profiles for the physicians in the database were examined.
The researchers found significant variation in the resulting cost profiles when the different models were used, which means that the same physician providing the same services for the same patients could easily receive very different cost profiles from different payers.
While the attribution model currently used by many payers may not be perfect, the RAND study is quick to point out that none of the other models in the study were either, and that some physicians will inevitably be dinged for treatments billed by other physicians working with the same patient. What the study can do is encourage payers to evaluate the impact of their attribution models more closely and be more transparent about how the models work and how they impact physicians’ cost profiles.
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The ABCs of ACOs
Source:
H&HN Magazine
Date:
05/05/2010
Affordable care is pretty much the goal of the next decade. To achieve this goal, a number of pilot projects are underway across the nation to determine the best models of care delivery for a cost-conscious system. Among these is the accountable care organization.
Accountable care organizations are collaborations among providers in which all providers caring for patient populations share responsibility and risk as well as part of the cost savings produced from their collaboration. Dozens of ACOs exist in one form or another across the nation, most including hospitals, physicians, and other providers. ACO participants adopt evidence-based quality standards and measurements while aligning hospital and physician incentives.
Under the Medicare Shared Savings Program, which begins in 2012, ACOs meeting quality standards will receive a portion of any cost savings Medicare accrues due to their operations. These ACOs will have to include primary care providers, evidence-based medicine, and high levels of service integration and information sharing. Qualifying programs must sign three-year agreements and attract at least 5,000 Medicare beneficiaries.
Organizations already operating within the mold are somewhat ahead of the curve, as the trend in reimbursement appears to be away from silos and toward greater collaboration among providers. Tests underway in Virginia, Kentucky, and Arizona have given promising results, with participants indicating they believe the model could lead to reduced ancillary and ER visits as well as fewer hospitalizations and readmissions.
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Credentialing, Licensure, Quality Management
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Credentialing Process Can Be Made Simple
Source:
Dermatology Times
Date:
05/01/2010
Credentialing is tedious but necessary, and keeping up-to-date on your practice’s credentials can save you a lot of headaches in the long run. Following a few simple rules is generally enough to make sure the process is as painless as possible.
The first step is to make sure you’re using the correct credentialing forms. Medicare has specific forms for sole proprietor practices and group practices. If you have physicians working for you, you’ll need to apply for a group number in order to be in compliance.
Other hints for streamlining the credentialing process include using your legal business name on forms instead of a “doing business as” name. Make sure whatever you report to Medicare, you do the same to all carriers. Also, make sure to include all necessary information on the Medicare credentialing form, as incomplete forms are rejected. Complete all three Medicare forms–CMS855, CMS460, and EFT588–or you risk rejection. When sending in your application, send it with a signed certified receipt so that you can verify delivery.
Once you’ve applied, stay on top of the approval process, as you only have 30 days to correct a problem if you’re rejected before you have to start all over again. It also doesn’t hurt to stay on top of the people handling your application, as many have found a regular, friendly contact to help speed the process along. The credentialing process is no picnic, but it’s necessary to get proper reimbursement; so it’s best to do it the right way.
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Impaired Physicians: How to Recognize, When to Report, and Where to Refer
Source:
Current Psychiatry Online
Date:
06/06/2010
Recognize, report, and refer: these are the supposed steps for dealing with an impaired physician. In real life, though, it is not so easy to carry through on the process when the impaired physician is a friend or a colleague. Getting over obstacles to proper reporting is necessary, though, as impaired physicians put themselves and others at risk.
Among physicians, chemical dependence is the most frequent disabling illness, most commonly coming in the form of substance abuse. Marital and relationship problems are often the earliest detectable signals of a doctor’s problem, and professional performance tends to be the last affected.
Cognitive decline is an especially important problem in the physician community. Among individuals older than 65, rates of dementia run from three percent up to eleven percent. Nearly one in five physicians is part of this group.
Only 45 percent of respondents in a national survey indicated that they had notified licensing boards of an impaired colleague, while 96 percent indicated that these colleagues should be reported. Persons considering a report but hesitant to carry through due to liability concerns should be aware that they may be legally required to breach confidentiality if there is evidence of an imminent risk or serious harm to physicians or patients.
In looking to refer a physician to assistance, look to nationwide directories of physician health programs. These programs maintain confidentiality in helping physicians deal with chemical dependence, mental illness, or disruptive behavior. They are largely rehabilitative and non-punitive and have a better rate of success than comparable programs for the general populace.
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CMS Proposes Less Burdensome Telemedicine Credentialing Rules
Source:
Healthcare IT News
Date:
05/25/2010
The credentialing and privileging process for hospitals offering telemedicine services looks to get a bit easier soon, as the Centers for Medicare and Medicaid Services has proposed rule changes to streamline the process.
Currently, the credentialing and privileging process requires all decisions be made by the governing body of a hospital based on examinations and recommendations developed in house.
Citing the burdensome nature of the current process and its heavier impact on smaller hospitals with fewer resources, CMS’s proposed rule change will allow hospitals to use information provided from another location as a basis for credentialing and privileging decisions regarding telemedicine practitioners at their facility.
Additionally, CMS is proposing allowing distant-site hospitals to evaluate the quality and appropriateness of diagnoses and treatments conducted by its own staff during telemedicine service provision. The proposed rule was published on May 26 and is open for comment for 60 days.
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Health IT to-do List: Timetable for Maintenance and Security Tasks
Source:
American Medical News
Date:
05/31/2010
Running your EHR isn’t as simple as turning it on: there are a number of tasks that will have to be performed regularly to ensure that the system runs smoothly and helps your practice along. American Medical News has a few major ones you’ll want to keep an eye on.
First off, you’ll want to keep watch on the overall acceptance of the EHR among your staff. Find out what they like about the system and what they don’t. Your aim is to find things about the experience that can be improved to suit your practice needs. Additionally, keep an eye on your practice’s electronic infrastructure. Network connectivity, software upgrades, storage space: all of these are metrics you’ll want to pay attention to, because a problem in any of these immediately affects practice operations. For this reason, you may want to consider a system hosted by a third party.
An EHR is a sizable security commitment. You’ll need to ensure your practice’s security by creating unique credentials for all users as well as deleting access for former employees. Along the way, you’ll need to institute regular practice audits, reviewing the potential exposure of your health records. You’ll also need to backup data regularly—at least several times a week, either virtually or on portable devices.
Take a look at your practice’s financial and clinical performance following the implementation of an EHR. Doing so will allow you to get an idea of where you can improve services. Lastly, keep an eye on emerging technologies. You never know what’s around the corner and what can positively impact your practice. Check out blogs and talk to fellow physicians and employees to see what is new and easily implemented.
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A Perilous Path to Paperless
Source:
The Arizona Republic
Date:
05/02/2010
The federal government is putting $19 billion toward the computerization of the nation’s health care system. The push for adoption of electronic medical records is being hailed as an indispensable aspect of cost-savings that are essential to safeguard the nation’s health system from collapse. So you’d expect that the savings from these systems would be noticeable pretty quickly, no? Well, not exactly, according to researchers at Arizona State University.
Researchers at ASU’s W.P. Carey School of Business studied 526 California hospitals over the course of a decade. They found that hospitals using computerized records saw improved mortality rates, but realized no cost savings and no reductions in patient complications. The researchers attribute this, in part, to difficulties associated with registered nurses handling multiple computer records and getting enough time with patients. They also found that hospitals with computerized systems had patients with more complications, though they attribute this to the computerized systems helping to identify more health problems.
The study is the latest to question the efficacy of EHRs. Additional studies have found EHRs tied to higher hospital costs. The researchers note, though, that, while the benefits of the systems may not be immediate, they will eventually pay off over time.
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Electronic Medical Orders May Save Lives
Source:
Reuters
Date:
05/03/2010
So maybe they are linked to higher initial costs, but there must be some evidence that electronic health records improve patient outcomes, yes? In fact, there is--or at least so attests a children’s hospital in California that claims to be the first hospital to produce evidence linking computerized physician order-entry systems to reduced mortality.
Researchers at Lucile Packard Children’s Hospital and the Stanford University School of Medicine examined 100,000 patient discharges from January 2001 through April 2009. When comparing the 18 months with CPOE in place to the previous months, the researchers found two fewer deaths per 1,000 discharges.
CPOE is in use in nearly 30 percent of American hospitals. Despite this, no hospital has been able to show a link between reduced mortality and the systems until now.
The researchers cite other factors impacting mortality rates as well, such as staffing and workflow changes. They claim that the study offers solid evidence of not only the impact of CPOE on hospital-wide mortality, but also the short time frame in which such effects occur.
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A Snapshot: Defining Meaningful Use
Source:
Trustee
Date:
04/04/2010
Just about no other two-word phrase has caused as much tumult in the medical world as “meaningful use.” These two words have hospitals scrambling and worrying whether their efforts will prove to be in vain when we get a final federal rule governing eligibility for financial rewards for IT implementation. But taking heed of a few items of note on the issue will likely reduce your stress over whether your organization is meaningfully using technology.
The first action you can take is to conduct a sober assessment of your organization’s technology usage and plans. Are you upgrading for the financial incentive or are you doing so because it’s the best move for your patients? Your aim should be improving care, and to do so you’ll need to do a lot more work than buying an EHR. In looking at your IT status, you’ll need to view it in terms of your organization’s entire strategic outlook. Then you’ll need to assess whether it is better to roll out a project quickly with an eye for early incentives or more gradually in order to achieve full compliance and avoid penalties.
CMS isn’t setting specific dates for meaningful use compliance. Rather, compliance comes in three stages: initial EHR adoption and use; quality improvement and information exchange; and quality, safety, and efficiency promotion. Studies suggest that most organizations aren’t very far along to achieving compliance with the first measure, but there is a significant amount of time to catch up. Organizations that look to tackle each stage successively will likely fare better than those trying to leapfrog to full compliance without a final rule in place
Compliant EHR adoption will not be an easy task. However, if you keep your organization up-to-date on the latest definitions, goals, and criteria, you’re likely to find it much easier to accomplish than if you wait to implement an all-in-one solution in time for financial incentives.
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Beyond Paperless
Source:
Physicians Practice
Date:
06/06/2010
Sure, they’ll cut down on storage needs and papercuts, but are there tangible benefits to electronic health record systems? A number of practices are finding that 21st Century technology is indispensable to the practice of 21st Century medicine.
The benefits of EHRs are more than increased ease of access and federal reimbursement; but practices need to modify the way they look at medical practice in order to take full advantage of these systems. Switching to an electronic patient management mindset is key to taking full advantage of these systems. Some practices, for example, have created digital dashboard tools that aid in tracking diabetes, hypertension, and other chronic ailments. This sort of data presentation allows for much higher-level patient and process evaluations.
EHRs also can make sure your patient population is adequately tested so that you don’t have to leave it up to your staff’s memory. An EHR package keeps track of tests, normal result ranges, and recommended activities, and can be set to alert staff to the necessity of any of these.
If data organization and population metrics don’t have you excited over getting an EHR, there is also the ease and access factor to be considered. EHRs allow for persistent access to vital records that can be viewed, altered, and forwarded to other practitioners from your home, office, or even a smartphone.
Of course, there is always the cost of these systems to consider: as much as $25,000 for some solutions. There is the up-front cost as well as the cost of training physicians on these systems. After absorbing such costs, though, it’s likely that your practice will see immediate and continuing benefits for the adoption of such a system.
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Automated Phone Trees
Source:
Physicians Practice
Date:
06/06/2010
Press “1” for English. Press “2” if you’ve ever lost your temper trying to navigate an automated phone tree. Press “3” if your practice has such a system in place. To read Physicians Practice’s tips on sparing your patients the headache of navigating automated systems, press “4,” or just read on.
Automated phone systems are a cost saver, easily routing patients to the correct office for their needs and cutting your receptionist staff’s duties by automatically dispensing information such as practice address and hours of operations. These platforms come in a variety of setups, from simple connection and call routing to more complex systems that recognize spoken words. The question to keep in mind, though, is whether or not your practice really needs such a system.
The real impact of an automation system isn’t the system itself, but the user and usage patterns. Technical possibilities of particular systems may not, in fact, be the best solution for your practice. To avoid pitfalls, try setting up pilot projects in small clinics before making major rollouts. Also, don’t set your mind on one system setup. Instead, look through the capabilities of your choices to see which ones best suit your practice operations. These systems can do a good deal to simplify the way your practice runs, but, if not implemented properly, they could be as annoying as hold music.
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Reporting Adverse Events to Patients: A Step-by-Step Approach
Source:
Physician Executive Journal
Date:
06/06/2010
For serious adverse events, Pennsylvania health care providers must report under the Pennsylvania Patient Safety Reporting System. Hospitals must provide written notification of serious events to patients or appropriate family members within seven days of the occurrence or discovery of the event. In reporting to patients, though, it is important to follow steps to ensure that the optimal method of approach is used.
First, it is necessary to get as much information on the event as possible. Serious events typically have many causes, and a clear understanding of the circumstances surrounding an event is necessary. Gather information on patient interactions with the hospital leading up to the event and following it. Determine the level of knowledge the patient or patient’s family possesses now and identify whether the patient's or family’s interests run against hospital interests.
Next, identify the individuals that will participate in the notification meeting. The number of hospital representatives shouldn’t significantly exceed the number present on the patient’s side. This sort of meeting–being largely informational–shouldn’t typically be attended by a legal representative. In the notification meeting, hospital representatives should make plain that the goal is to report the event to the patient and family and to discuss mutual concerns. The meeting should be a venue in which the family can pose questions without fear and expect an honest answer from staff. Also use this time to dispel any faulty notions the family may have. Disagreements due to lack of information, miscommunication, or misinformation must be dealt with.
Be open to suggestions from the family for how to keep such an event from happening again. As to corrective action items: be willing to give and take on these. Be willing to give information, a commitment to addressing failures, and an apology for not living up to service ideals. You can expect to receive conflict resolution, reduced liability risk, and increased trust among the community.
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