| |
Complimentary copy only,
click for free subscription. |
| |
By J&C Research Associates |
|
 |
|
 |
Michael O. Ugwueke, DHA, FACHE Sr.
- VP / CEO of Methodist Healthcare – North & South Hospitals
Representing Jackson &
Coker - Thomas McKeever, ACHE, National Sales Director
|
Where Do We Go From Here?
After a year of heated debate and vociferous public opinion, the U.S. Congress has passed the “Patient Protection and Affordable Care Act.” At this point in time, the public is divided over the merits of the bill in terms of immediate and long-term consequences.
Authors of the bill – and the presidential Administration -- hope the sweeping, historic legislation will result in greater access to better and more affordable health care for all American families, whether or not they are currently covered by medical insurance.
Opponents of the bill are not so convinced that these favorable results will ensue. Proposed lawsuits threatened by attorneys general in sixteen states (at this writing) question, in fact, whether portions or the entire bill is constitutionally legal and enforceable.
“Time will tell” how all of this plays out. Meanwhile, our Special Report paints a picture of the “changing face of medicine” in terms of who is entering and exiting the physician pipeline and what considerations are most important to those who remain true to their calling despite the uncertainties on the horizon.
Cordially,
Calvin Bruce
Managing Editor
| |
Risk Management Tip of the Month: Remember to always sequester and maintain any faulty equipment or supplies that may have resulted, or could result, in injury to a patient. |
|
|
|
|
MGMA Data Show ‘Meaningful Use’ Requirements Will Lead to Decreased Physician Productivity Unless Changed
Source:
MGMA
Date:
03/04/2010
Electronic medical record systems are supposed to increase productivity and make the practice of medicine easier, yes? Well, such is not the case according to new research conducted by the Medical Group Management Association. Their research suggests that, instead of making the practice of medicine more streamlined, the CMS Meaningful Use criteria will actually decrease productivity in a majority of practices.
The research, a questionnaire conducted in January and February of 2010 that garnered responses from 445 practices, asked participants whether they thought the implementation of all 25 of the meaningful use criteria would negatively impact productivity in their practices. More than two-thirds of respondents indicated that physician productivity would decrease. Thirty-one percent indicated that implementation would result in a more than 10% decrease in productivity.
Particularly troublesome to respondents were two criteria, which they labeled as difficult or very difficult to achieve. Nearly half of respondents found the requirement that 80% of all patient requests for an electronic copy of their health information be fulfilled within 48 hours difficult to achieve, while more than half of respondents said the same about a requirement that 10% of patients be given electronic access to their health information within 96 hours of it being available.
While MGMA still supports the adoption of EHRs in medical groups, they contend that the incentive program needs to be streamlined dramatically in order to engender widespread adoption among practices.
Full Article |
Comments |
Back To Top
Treating Panic Disorder on the Web
Source:
ScienceDaily
Date:
01/20/2010
Patients suffering from panic disorders may soon have a much easier treatment for dealing with the disorder, and they’ll be doing it through their computers and mobile phones—this according to a report published in the International Journal of Business Intelligence and Data Mining.
The report, authored by researchers at the National Cheng Kung University and the Chi-Mei Medical Center in Tainan, Taiwan, details the development of a system using biofeedback therapy and web technology to offer remote treatment of panic disorders and anxiety problems.
While panic disorders are not easily diagnosed, their symptoms are relatively common, and can be confused with other incidents such as asthma and heart attack. For this reason, patients experiencing panic attacks often report to the emergency room with dizziness, chest pain, racing pulse, and even palpitations.
The new system consists of a wireless-enabled finger-ring device. The device measures skin temperature, relaying the information to a web-enabled system. Patients are able to communicate with health care workers and workers are able to ask patients about their symptoms and teach patients how to monitor and control their own level of relaxation.
The system has been tested with ten patients in a pilot study. The researchers concluded that, once patients learned the relaxation techniques, they were able to apply them on their own to relieve their panic attacks. A large multi-center clinical trail is underway, and the researchers indicate plans to modify the system to make it work with mobile devices as well.
Full Article |
Comments |
Back To Top
Competency-based Advancement: Risky Business
Source:
The American Journal of Medicine
Date:
02/04/2010
Residency education is undergoing a structural shift which will see a greater emphasis on educational outcomes over process. But could elements of this shift actually wind up hurting residents? Such is the case, according to a position paper published in The American Journal of Medicine.
The controversy centers on the means by which residents progress through a residency program. Along with the push toward educational outcomes has arisen an emphasis on allowing early progression through the residency program dependent upon resident attainment of specific competencies. Under such a system, high-achieving residents would be able to complete their residencies more quickly, moving on to fellowship and practice while their lower-achieving peers complete the program normally. Herein, say the authors, lies the problem.
Allowing early departure from residency programs opens up a number of issues that the current system is unprepared to address. First, it introduces an element of disunity into the system. Whereas previously, the residency program has been a means through which students develop ties to patients, teachers, and their peers, a shift to competency-based advancement would likely have the effect of making students much more concentrated on their own progression, with the possible effect of damaging the team-learning aspect. Additionally, the early departure of high-achieving students would deprive lower-achieving students of a crucial benchmark.
Time-based advancement also carries the risk of disrupting the fellowship process, which is mapped out years in advance and can be upset easily by insufficient achievement on the part of an already-selected student. Finally, the residency process should not be simply a pit stop on the way to a fellowship or practice, but a learning period in which students are able to develop a closer tie to patients, teachers, and the practice of medicine on the whole. Early departure endangers the development of such ties.
While the recent changes to the structure of resident education are likely to have positive effects, the authors contend that the community is better served by encouraging individual learning while at the same time impressing upon students the proper role of high achievers with regard to the group on the whole. This would have the effect of sponsoring a community of excellence rather than singling out a few high achievers for special progress.
Full Article |
Comments |
Back To Top
The Big EHR Question: What Does “Meaningful Use” Mean?
Source:
Physicians News
Date:
02/09/2010
It’s a term that’s caused concern and confusion among physicians and practice administrators since the passage of last year’s American Recovery and Reinvestment Act: “meaningful use.” Well, the government has finally released a definition for this critical term. How will it affect your practice? Will your electronic medical record system suffice? Read on for details.
EHRs meeting the meaningful use criteria will qualify practices for incentives of up to $44,000 over five years from Medicare incentive payments or $65,000 in Medicaid incentive payments per eligible physician. Eligible professionals are doctors of medicine or osteopathy, dental surgeons and dental doctors, podiatrists, optometrists, and chiropractors who are authorized to practice under state law.
The meaningful use criterion is to be rolled out by the government in three stages. In the first stage, the term focuses on electronic capture of health information in a coded format. That information must be used to track key clinical conditions and communicate that information to other health professionals and bodies.
The next stage is an expansion of the rule to address disease management, clinical decision support, medication management, patient information access, care transitions, quality measurement, and research. The third stage will focus on quality, safety, and efficiency improvements.
The rule will be open for comment, as revisions and alterations are inevitable. CMS will accept comments on the rule through March 15, 2010. Until then, experts recommend that practices maintain a certain flexibility with regard to EHR systems, so as to be able to quickly and easily adopt whatever standard emerges from the agencies.
Full Article |
Comments |
Back To Top
Social Media Consults May Harbor Dangers
Source:
American Medical News
Date:
02/08/2010
The Internet affords physicians an array of means to communicate with peers and patients. Physicians, along with everyone else, are increasingly taking part in social media networking groups, using them to discuss professional issues and even receive advice on treatments. But could the use of a social networking site constitute an inexcusable breach of patient confidentiality? The potential is there, and if you want to avoid it, you’ll need to keep a sharp ethical eye on your online interactions.
The rise of social media networking has led to a surge in the number of consultation avenues available to physicians. Sermo, Medscape, Physician Connect, Ozmosis: all are medically-oriented social network communities with access limited to physicians only. On sites such as these, physicians confer on professional issues and consult the wisdom of the crowd on diagnoses and treatments. But taking patient information to these sites puts you at risk for compromising patient confidentiality.
In disclosing information, you’ll want to make sure that you’re doing so on an HIPAA-compliant site. But before even doing that, make sure that the disclosure is necessary. Will you be more likely to get valuable help online than from those immediately around you? If so, would it be more effective to use a secure e-mail to communicate with a specific consultant? If it does come down to posting information on a social site, make sure that your case descriptions contain no HIPAA-protected identifiers. Also, use as little identifying information as possible: you’d be surprised how readily patient identities can be compromised even with a couple of unique details.
Social networks can be a critical tool for physicians. In remote areas in particular, they have the potential to increase provider access to medical information. At the same time, these tools must be used in an ethical and responsible manner in order to maintain patient privacy while ensuring improved outcomes.
Full Article |
Comments |
Back To Top
California Limits HMO Wait Times
Source:
Los Angeles Times
Date:
01/18/2010
Members of California HMOs will now have faster access to medical services, thanks to new regulations going into effect in the nation’s largest state. The California Department of Managed Health Care has finally passed regulations that have been in the works for nearly a decade.
The regulations call for HMO patients in the state to be treated by HMO doctors within 10 business days of requesting an appointment, and by specialists within 15 days. Urgent care patients not requiring prior authorization will have to be seen within 48 hours. These are not the only alterations to the law, though, as the new regulations now require calls to doctors’ offices to be returned within 30 minutes, on top of 24 hour availability of physicians and health professionals.
The regulations stem from actions initially brought about in 2002 by Health Access California and other groups. Over the past seven years, the regulations have undergone numerous alterations and tweaks to satisfy various parties and clear bureaucratic hurdles.
HMOs, for their part, are still analyzing the potential impact of the regulation, though some are on record indicating it will result in increased costs. Others are investigating potential gaps in the delivery of medical services to fulfill the requirements. The regulations come at a time when California, like much of the rest of the nation, is struggling to meet patient demand for physician services. HMOs contend that the regulations will require the state to spend more time attracting doctors and more money training doctors to meet the increased demand.
Full Article |
Comments |
Back To Top
Getting Your Feet Wet
Source:
H&HN Magazine
Date:
02/01/2010
A wave of consolidation appears to have hit the health care industry, with larger players using their deeper pockets to snatch up their smaller counterparts. In light of the current industry environment, your organization might be looking to consolidate operations with a larger health care group, be it for firmer financial foundation, access to technology, or any number of other reasons. If you’re looking to consolidate, though, you’ll want to test the waters on four key issues before taking the plunge.
First off: the due diligence. Do it. It’s indispensable to know just what sort of organization you’ll be partnering with if consolidation occurs. And don’t simply leave the due diligence to your accounting staff. While they may be well versed in your own financial workings and books, you’ll want to bring in a multidisciplinary team to examine the operations of your soon-to-be partner.
Next, you’ll want to take a look at how the merger will affect your institutional mission. Ideally, joining a larger system would be a means to improve your ability to provide a service to your community. In a worst-case scenario, the merger shouldn’t hurt your ability to do so. You’ll want to have a good picture of how the merger will help you serve your community better, and you’ll want to have the deal contingent upon your access to those resources that the larger institution can provide.
The last two tips go hand in hand. You’ll want to ensure that your current staff isn’t overly put out by the deal. If the deal calls for the dismissal of management staff, you’ll want to ensure that they are adequately compensated via severance pay. And, of course, you’ll want to bring in your medical staff as early as possible, as the deal will most powerfully affect the way that they practice day to day. Physicians might want to stay in a smaller configuration so as to have more say in operations; so it will be incumbent to make assurances to them regarding operations before any deal goes through.
While there’s more to it, these are the major sticking points that can sink any merger or make operations thereafter a nightmare. In guiding the merger through, you’ll want to keep an open mind, always accepting the possibility that a larger system might not be the best option. And if the deal goes through, it’s then your job to ensure that all the protections you negotiated are adhered to by the larger company.
Full Article |
Comments |
Back To Top
Medical Malpractice Payments Continue to Fall, Public Citizen Analysis Shows
Source:
Public Citizen
Date:
03/03/2010
For the sixth straight year, the total value of malpractice payments in the nation fell. This is in addition to a decline in the number of payments, the fifth such decline in as many years. This is a conclusion reached in a recent analysis released by Public Citizen.
In 2009, 10,772 payments were made on behalf of doctors for malpractice suits. This totaled about $3.5 billion dollars for the year. Since 2000, the amount paid out for medical malpractice settlements and decisions has fallen by 8%. Over the same period, the amount spent on health care as a whole rose 83% percent. Last year marks the lowest total value for malpractice payments for any year since 1999.
The analysis represents another salvo in the battle between proponents of medical tort reform and those that contend that malpractice comparatively amounts to only a fraction of the nation’s total annual health care spending and that alterations to existing laws would have only a minimal impact on spending growth.
Full Article |
Comments |
Back To Top
Successful Physician Retention Must Start During Recruitment
Source:
HealthLeaders Media
Date:
03/03/2010
Q: Why didn’t that prime resident wind up signing with your institution?
A: Because your competition never stopped recruiting, even after you thought you’d landed the recruit.
The same goes for why that top talent your institution landed wound up leaving after just a few years. The job you do recruiting doesn’t just affect who signs with your institution: it also affects who stays with your institution. So what can you do to sign and keep the top talent? HealthLeaders Media has some helpful hints.
For starters: honesty is the best policy. When recruiting, you’ll want to give your recruits a full picture of what they can expect while working for your institution: good and bad. If your recruit signs with you only to find some unbearable negative that you neglected to mention, they’re likely to bolt at the first opportunity.
Next, you’ll want to provide candidates with information about your organization and the local community. Economic statistics, scores, hospital rankings—all of these will let your recruit know that you’re trying to give a full view of what he can expect.
When a physician has signed on, you now have two parties that must be convinced to stay: the physician and his family. Send the family a welcome basket with a local paper and information on banks, insurance, and attorneys. You’re trying to woo the family just as much as the physician at this point. As to the recruit, roll out the red carpet. Introduce the recruit to community leaders, medical staff, department directors, and so on. Make sure to envelop them as quickly and fully as possible in organizational culture so that they feel a part of the whole from the start.
Keeping top talent is a process that starts from the moment you’ve located them. It’s a task for your recruiters, your marketing department, and your medical staff on the whole. But if you tackle it as a team, you’ll find talent sticking with you for years on end.
Full Article |
Comments |
Back To Top
What Every Physician Recruiter Should Know about Physician Disability Benefits
Source:
Journal of the Association of Staff Physician Recruiters
Date:
02/02/2010
Whether it’s your first placement or your fifth, if you’re a physician scouting new job opportunities, you may be impressed by the disability coverage one location or another offers, but how do you know if it’s really “best in class”? In a recent article in the JASPR, the authors—a lawyer and two corporate insurance brokers—provide a run-down of the trends in disability coverage that all physician recruiters (and thus, why not physicians?) need to know.
The authors do address sick leave and short-term disability benefits, but for the most part, the focus is on long-term disability coverage. “Must have” or “best practice” LTD provisions include the following:
-Provide a long-term disability benefit of 60% of income up to a maximum benefit in the range of $15,000 to $25,000 per month.
-Allow physicians to be insured in their specialty or subspecialty rather than simply as physicians.
-Allow disability benefits to be paid tax-free. If the premiums are paid by the employer, the payments must be reported on the physician’s W-2.
-Set up partial benefit coverage so that disabled physicians will be paid based on either the “proportionate loss” or “income offset,” depending on which is greater.
-In the event of a progressive disease, such as Parkinson’s, benefits should remain based on the physician’s income at the time the policy began or the diagnosis was made and not at any point after the disease has progressed.
On the other hand, provisions to avoid include:
-Mandatory rehabilitation requirements, which could keep a specialist from receiving benefits if he is able to work in a new specialty, or possibly even a new career altogether.
-Benefits offsets that reduce benefit payments based on other policies held.
-Policies that lack asymptomatic infectious disease coverage.
Finally, the authors point out a few general trends in disability coverage:
-A health care employer’s disability plan may be fully insured, self-insured, or partially self-insured. While the “vast majority” are fully insured, it is increasingly common for employers to self-insure aspects of the disability coverage because they have achieved economies of scale--either by pooling their coverage with other employers or by growing their own operations through mergers and acquisitions. The nature of the coverage can affect, for example, who actually pays a physician during the first year of their disability—whether it’s the employer or the insurance carrier.
-States such as California, Hawaii, New York, New Jersey, and Rhode Island require employers to provide short-term benefits to all employees.
-Physicians may receive additional disability protections under the Family and Medical Leave Act of 1993. Employees taking FMLA leave “must be restored to the job when the leave started or, at the employer’s option, to an equivalent position with equivalent benefits, pay, working conditions and seniority.” While the smaller employers are not subject to FMLA regulation at the federal level, some states have developed similar protections for employees of smaller companies.
Awareness of the above-mentioned points should give physicians greater confidence in accepting or renegotiating a new benefits package that includes disability coverage. Furthermore, even those not planning to leave their position any time soon can benefit from a better understanding of their coverage and may take the opportunity to shore up parts of their current policies that are lacking.
Full Article |
Comments |
Back To Top
Recruiting, Retention, and RACs Top Concerns
Source:
HealthLeaders Media
Date:
02/02/2010
The results are in from HealthLeaders Media’s annual Industry Survey and a breakdown of responses to the survey administered to “Community and Rural” hospital CEOs provides insight into the latest staffing needs in these perpetually underserved areas.
While only the fifth-highest priority for hospital CEOs in urban areas, “physician recruitment and retention” was cited as the most important issue to address in the next three years by the rural hospital CEOs who completed the survey (175 in total). Interestingly, nurse and other staff recruitment and retention ranked near the bottom of the list of priorities for rural hospital administrators. Administrators in both rural and urban areas agreed that quality and patient safety was the second most important issue their hospitals face, with “reimbursement” ranking third. Cost reduction was cited as the top priority among urban hospital administrators.
In a related series of questions, rural hospital administrators were asked how certain trends will affect their hospitals over the next three years, presumably if no efforts are made to reverse their course. When asked about the shortage of primary care physicians, 20% said it would have no impact, while 38% said the impact would be slightly negative and 29% said the impact would be strongly negative. It is not clear why roughly 13% of respondents would consider a PCP shortage to be positive, but these responses are interesting. In comparison, 23% said shortages of specialists would have no impact, while 42% predicted a slightly negative impact, and 24% predicted a strongly negative impact. Only 12% said that a shortage of nurses would have a strongly negative impact. Perhaps not surprisingly, only 4% said that organized labor would contribute positively to their hospitals’ operations in the next three years, though 44% either had no opinion or felt the impact would be negligible.
Other key findings from the survey include the following:
-When asked what strategies are proving the most effective in dealing with the economic crisis, 26% of the rural CEOs polled said that they thought “physician alignment” was very effective, while 39% said they thought it was slightly effective, and most of the rest were “neutral” on the subject.
-When asked to rate current workplace morale, 74% said it was slightly important or very important.
-The specialties mentioned as having the highest growth potential in rural hospitals over the next three to five years were geriatrics, imaging, and orthopedics, with 28%, 25%, and 25%, respectively, of respondents predicting growth of 6% or more. Additional specialty areas projected to see significant growth include general surgery, gastroenterology, and women’s health.
Based on these results, it appears that rural hospitals are making efforts to reduce operating costs during the recession, but scaling back on physician employment is not one of them. If the recruitment and retention of physicians is truly the top concern for these administrators, then physicians, and particularly PCPs and other high-growth specialists, should look for increasingly attractive offers from providers in rural areas for years to come.
Full Article |
Comments |
Back To Top
|
|
 |
 |
|
Employment & Compensation
|
|
|
| |
|
|
Campaign Calls for Limits on Doctors’ Hours
Source:
MedicineNet
Date:
02/04/2010
Are residency training programs placing residents and patients in unnecessary danger? That’s the claim from activists urging the Accreditation Council for Graduate Medical Education to limit the amount of time residents can work without sleeping. Fatigue, they say, is placing patients in grave danger.
Fatigue is often sited as a factor in car crashes, with some advisory boards likening brain function after a sleepless night to brain function while inebriated. Yet more than 100,000 residents regularly work 30 hours or more at a time, logging hundred hour workweeks. This, some activists contend, is unacceptable.
Beside practice impairment, doctor fatigue is linked to car crashes, depression, and harmful reproductive effects. Activists are arguing that the ACGME should limit the amount of time residents go without sleep to 16 hours as well as increase supervision of residents. Such a move would align rules with previous recommendations made by the Institute of Medicine in 2008.
More than 40 organizations have signed on to a letter to the ACGME, but organizers note that it may not be possible for ACGME to implement such changes without increased accountability. Such accountability would likely come from increased federal legislation regarding resident work loads.
Full Article |
Comments |
Back To Top
How to Get Paid for Care Delivered Over the Phone
Source:
American Medical News
Date:
02/01/2010
Talking on the phone with patients can sometimes be a useful way of extending your practice without necessitating more in-office contact. If you’re going to counsel patients by phone, though, you should be aware that a framework for billing for such services does exist. Using it, though, requires a careful adherence to regulations.
Billing codes exist for phone consultations, and payers do actually reimburse for such codes, though at a lower rate than for, say, e-mail consultations. If you’re going to bill for phone visits, you’ll be using codes 99441-99443 for calls of five to thirty minutes of medical discussion, or codes 98966-98968 for other health professionals.
Billing is one thing; ensuring payment is another. A good rule of thumb is that the call has to be taking the place of an actual office visit. To make sure you’re reimbursed for these services, you’ll need to make sure the call falls within acceptable guidelines. The calls must be initiated by an established patient or the patient’s guardian. Calls cannot relate to face-to-face appointments within the last week or the next 24 hours. Additionally, you’ll want to make sure you spell out payment terms in contracts with payers.
If you can’t get reimbursement out of payers, it may be time to bill your patients for calls. This may sound like a non-starter at first glance, but many patients actually will put up with additional billing for the convenience of being able to reach a physician by phone. You’ll want to inform patients ahead of time so that there is no confusion over the policy once it’s instituted. It’s somewhat tricky to get a system like this up and running, but once you do, you’ll add another potential revenue stream to your bottom line while increasing your patients’ access to services.
Full Article |
Comments |
Back To Top
Fla. Woman Fights Ruling That Kept Her in Hospital
Source:
Atlanta Journal-Constitution
Date:
01/26/2010
At what point does the privacy right of a mother-to-be end and the imperative to aid an unborn child begin? That’s the question at hand in a Tallahassee court, where a Florida woman alleges that doctors trying to save her baby unlawfully prevented her from leaving the hospital.
The patient was admitted on a false alarm of premature labor. She admitted to having smoked cigarettes during the first six months of her pregnancy. Upon examination, the physician noted that the patient’s membranes had ruptured, contractions had started, and the fetus was in a breech position. Despite this, the patient–feeling she was receiving insufficient care at the hospital–expressed her desire to go home to take care of her children and relocate to another facility. Fearing for the safety of the fetus, the doctor got a judge to deliver an emergency ruling by telephone, barring the patient from leaving the facility.
The suit alleges that the decision was reached without a necessary second opinion, while the physician counters that there was not enough time to get such an opinion. While the case is not the first to pit patient wishes against doctor’s orders, noted bioethicists and rights activists note that, should the decision stand, it could set a poor precedent in Florida law regarding the treatment of pregnant patients.
Full Article |
Comments |
Back To Top
Could Gynecologists Be Sued for a Missed Breast Cancer Diagnosis?
Source:
Contemporary OB/GYN
Date:
01/01/2010
Lowering the risk of malpractice action is a necessary step in today’s medical practice environment. Particularly in cases involving breast cancer, physicians must be aware of the risks they incur by providing treatment. An article in Contemporary OB/GYN spells out exactly what you need to be on the lookout for in order to keep yourself out of the courtroom.
The most essential step in avoiding litigation is proper documentation. While the medical record is primarily a means of facilitating quality care, it is also an indispensable ally in your defense if a patient outcome results in a lawsuit. You as a physician need to be aware that, once a patient has contacted a lawyer, the focus is not on whether or not you provided sufficient care, bur rather on whether or not there is grounds for legal action. With that in mind, document everything. And document it clearly: preferably electronically, but in legible handwriting if necessary. In court, the two main pieces of evidence are the patient’s testimony and your medical records. Because of this, you’ll want to ensure that your records are plainly legible, clear, and complete.
As to what to document, you’ll want a record of all interactions with the patient and all subsequent contacts, refusals, and concerns coming out of such interactions. Have your patients fill out short intake forms for each visit in which they document their reasons for coming in that day. If you discuss treatment and the patient refuses treatment, get her to sign a release form stating such. In this manner, you’ll avoid any unpleasant surprises on the witness stand, such as accusations that you did not adequately inform a patient of the risks of avoiding treatment.
All communication with patients should be documented as well. It might help to set specific times for patients to call back for test results if they haven’t heard from you. Also, don’t ignore complaints from patients; doctor-patient communication is essential, and in the case of litigation, such communication could swing a jury’s decision.
In the event of a complaint, contact your malpractice insurer immediately, as most insurers will provide advice on how to handle the situation. While there’s no way for certain to avoid the courtroom, a thorough medical chart is your best defense against such actions. Make sure to note all of the preceding items, and you’ll go a long way toward ensuring your practice’s safety from liability.
Full Article |
Comments |
Back To Top
Judge Hears Arguments in Challenge to Patents on Genes Tied to Breast, Ovarian Cancer
Source:
Medical News Today
Date:
02/05/2010
Controversial patents on human genes are under fire again, this time in a suit alleging the right of patients to know their own genetic makeup and the subsequent unconstitutionality of gene patents. A decision in the case has the potential to impact the entire biotech industry, with supporters of the patent alleging that their nullification would cripple the industry on the whole.
The case was filed by the American Civil Liberties Union and the Public Patent Foundation in the U.S. District Court in Manhattan against Myriad Genetics, the University of Utah Research Foundation, and the U.S. Patent and Trademark Office. Myriad holds patents on two genes associated with an increased risk of breast and ovarian cancers.
The plaintiffs hold that the patent–granted to Myriad a decade ago to cover the BRCA1 and BRCA2 genes and the genetic test that identifies them in patients–is unconstitutional. They argue that the isolation of genes doesn’t make the genes patentable, and that such patenting flies in the face of prior Supreme Court precedent regarding the non-patentable nature of natural phenomena. Since all humans have genes, they argue, the patents infringe on freedom of scientific inquiry.
The defendants argue that the patent system provides a financial incentive for the creation of the genetic tests, and the patent applies to the process developed to isolate chemical composition. They argue that invalidation of the patents holds the possibility of undercutting the biotech industry and could throw thousands of genetic patents into reversal. The judge heard arguments from both sides, but has declined to immediately rule.
Full Article |
Comments |
Back To Top
Liability by Locality: Practical Standard or Outdated Notion?
Source:
American Medical News
Date:
01/18/2010
One aspect of medical liability reform is causing a bit of a stir throughout the country. Proponents of the system claim that it is a means of protecting physicians who are situated away from the typical centers of medicine, while those who want to change the system call it an outdated model that holds back practice progress and prevents qualified individuals from serving as expert witnesses.
At issue is the validity of the local standard of practice system. In jurisdictions operating under the system, the standard of practice–the means by which a doctor’s actions are judged–is set at a local, state or regional level. The system came about in the 1880s in order to protect remote physicians from litigation due to their being unaware of the medical customs of their more urban counterparts. Those in opposition to the local standard rule call for the adoption of national standards, arguing that the local standard system brings about ethical issues in which a physician might be inclined to take one course of action but impelled to take another due to fear of repercussions for not adhering to the local standard.
The system has come under fire in a number of rural areas where the rule keeps out expert witnesses that are not familiar with local customs in practice. Proponents claim that it attracts physicians to underserved areas by reducing the risk of litigation against them. Compromises are in the works, though, to implement national standards with exceptions for local providers when access to resources necessary to achieve the national standard is limited.
Full Article |
Comments |
Back To Top
Divorcing Your Practice? Check Finances First
Source:
American Medical News
Date:
03/01/2010
Maybe the thawing of the credit markets has provided you with the opportunity to leave a practice you’ve outgrown. Maybe your retirement portfolio has recovered enough, or your locum tenens work will fill in the gap your practice work would otherwise fill. No matter the reason, if you’re looking to leave your practice, you’ll want to take a close look at your financial obligations, because it’s really not as easy as just stepping out the door.
You’re going to want to look at your practice’s finances. Pay particular attention to the lending agreements:
-If you have joint and several liability in the practice, each partner has signed for the entire amount of credit for the practice. That means that the bank can come after you for funds owed if the practice can’t pay the debt.
-Under several liability, each partner guarantees his own percentage of the loan. That means you’re protected if the practice owes money but you’ve already paid off your share of the debt.
-With capped several liability, there’s a limit on personal exposure that is less than your percentage interest in the outstanding debt. The cap reduces your own liability for the debt if the practice is unable to retire it.
-You should request any releases directly from the bank, as the bank isn’t bound by any agreement reached among you and your partners.
With regard to the lease, you’ll want to think of the landlord like you would a bank. Go into any lease negotiations with the previously mentioned strategies in mind, and you’re sure to come out a winner. As to the protection of personal assets, you’re practicing under the umbrella of a professional corporation, but that doesn’t shield you from liability with regard to negligence. You will want to structure any practice plans with a special regard to tax laws and state regulations, as you will be the party that is in trouble if your severance agreements are in conflict with the law.
Full Article |
Comments |
Back To Top
Opening Pandora’s Box: The 19 Worst Suggestions for DSM5
Source:
Psychiatric Times
Date:
02/11/2010
The Diagnostic and Statistical Manual of Mental Disorders is an indispensable tool in the practice of psychiatry. Any alterations to the content of the manual must be undertaken with extreme care, as they have the potential to adversely affect the lives of thousands. But the former chair of the DSM-IV Task Force is claiming that the newest edition of the Manual is inexcusably flawed, to the extent that it’s bound to have a deleterious effect on the field of psychiatry.
The newest edition of the DSM has been plagued with controversy and delays. After reports that field trials were slated to begin in the summer of 2009, the process has undergone numerous postponements, with the target date for publication now pushed to May, 2013.
The main problem arises in part from the poor and inconsistent writing of the manual. Advance releases contain amorphous wording, which allows for an increase in false positives. In fact, the potential increase in false positives is a major complaint with the new Manual: the definitions and tools included are at times so vague, and the thresholds lowered so much, that it seems almost certain that an explosion of diagnoses will occur following its publication.
From ADHD to Autism Spectrum Disorder to Major Depression, DSM-V threatens to lower the bar for diagnosis to include a wide array of behaviors that are found normally in the general population. Major Depression, for example, might be widened to include those symptoms displayed following the loss of a spouse. That is: bereavement would become a mental disorder. Other criticisms relate to changes in severity ratings for certain disorders and a ’paradigm shift’ toward the use of dimensional assessments for severity, co-morbid symptoms, and personality traits.
In all, the now three-year-old process of developing DSM-V has produced a potentially dangerous collection of sometimes amorphous criteria. This has opened the editing board up to accusations of widening the disorder net for personal and professional gain, a charge the author strongly rejects. Still, with the deadline for publication some three years out, it’s hoped that the editorial board will take the time to hone their product to result in a more useful diagnostic tool.
Full Article |
Comments |
Back To Top
Doctors Sue to Stop Unsupervised Nurse Anesthetists from Administering Anesthesia
Source:
HealthLeaders Media
Date:
02/03/2010
A lawsuit filed against California Governor Arnold Schwarzenegger alleges that a recent health policy alteration is unnecessarily putting patients at risk while damaging the relationships among physicians and nurses. The risk: unsupervised nurses administering anesthesia.
Typically, nurse anesthetists are required to be supervised by anesthesiologists while administering anesthesia. Under Medicare rules, though, hospitals may qualify for exemption from this rule if the governor, after consultation with a state’s medical board, sends a letter to the Centers for Medicare and Medicaid Services requesting such an exemption. Governor Schwarzenegger sent such a letter, and is now encountering resistance from physician groups.
The groups charge that nurse anesthetists, while a vital part of the operating room team, are insufficiently trained to handle all likelihoods that may emerge while administering anesthesia. Further, they charge, the governor did not seek proper consultation with the state’s licensing agencies. As a result, they have brought suit against the governor, asking the court to overrule the CMS letter and reinstate anesthesiologist primacy.
Spokespersons for the governor assert that the policy change was undertaken with solid consultation and does not constitute a significant raising of the risk level for surgical patients. Opponents note that, while it is not known how many hospitals are moving to allow CRNAs to administer anesthesia, it is a more likely occurrence thanks to the new rule.
Full Article |
Comments |
Back To Top
Introducing RoSS, a ‘Flight Simulator’ for Robotic Surgery
Source:
Physorg.com
Date:
02/25/2010
The da Vinci robotic surgical system looks to transform the practice of surgery, bringing improved outcomes and eventually opening the way for remote surgical procedures. But, if you feel like your skills are not quite up to the challenge, fear not. A collaboration between the Center for Robotic Surgery at Roswell Park Cancer Institute and the University at Buffalo’s School of Engineering and Applied Sciences has developed a “flight simulator” for the da Vinci system that lets inexperienced surgeons develop their skills on the next best thing to the real thing.
The Robotic Surgical Simulator–or, RoSS, if you’re feeling friendly–is an educational tool for surgeons that’s going to be rolled out over the next few years. For institutions offering robot-assisted surgical training, RoSS will be an indispensable ally.
Some 70% of prostate surgeries in the United States are performed using robotic surgical centers, and the surgical medium is seeing growth in gynecologic, gastrointestinal, cardiothoracic, pediatric, and other urologic surgeries. Currently, though, surgeons acquire proficiency on these systems by watching a more experienced colleague and performing on their own patients after attaining some degree of know-how. With RoSS, these surgeons will now have a better system that realistically simulates the feel of robotic surgery.
The technology is expected to go on sale by the end of 2010.
Full Article |
Comments |
Back To Top
Taking the Scut Work Out of Comanagement
Source:
Today’s Hospitalist
Date:
03/03/2010
Surgeons or hospitalists: who’s got the right of way? Comanagement is a source of contention no matter where hospitalists practice. But the Loyola University Medical Center has developed a program that may work to alleviate some of the contention over proper roles.
Before 2007, the whole hospitalist group provided consults to orthopedic patients on an as-needed basis. This led to hospitalists encountering difficulties in dealing with perioperative morbidities, as they were not necessarily equipped to handle such ailments. Additionally, there was too much variability in the speed with which hospitalists were able to address patients and care for their problems.
As a solution, Loyola’s system dedicates two rotating hospitalists to the comanagement of high-risk orthopedic patients. In orthopedics, these were predominantly patients undergoing elective surgery who had had hip fractures. Patients, upon admission, are triaged by the surgical team. Those patients designated as being at high risk are referred to the dedicated hospitalists in the surgical ambulatory center for preoperative assessment.
The result has been not only a decrease in in-hospital time among these patients, but also an increase in patient satisfaction. Patient satisfaction is up five percent, with 14% more patients reporting that their doctors treated them with respect. There are plans to expand the system to include other departments, though such expansion is limited as yet due to staff resources.
Full Article |
Comments |
Back To Top
|
|
|
|
|
Payer & Reimbursement Issues
|
|
|
| |
|
|
Medicare Physician Pay Cut Delayed as Senate Clears Logjam
Source:
American Medical News
Date:
03/03/2010
A procedural roadblock in the Senate has been overcome, and a possible 21% reduction in Medicare compensation for physicians has been avoided. And all of this happened in the last minutes before the Medicare reimbursement standards were set to expire. But why are physicians really only granted a month’s reprieve from the pay reduction?
By a 78-19 vote, the Senate passed the Temporary Extension Act of 2010. The Act puts off a planned reduction in physician pay of 21% that was supposed to take effect in March 2010. The vote passed by a wide margin despite efforts by Senator Jim Bunning of Kentucky to hold up the measure over concerns with its funding mechanism.
The measure as passed does not kill the reduction. Rather, it extends the deadline for the payment reduction until the first of April of this year. The House has already passed a permanent overhaul of the Medicare physician payment formula, and numerous physician groups have decried the Senate’s lack of prompt action on the topic, even though they have known the cut was coming for more than a year.
Full Article |
Comments |
Back To Top
Payer Take-backs, Take That!
Source:
Physicians Practice
Date:
03/03/2010
Payer take-backs can be a real headache. They pop up often well beyond any time that you might have had a patient’s case fresh in mind; they typically have incomprehensible documentation; and, if you’re not quick to resolve them, they could land you in a collections department or a payment offsetting nightmare. If you’re keen on avoiding such headaches, Physicians Practice has some tips to keep the hassle from payer take-backs to a minimum.
First, you’ll want to make sure you’re acquainted with your state’s laws. Some states have expiration dates past which payers cannot file for payment recalls. Next, make sure you get all the information you need to make a determination on the case. This will require a certified letter to the payer requesting further information. If the overpayment turns out to be verifiable, send the insurance company a check. If you simply tell them to offset the amount, the offset may be delayed and when it does come into effect, it may not be clear where the insurer is reducing payments.
If a recovery company comes after you, you don’t have to discuss collection action over the phone with them. If you request all communication be conducted in writing, they will have to send you evidence of your debt, which will let you view a physical copy for proper comparison against your own records. And do not simply send out checks. Wait for requests for refunds. If you send a check and the payer specifies a different party that is to receive the payment, you may well just be out that money.
Finally, don’t panic. If you’ve got a firm footing on state regulations, thorough documentation of transactions, and keep a cool head about you, then you’ll come through the process in no time with as little stress as possible.
Full Article |
Comments |
Back To Top
|
|
|
|
|
Credentialing, Licensure, Quality Management
|
|
|
| |
|
|
Medical Practice Benchmarking, Financial Performance, and Quality Care
Source:
Physicians News
Date:
01/13/2010
Everybody’s looking for a way to shore up the bottom line these days. At the same time, there’s increasing focus on improving patient outcomes. How can your practice pull together these two seemingly opposite influences? In a word: benchmarking.
Benchmarking, properly conducted, allows practices the chance to better understand not only the workings of the top performers in their areas, but also the financial dynamics of their own practices. This leads to more efficient practices that have a greater ability to focus on patient care delivery. That is, identifying best practices leads to efficient operations, which necessarily results in better care delivery, as physicians and providers are less focused on the particulars of running the practice and more focused on helping patients. A recent study found that 85 percent of practices could benefit significantly from a benchmarking initiative. Some experts even contend that benchmarking can increase bottom lines by 20 to 30 percent.
In beginning a benchmarking initiative, you’ll need to decide where you’re going to focus. Your practice could measure financial performance, productivity, clinical performance, or patient satisfaction, to name a few options. While it’s possible to evaluate your practice on all of those, it’s probably best to pick one area and devote energy to that. No matter what way you go about it, know that benchmarking gives your practice the opportunity to see what the best in your field are doing and to learn from them. Optimizing your practice will result in less wasteful activity, which will eventually improve patient outcomes.
Full Article |
Comments |
Back To Top
Joint Commission: Quality of Patient Care Improved in 2009
Source:
HealthLeaders Media
Date:
01/18/2010
U.S. quality of care was on the rise last year. In fact, last year marked significant quality improvements in most measured areas of care, according to a new study out from The Joint Commission.
The report, “Improving America’s Hospitals: The Joint Commission’s Report on Quality and Safety 2009,” examined care for critical medical events such as heart attacks, heart failures, pneumonia, and surgical conditions. The quality measurement focuses on preventable conditions, under the thinking that avoidance of preventable adverse events is a solid basis for cost reductions within the system. The report tracks 31 measures, covering more than 3,000 Joint Commission accredited hospitals.
Overall, the study found improvements in heart attack care, with a rating of 96.7% in 2008, up 9.8% from the 2002 ratings. This means that the hospitals surveyed provided best practice, evidence-based treatment for heart attack cases 96.7% of the time. Heart failure care ratings rose from 59.7% in 2002 to 91.6% by 2008. Not all of the news was positive, though, as fibrinolytic therapy and antibiotic provision were seen to have low rates of performance.
Full Article |
Comments |
Back To Top
Norway Conquers Infections by Cutting Use of Antibiotics
Source:
Miami Herald
Date:
01/11/2010
Quality improvement initiatives are a big topic nowadays, and a major point in these initiatives is the reduction of hospital-acquired infections. So, when Norwegian hospitals say they’ve virtually eliminated the occurrence of the most dangerous hospital-acquired infection, people take notice for good reason. But could their answer really be as simple as “Take a Tylenol instead of an antibiotic”?
Methicillin-resistant staphylococcus aureus (MRSA) is responsible for thousands of deaths around the world each year, including 19,000 in the United States alone. In Norway, though, hospitals show no signs of this dangerous and contagious infection.
The reason? It’s threefold: fewer antibiotics, isolation of positive-testing MRSA patients and staff, and thorough tracking of MRSA cases by strain.
American administrators say that the system is reproducible within the United States, and is being incorporated to some extent. However, there is little in the way of accountability to ensure hospitals are following best practices in dealing with the problem. There have been instances of successful adoption in the United States, though. A Montana medical center cut MRSA infections by 89% by adopting a variation of the Norwegian program. Likewise, such programs have been adopted at all VA hospitals, resulting in a 50% reduction in MRSA infections. The best part? The program virtually pays for itself, with the costs and man-hours saved by not having to deal with MRSA in the first place.
Full Article |
Comments |
Back To Top
Do You Hold Staff Accountable for Safety?
Source:
H&HN Magazine
Date:
02/02/2010
All the patient safety initiatives in the world will come to naught if there aren’t strong accountability standards to back them up. But how do you go about making your employees accountable without harming morale or driving away valuable physician talent? It’s actually easier than you think.
Safety-improvement efforts are on the rise in hospitals across the nation, and increasingly hospitals are making use of accountability standards to improve patient outcomes. But it’s not all blame and shame. In fact, many institutions are taking a wider view of the problem: they’re using their safety initiatives to shift the whole institutional culture toward employee safety compliance.
A common path involves initial warnings for violators, followed by strengthening penalties for those who continually violate the rules or flout them. Some institutions temporarily suspend physician privileges if they fail to comply with the safety regulations. Repeat offenders might be sent a letter from a medical staff leader, or even terminated if it appears they are simply unwilling to conform to the rules.
Beyond just the rules, it’s about creating a culture of safety throughout your organization. Administrators must demonstrate that hospital leadership is fully on board behind the proposals. This will give lower-level employees the confidence to either confront or turn in non-compliant coworkers.
Full Article |
Comments |
Back To Top
Getting Docs to Finish Documentation
Source:
Health Data Management
Date:
03/04/2010
Are your institution’s physicians slow to complete their documentation? Need to give your doctors some motivation to fill out those discharge summaries and operative reports? UC-San Diego Medical Center has a system in place that’s 95% effective, and Health Data Management detailed the secrets to their success.
UCSD’s system has been in place since 1992, when administrators designed a system using homegrown software to penalize physicians for failing to complete discharge summaries and operative reports. Under the system, doctors not completing reports are locked out of the facility’s electronic system until they complete all necessary paperwork. This means physicians can’t admit patients, order prescriptions, or perform operations until their reports are up to date. Initially, the system allowed doctors 28 days to generate and sign paperwork before the restrictions went into place, but subsequent technology upgrades throughout the system have left physicians with 14 days for discharge summaries and virtually no window for operative reports.
The system has been met with some choice words from physicians–“evil” and “stupid” being among the nicer things administrators have been called–but you can’t argue with its results. Ninety-five percent of operative reports are now completed on the day of the procedure. For discharge summaries, 85% are done on the day of discharge, and 97% are done within 14 days. Administrators now have plans to expand use of the policy to improve compliance among physicians providing ambulatory care.
Full Article |
Comments |
Back To Top
Military Health System Lays Out Five-Year IT Plan
Source:
Government Health IT
Date:
01/20/2010
Dealing with the ins and outs of implementing an electronic medical record system? You’re not alone. One of the largest health plans in the country, the Military Health System, is still optimizing its own adoption of a vast new information management and technology system and has just finalized its strategic plan.
The MHS’ five-year plan focuses on interaction between the armed forces, military health plan organization Tricare, the Joint Chiefs of Staff, the MHS chief information officer, and the Department of Defense. The plan—the first formally adopted since 1999—emphasizes a redesign of the current MHS IT architecture and the development of a robust electronic health record system.
Administrators note that it is important for the plan to yield solutions that are adaptable, interoperable, and quickly implemented. As a result, the EHR system they call for will have to aggregate patient data over time and across providers, operate in multiple settings, and permit information sharing. The IT architecture is centered around service-oriented architecture, in which information management improvements are rolled out at the same time.
The resulting IT structure will tie together all branches of the military with regard to patient health information, eventually allowing for patient access to medical records, virtual visits, and online transactions. This structure is a result of a presidential mandate to develop such records for greater integration of government beneficiary records.
Full Article |
Comments |
Back To Top
HITECH Ratchets Up HIPAA Accountability
Source:
Modern Medicine
Date:
01/11/2010
Health information technology has opened up entire new worlds of interconnectivity and interoperability for practices, health plans, patients, and other parties. At the same time, though, it’s opened up patient data to malicious compromise like never before. So what are your responsibilities in keeping yourself and your patients secure? Modern Medicine has the story.
Smart phones, laptops, flash drives, PDAs, and more: today’s physicians have access to them, and they’re all stuffed with patient data. Thus, they’re all in need of protection and subject to federal regulations covering handling of health information data. For providers, this regulation started in 1996 with the passing of HIPAA. As of February 2010, however, much of this same oversight and liability has now been extended to third parties and health care providers’ “business associates” through the Health Information Technology for Economic and Clinical Health Act (HITECH). While such third parties, which will play an increasing role in higher tech patient care models, are themselves now liable for the protection of data sent by providers, providers could still be held accountable for their business associates’ improprieties “under certain circumstances.” In June, new regulation will also take effect through the Fair and Accurate Credit Transactions Act (FACTA), requiring some providers to develop a protocol to “spot warning signs of suspicious requests for consumer data.”
In meeting your obligations under these laws, you’d do well to look at them as minimal compliance, not a goal to shoot for. To secure your data, you’ll need to take certain measures, some of which are outlined in the Modern Medicine article. You’ll need to properly screen employees and ensure appropriate firewalls around data systems following employee terminations or resignations. Business partners must commit to maintain your high standards of privacy, and risk assessments must be conducted, taking into account the possibility of audit by outside agents. You’ll also need a plan for dealing with data compromises quickly. If a breach involves more than 500 persons, you’re required to notify local media outlets.
It’s best for you, your HR staff, and your IT staff to completely familiarize yourselves with the rest of the security requirements to which you are beholden under HITECH and HIPAA. Doing so can mean the difference between efficient electronic operations and an embarrassing public revelation of security breach.
Full Article |
Comments |
Back To Top
Five Ways Health IT Leaders Can Fight Medicare Fraud
Source:
HealthLeaders Media
Date:
03/05/2010
With the government looking to stretch every health care dollar as far as it can, Medicare fraud was bound to come under greater scrutiny at some point. Now is that point, as Medicare administrators and fraud monitoring professionals turn their eyes to the $40 to $80 billion in taxpayer dollars lost every year to fraud. And your IT department can help.
Medicare fraud hurts everybody, as any institutions that are playing by the rules must suffer the repercussions whenever someone else breaks them. In the fight against fraud, electronic medical records may prove invaluable too, as they give easy access to data and tracking capabilities. Leaders of the anti-fraud crusade are calling for IT professionals to join them in the struggle, and there are five ways they say your practice can help:
-Education–Make sure your staff is up to date on the happenings in the fraud monitoring world. Have your IT department become a member of a professional organization with a code of conduct.
-Monitor trends and changes in data–Any sudden jumps in revenue that have no apparent reason are a cause for IT leaders to speak up. Also ensure that you are benchmarking against other organizations in your area.
-Vendor gifts–Avoid them. These are the easiest things for fraud investigators to latch onto, so even if you chose a device for its quality, you appear suspect if you accepted a gift from the vendor as well.
-Profiling–If you have a doctor constantly complaining about how he should be making more money, keep an eye on him. This type of individual is more often to engage in fraud because he operates from a sense of entitlement.
-Blow the whistle–When you see fraud, speak up. Even if you’re part of it, you may have protections as a whistleblower.
Fraud monitoring practices are only going to get more aggressive from here out. The future will likely bring “undercover patients,” who will investigate whether your practice is performing unnecessary procedures or billing for work that wasn’t done. In the mean time, you can follow the above hints to make sure your practice is operating in the clear.
Full Article |
Comments |
Back To Top
|
|
|
|
|
Physician Practice Management
|
|
|
| |
|
|
Top 10 Tips for Ensuring Medical Practice Success in 2010
Source:
Physicians News
Date:
02/19/2010
With the economic turmoil of late finally appearing to calm somewhat, you really should be using this year to get your practice on a firm footing from which you can become successful for years to come. If you’re struggling to hold onto or regain profitability, here are ten things you’ll want to keep in mind.
-Budget–Plan a realistic one. Don’t just assume arbitrary revenue and expense increases year to year.
-Billing–Keep an eye on billing staff, and make sure unpaid claims are being pursued vigorously. The same goes for patient collections.
-Recalls and follow-ups–Make a policy and stick to it. Your goal is to get patients back to the office regularly, and follow-up visits are the best way to do this.
-Fee schedules–Take a look at them. If you’re billing less for a procedure than insurance would reimburse, there’s room for improvement.
-Provider referrals–Do you have a lot of referrals to one specialty? Can you bring them in-house?
-Purchasing–Centralize it. This eliminates waste and allows for bulk buying, which opens up the possibility of discounts.
-Strategic plan–You need one. Develop a realistic vision of where your practice is going and build toward it.
-Staffing–If you’re simply adding staff each year, you’re likely not using the staff you have fully. Introduce efficiencies by having staff multitask.
-Practice dashboard–Develop some crucial metrics that will give you a snapshot of how your practice is doing. These could be cash positions, patients seen per day, expenses, or any number of factors. This allows you to keep a close eye on your practice without digging into specifics.
-Cash controls–If you’re leaking cash, profitability will be a longshot. Find out where the leaks are and patch them. The best way to quickly address this is with a professional review of internal cash controls.
It’s early into the year; so it’s not nearly too late to start instituting these changes. If you do, you may find that 2010 was the year your practice recovered and hit the ground running.
Full Article |
Comments |
Back To Top
Need to Calm Down a Frustrated Patient?
Source:
Today’s Hospitalist
Date:
02/02/2010
Regardless of your years of training and experience and the quality of your health care system, sometimes you just run up against a difficult patient, no? The February issue of Today’s Hospitalist takes a look at the problem of difficult patients, finding four crucial tips that can help you avoid a headache while still providing the care that these patients need.
First, you’ll want to make sure your patient is calm. If a patient is angry and vocal over perceived mistreatment, invite them into a consultation room to discuss their treatment calmly. If necessary, apologize to address the patient’s perceived wronging. If they are demanding something you cannot provide, tell them exactly why you cannot provide such and remain firm. Above all, stay calm yourself.
If a patient doesn’t want to leave a facility, you’ll need to fully explain what the hospital can and cannot do. Explain the limits of service–pain management, physical therapy, etc.–that your facility can provide. Separate yourself from Medicare rules, so that patients do not think that you have the ability to simply skirt established law whenever you so decide. Also be sure to suggest alternatives to patients with regard to less costly treatment, such as home care with visiting nurses and physical therapists.
In the case of a terminal patient, you may encounter family members who simply want you to make the patient better. Sometimes this is possible; other times not. You’ll want to ascertain first what the family members understand about the patient’s condition. From there, you can build a foundation for future communication. Ask what the patient’s wishes would be regarding DNR and extended care, and make sure that the family knows that there have to be contingency plans if the patient’s health does not improve.
If you’ve come across a patient that is unmanageable due to perceived importance, you’ll want to increase your own importance in the patient’s eyes. Refer to yourself as “Dr.” in your introduction to establish authority. When dealing with colleagues who may be interfering, maintain cordiality, listening to their opinions but strongly asserting your own. Be plain that you appreciate their input, but you are making the final decision.
As in all of these cases, difficult patients are no walk in the park; but if you handle them the right way, you can save yourself quite a headache in your practice life.
Full Article |
Comments |
Back To Top
Your Practice Manager: Controlling Too Much?
Source:
American Medical News
Date:
02/15/2010
Your practice manager is a lifesaver, no? Controlling all those tedious aspects of the practice and freeing you and the staff up to practice medicine, not fill out paperwork, are highly desirable objectives. Everything’s going fine; until, that is, you find out he’s been paying himself as a vendor. Or maybe she comes down sick and can’t make it in for three months. What do you do when the engine behind your practice breaks down for one reason or another?
While you might like regarding your practice manager as “indispensable,” that actually isn’t the best thing for your practice. If your practice manager has too much control over the workings of your office, you’ve created a liability through which embezzlement and even office paralysis can result. For this reason, it’s best to build some checks and balances into the practice manager position. Such a process starts with consulting your practice manager on placing checks on his position. If he refuses or resists, you might have reason to worry about his performance.
With the practice manager position, you’ll want to structure it so that not too much power is placed in the hands of one person. If your practice manager handles the books for your practice, then you’ll want an outside auditing firm taking a look at your financials regularly. If your manager handles the hiring and firing of personnel, you’ll want to keep a close watch on staff to see if the manager’s method is lowering staff morale. If you’ve already got a manager in place and are looking to institute these sorts of changes, make sure they know that you’re just trying to get all of the practice on the same page.
As a physician, you’ll have to strike a delicate balance between micromanaging aspects of your practice and letting your staff have the freedom to do their jobs. You can make your staff’s job easier by setting out a clear annual budget, meeting regularly with staff to discuss income and expenses, doing random checks of your finances personally, and cross-training staff for all positions. This last tip is an essential way to avoid setbacks due to temporary personnel losses.
Following the steps outlined above should go a long way in helping to keep any one employee from holding too much sway over practice operations, which is likely to keep you from catastrophic consequences if you find one day that you simply hired the wrong person for the job.
Full Article |
Comments |
Back To Top
Participatory Medicine: A High-Tech Alliance with Patients
Source:
American Medical News
Date:
01/18/2010
Looking to cut costs and improve outcomes? Strapped to find another way to improve your practice’s efficiency? Maybe your most valuable human resource–aside from your staff, of course–is your patients. American Medical News offers specifics on helping your patients take a more active role in their own care.
Participatory medicine basically means shared decision-making and sustained patient engagement. Advances in technology have vastly expanded the potential for such medicine, whereas in the past it was largely limited to patient-physician exam room conversations. Participatory models of care increase patient satisfaction while producing time savings, cost reductions, and quality improvements. Additionally, they have the potential to result in lowered liability for physicians.
Participatory care grows largely out of the Internet and the explosion of social networking sites. Patients are now able to access more information on their conditions and confer with similarly-afflicted patients around the country and around the world. This means patients have more information at their hands and are more readily able to converse with physicians regarding their conditions.
The real impact of this sort of practice remains to be seen, as yet. A recent study found that patients more involved in their own care were less likely to take part in risky procedures, but it is not clear the effect such tendencies will have on cost reduction efforts. It is likely, though, that increased involvement of patients in their own care has a depressing effect on the likelihood of a patient suing. Additionally, the decreased load on office resources can increase practice productivity.
In moving your patients to a participatory model, experts recommend starting with 10 to 20 chronically ill patients. You should already have a good relationship with these patients, who should also be fully employed and busy enough to appreciate the time saved by a high-tech approach to communication.
Properly implemented, such a system can bring doctors and patients closer together while improving patient outcomes and freeing practice resources: a sort of digital win-win proposition.
Full Article |
Comments |
Back To Top
|
|
Complimentary copy only,
click for free subscription.
|