|
|
|
Complimentary copy only,
click for free subscription. |
In a time of economic uncertainly, many professionals in
the health care field are concerned about their careers—not just keeping their
jobs but maintaining a sense of overall career satisfaction in their current
position.
This Special Report discusses factors that have a significant impact on career
satisfaction--or dissatisfaction. After all, physicians who are generally
satisfied with their specialty choice, workplace environment and clinical
involvement are happier, perform more effectively and contribute to quality
medical care.
|
| |
By J&C Research Associates
|
|
 |
|
 |
Job Satisfaction in a Downturn Economy
The deepening economic recession facing the United States—and the entire
world—continues to dominate the news. Last month’s Special Report examined some
practical measures hospitals have adopted for riding out the financial storm
that has hit the health care industry particularly hard.
This month, we take a
look at some pragmatic ways that individual physicians can make the most of
their current economic situation—and even contribute to a sense of career
satisfaction.
Two articles in the Physician Practice Management section of the
JCIR discuss how to save money through smarter inventory management and better
tax planning. Other ways to come out ahead is to “bill like a lawyer” and to
understand the “legalese” of contract clauses that can be needlessly costly.
Additional articles discuss the practicality of offering discounts to patients
for medical services rendered (“something is better than nothing”),
practitioners seeking closer alignment with hospitals, and re-thinking pay for
performance (P4P) as an option for maintaining revenue streams from payers that
insist on providers accepting that reimbursement model. For doctors who are job
hunting, it might be wise to set one’s sight a bit lower in terms of initial
compensation or ideal location, realizing that moderate sacrifice now can pay off later.
Finally,
our Special Report focuses on non-monetary factors that contribute to career
satisfaction. Physicians who are appreciated, challenged, relate well to the
workplace culture, and enjoy their work-life balance and the communities in
which they reside are more likely to experience career satisfaction irrespective
of other influences on their lives.
As the nation awaits a significant turnaround in
the economy, it’s worthwhile to focus on what contributes to job satisfaction
here and now.
Cordially,
Calvin Bruce
Managing Editor
 |
|
 |
| |
In tight economic times, for-profit hospitals and medical groups are all the
more concerned with how dollars are spent, especially concerning physician
staffing. In forecasting budgetary allotments for staffing, it is important to
consider return on investment. To assist hospital administrators and group
practice managers in making this determination, Jackson & Coker presents the
2008-2009 Return on Investment Calculator, which focuses on statistics compiled
from surveying hundreds of hospitals and healthcare organizations across the
United States.
This handy online tool provides information concerning average compensation for
doctors in major specialties as well as the revenue their medical service
generates. Other helpful information includes the total number of licensed
doctors per specialty, along with the percentages of doctors who are board
certified, International Medical Graduates, 55 or older (in the retirement
zone), and current residents.
| |
|
|
|
How Can Small Hospitals Survive?
Source: Trustee
Date: 01/01/2009
Driven by constrained budgets, rural hospitals over the past decade have increasingly turned to the benefits provided by serving as critical access facilities, while other rural hospitals – “tweeners” – look for ways to maintain a high level of proficient staff and technology amid financial difficulties and bureaucratic complexities.
Partnering with a larger organization can help save these smaller hospitals. With additional funding from a larger health system, tweeners are able to retain doctors who are otherwise unhappy without colleague interaction, while financing new technologies and addressing community medical needs.
The article argues that hospitals looking to secure additional funding from larger partners should focus on their own institution’s strength as well as figuring out how their institution can make their prospective partners as well as the surrounding community stronger, as strong hospitals that surround the community will make the region stronger. Key to this is the ability to look forward and realize one’s future needs before they begin to have a real impact on the hospital’s bottom line.
While negotiating financial and management issues between small hospitals and larger networks can be difficult, a strong hospital governing board can keep the benefits of the merger at the fore. To help directors correctly assess their hospital’s capacity for a partnership, experts recommend examining the following:
-The hospital’s business: Is there the “right” make-up of physicians in numbers and types? How are the financial benchmarks and capital funds holding up?
-The board’s vision: Is the hospital able to maintain a standard of care that’s appropriate for the community? Is the hospital operating at enough of a margin to keep up with necessary retooling and equipment updates to provide the community with the best possible secondary care?
-The best-fit partnership: Is the hospital within an hour’s drive, for both patient and staff convenience? Are the organizational cultures complementary? Have you considered all partner possibilities?
Answering questions like these will help board members reach a more informed decision on matters related to economic survival for small hospitals amid the current economic downturn.
Full Article | Comments | Back To Top
Economy Sends Physicians to Hospitals for Help
Source: American Medical News
Date: 12/15/2008
The effects of the economic downturn continue to send ripples through the world of health care, causing sizeable realignments in provider structure, according to a recent report from the American Hospital Association.
The report, a study of responses from 736 hospital chief executive officers and 557 hospitals participating in DATABANK’s web-based reporting system, found a collective drop in nonoperating revenue from $396 million in 2007 to negative $831.5 million in 2008. Thirty-one percent of responding executives indicated a shortfall in elective procedures versus expectations for the year, and 38% reported a similar situation with regards to admissions. As a result, the collective hospital operating margin declined from 6.1% to negative 1.6%.
As a result, hospitals are trying numerous approaches to cut costs. Most are trimming their administrative costs, and some are cutting certain services altogether. A majority of CEOs report an increase in physicians actively seeking help from hospitals as their costs have risen as well. And 83% of respondents reported physicians asking about hospital employment, while others reported increases in inquiries about purchase of physician practices and/or equipment.
This is a continuation of a recent trend of physicians seeking closer alignment with hospitals as a way of defraying operational costs. With this trend, it is generally the hospitals that have the leverage in negotiations, though experts contend that physicians can increase their leverage in deal making by laying out their full cash value for the hospital.
Full Article | Comments | Back To Top
Obama Signs Children’s Health Insurance Bill
Source: The New York Times
Date: 02/04/2009
President Obama signed legislation that extended the State Children’s Health Insurance Program (SCHIP), extending coverage for over four million children by 2013 while continuing coverage for seven million children already covered by the plan. Signed first in 1997, SCHIP is intended for children in families that do not qualify for Medicaid but make too little to afford private health insurance.
Legislation related to SCHIP had been voted on seven times since August 2007, but President Bush was opposed to extending coverage, a move that might lead to “government-run health care for every American,” traditionally an unpalatable plan for Republicans.
The article points out some changes to the legislation. Most prominently, SCHIP now covers two populations of legal immigrants: children under 21 as well as pregnant women. Historically, legal immigrants were not eligible for Medicaid and SCHIP until they had been in the United States for five years.
Other changes include a requirement for dental care coverage and allowance to provide that care as a supplement to private health insurance and a requirement to provide “mental health parity,” meaning equal coverage of mental and physical health, when invoking SCHIP.
Full Article | Comments | Back To Top
Doctor-Owned Hospitals Fare Poorly in Child Health Bill
Source: Wall Street Journal
Date: 01/22/2009
Physician-owned hospitals, according to a recent article in the Wall Street Journal, could soon go the way of the dodo bird. The hospitals are threatened by a new bill put forth by California representative Pete Stark (D), which will cut government sponsored Medicare payments to newly created physician-owned—or “specialty”—clinics. Additionally, extant specialty hospitals already participating in Medicare would be prohibited from increasing their capacity. Controversially, the bill would also prohibit specialty hospitals that had not received final Medicare authorization by January 1, 2009 from being grandfathered into the system.
Critics of the bill claim that specialty hospitals increase efficiencies and even lower government costs in addition to providing safe services and better outcomes. They contend that the proposed regulations threaten to drive scores or hundreds of physicians into personal bankruptcy. The bill’s supporters counter that referrals to doctor-owned clinics constitute a conflict of interest and that these clinics leave nonprofit hospitals with less lucrative procedures and patients, hurting institutions that perform a vital service for larger communities.
The bill is attached to the House version of a much larger child health bill currently making its way through both houses of Congress. The House bill recently passed, and a Senate version without the specialty clinic restrictions is slated for a vote soon. Thus, it is not certain whether the restrictions will be present in the final version to be signed by the president.
Full Article | Comments | Back To Top
“Capital Crunch” Forces Hospitals to Delay Facility and Tech Upgrades
Source: Healthcare Finance News
Date: 01/23/2009
The credit crunch and wider financial crisis are severely limiting the ability of hospitals to obtain funds necessary for facility upgrades or clinical and information technology investments.
According to a survey from the American Hospital Association, the vast majority of hospitals report that borrowing funds through tax exempt bonds is difficult bordering on impossible. Loans from financial institutions are also proving difficult to obtain. As a result, nearly 50% of respondent hospitals indicated postponement of projects set to begin within six months. Many report cessation on projects already in progress. Additionally, 43% of hospitals had planned to expand emergency rooms or urgent care centers but have postponed such plans due to the unavailability of funds, while 63% postponed projects intended to increase inpatient capacity.
Hospital representatives claim that the cessation of projects also means shortfalls in job creation for construction workers, contractors, and IT workers. They claim these shortfalls have effects that ripple out into the larger economy, and thus concern and effort should be devoted to solving the current capital crunch.
Full Article | Comments | Back To Top
Deloitte Sees $530 bln in US Health Care Savings
Source: Reuters
Date: 01/15/2009
Information technology and smarter use of drugs and procedures could save the United States more than half a trillion dollars in health care costs over the course of ten years, according to consulting firm Deloitte.
Deloitte, in a press release timed to mere days before the inauguration of the new U.S. president, proposed $220 billion in upfront spending on e-prescribing, EHRs, and coordination of care through primary care doctors.
In 2007, Americans spent $2.2 trillion on health care, or roughly 16.2% of GDP, a figure only forecast to go up. Deloitte’s plan to reduce that amount has at its core the evaluation of comparative effectiveness of various drugs with a goal of eliminating the use of ineffective pharmaceuticals. Additionally, the consulting firm sees sizeable reductions in cost with increased adoption of healthcare IT. The report doesn’t anticipate savings from its also prescribed “medical home” proposal, under which primary care physicians coordinate care for patients, but improved outcomes are expected, which the company views as a value-add for health care.
Full Article | Comments | Back To Top
Forecast for Retail Clinics: Heading Upward
Source: H&HN Magaziine
Date: 12/16/2008
A large retail clinic chain operating out of Wal-Mart stores in several states was forced to shut down recently due to market upheaval. So why did its CEO maintain recently that the retail clinic model is still quite sound and bound for growth? An article in Hospitals & Health Networks examines the claim and finds the CEO may not only be right about the retail clinic model, but may also have an inside track on the future of health care in the U.S.
From 2005 to 2008, the number of retail clinics in the country grew from 125 to 963. The industry, however, regularly takes steps back with sizeable numbers of clinic closings. Support from larger corporate entities, though, looks likely to keep the model alive, as Wal-Mart, CVS, and Walgreens have all ventured into the retail clinic arena in some form or another. Expansions are also envisioned in the workplace and airport clinic arenas, both envisioned as growth industries for the quick, non-acute services retail clinics often provide.
The article claims that, because of this, retail clinics are likely to continue to thrive and take on a new role due to sheer demographic facts. There are 78 million baby boomers due to retire over the coming decades, but only 7,800 geriatricians currently practicing. In combination with the shortage of primary care physicians and the overall doctor deficit, this means a potential boom market for the retail clinic in the near future. The author contends, with continuing pressures on the health care industry through shortages, the retail clinic market is due for a metamorphosis sooner or later into a vital arm for the industry--handling patients and cases the current system will simply be unable to process in the near future.
Full Article | Comments | Back To Top
Gifts to Doctors Must be Disclosed Under Bill
Source: Reuters
Date: 01/22/2009
Any gifts from drug and medical device manufacturers exceeding $100 in value will need to be publicly disclosed according to new legislation likely to pass through Congress soon.
The bill, put forward by Iowa Republican Senator Charles Grassley and Wisconsin Democrat Herb Kohl, would place penalties of up to $1 million on companies knowingly failing to report gifts in excess of $100. The bill, the Physician Payment Sunshine Act, is said to have strong support in Congress.
A previous bill setting the reporting cap at a total of $500 per year did not pass Congress in previous attempts. The pharmaceutical companies, which supported the earlier draft, claim that paid arrangements between pharmaceutical companies and doctors are necessary for advancements and patient care improvement. Supporters of the new bill say that the payments may skew doctors’ decision making. Furthermore, they contend the bill does not criminalize such gifts, but rather requires public disclosure, whereby they can be reviewed by the public.
Full Article | Comments | Back To Top
Hiring a Young Gun
Source: Physicians Practice
Date: 02/01/2009
Hiring young physicians today can prove difficult for administrators and practice heads. The younger generation of physicians has noticeably different life goals and ideas of what practicing medicine should involve. It takes an understanding of what the new generation is expecting out of medicine to make the right hires and keep them. An article in the February issue of Physicians Practice spotlights three key areas to cover in making sure that you are in the right mindset to land your practice a young gun:
-Flexibility—Younger physicians want more part-time and flex-time options for their schedules to allow for families and lifestyles. They watched the older generation dedicate themselves to their careers but do not necessarily desire to do so in the same manner. Practice directors can make up for the time lost due to a part-time physician by hiring two doctors to fill the role of one full-time physician or keeping older doctors on part-time to cover hours. Additionally, the hiring of hospitalists to care for inpatients can cover up other time discrepancies. However, in implementing policies such as these, care should be taken so that the bounds of schedule flexibility are set out in advance so as not to be abused.
-Compensation—In light of the cost of just about everything going up as well as the soaring cost of education, most young physicians are seeking higher pay. The article recommends trying practice transition allowances, stipends for residents being recruited, or practice coverage of inconvenient expenses such as CME or malpractice insurance as ways of hiring young talent.
-Cultural Fit—Perhaps the most important factor, younger physicians want to know where and how they fit into a practice’s culture. Mentoring is a good start to meeting this need, but in lieu of that, the creation of a generally welcome and open atmosphere—through a practice mission, a buddy system with an established physician, or community resource sharing—is a good way of making young physicians feel welcome.
Full Article | Comments | Back To Top
The Evolution of Background Investigations
Source: Journal of the ASPR
Date: 10/01/2008
The practice of background checks on prospective physicians has become an indispensable facet of the recruitment process. Background checks allow recruiters to ascertain whether a prospect has issues with substance addiction, criminal convictions, or has practiced bad medicine. An article in the Journal of the ASPR takes a look at the evolution of the practice and examines the options open to the modern physician recruiter.
The author dates her own first experience with medical background checks to the early ‘90s, around the time a book debuted detailing the saga of a doctor known by the FBI to be one of the most prolific serial killers in US history. The role the medical establishment played in abetting him led to the surge in background investigations of physicians.
Whereas physician recruiters of two decades ago had to rely extensively on the library and private investigators as well as government agencies for valuable background information, modern recruiters now can rely on the Internet for much of their research. Furthermore, whereas in the past recruiters needed to instruct investigators as to the nuances of residency programs and specialized referencing (and investigators had to instruct the recruiters as to criminal court records and cross referencing), recruiters now have the National Sex Offender Registry, Federation of State Medical Boards, AMA and AOA profiles, GSA debarment lists, Medicare and Medicaid fraud lists, and numerous other sources readily at their disposal online.
While much information is available online, the author still recommends not ruling out the use of a professional investigator. They go the extra mile and keep digging, possibly finding what might not have been uncovered otherwise. She also recommends making sure you’re aware of the Fair Credit Reporting Act and state regulations concerning investigations of private citizens, as there are strict guidelines as to what information may be accessed and why during the course of a background check.
Full Article | Comments | Back To Top
Using Media Type to Target Your Ideal Candidate
Source: Journal of the ASPR
Date: 10/01/2008
Recent years have seen the rise of a new generation of physicians. This generation is much more tech-savvy and thus pays attention to different media outlets than do their forebears. This, of course, results in a challenge for the modern recruiter: how to reach the younger generation while not abandoning the older physicians still necessary for practice. An article in the Journal of the ASPR examines the options available to recruiters.
The article discusses three media generally available to the recruiter: journal advertising, website advertising, and direct mail. Journal advertising, while it used to be the best means of reaching just about any candidate, is now probably best suited to attracting experienced physicians ready to immediately accept positions. The older generation of physicians is still best reached by this means.
Web advertising is considered the best for targeting younger physicians. A survey by the Health Care Advisory Board indicated that 77% of final-year residents conduct their job searches on the Internet. The last medium, direct mail, is best suited to attracting top talents that are not necessarily looking to leave their current positions. Direct mail can pique the interest of candidates you might not otherwise have reached.
The competitive physician recruiting market requires novel thinking and other skills, but most importantly, knowledge of what works and when to use a specific recruitment strategy. Knowing what kind of approach to use to hook a certain kind of prospect is an indispensable skill in the competitive world of modern recruiting.
Full Article | Comments | Back To Top
|
|
 |
|
|
Employment & Compensation
|
|
|
| |
|
|
Highlights from SullivanCotter’s 2008 Physician Compensation and Productivity Survey
Source: Journal of the ASPR
Date: 02/01/2009
Sullivan, Cotter and Associates, Inc. (SullivanCotter), recently published their annual physician compensation and productivity survey, which reports physician compensation data for over 41,000 staff, medical director/chief, and department chair physicians across 150 specialties and representing 257 different organizations.
The report found the average salary increase reported in 2008 was 4.4% for specialty and 4% for primary care physicians, nearly identical to the 4.4% and 4.2% respective increases reported in 2007. Surgical and procedural-oriented specialties remain the most highly compensated, while Primary Care specialties remain at the bottom despite a shortage for those specialties across the U.S. In fact, total cash compensation (TCC) for primary care had a median increase of 2.77% to 4.06%, showing that some primary care physicians are receiving below-average increases.
SullivanCotter, tracking changes in TCC across five years, shows that among the 20 tracked specialties, clinical pathology and neurosurgery have had the largest TCC increases: 69.28% and 68.75% change in the median staff physician TCC, respectively.
A notable trend in 2008 is the increased using of hiring bonuses. Compared with a 49% reporting rate in 2007, 57% of 2008 participants reported hiring bonus offers. In 2004, only 32% of SullivanCotter respondents reported hiring bonus use. SullivanCotter also believes that retention bonuses are on the rise but only has anecdotal evidence to account for this. The prevalence of retention bonuses will be measured in next year’s survey.
Full Article | Comments | Back To Top
Sacrifice as a Career Booster
Source: Unique Opportunities
Date: 02/01/2009
As hospitals continue to struggle to fill roles in the face of the physician shortage, an article in the January-February issue of Unique Opportunities contends that perhaps, in the interest of improving one’s marketability, physicians might want to consider accepting a position that they deem undesirable with the aim of attaining a better position in the long term.
The author details the troubles facing the modern hospital recruiter. Modern doctors, desirous of positions allowing for a social life in a desirable community, simply aren’t pursuing practice opportunities with undesirable hours, excessive call, or “poor location.” As a result, an oversupply of jobs exists, but in positions no one wants.
Nearly every specialty is experiencing a shortage like the one above. As a result, physicians willing to take on these less desirable positions stand to reap sizeable benefits. This can amount to up to $50,000 more per year in some fields if one is willing just to take on extra hours of call. More importantly, the author contends, the taking of such assignments means you’re more likely to find work and, when evaluations roll around, have already proven an ability and willingness to do the work that others will not.
Full Article | Comments | Back To Top
Does “Pay for Performance” Boost Quality or Just Cut Costs?
Source: The New Physician
Date: 02/01/2009
Although traditional payer models reward the profits to organizations providing shorter, quick-turnover appointments, payers are turning to pay for performance models. An article in the Winter issue of The New Physician examines the practice from the viewpoint of medical students looking to enter medicine in such a system, examining the benefits of P4P’s efforts at reducing the number of chronically ill patients and reducing costly procedures that eat at payer profits. The piece provides an insight into the mindset of some young doctors under such a system, ultimately finding the system a flawed but necessary facet of the American health care system.
The author notes the continuing clamor from numerous parties for the expansion of P4P systems in American health care. She notes with a bit of skepticism, though, the core of the system: payment based not upon provision of service but adherence to quality control metrics. This, the author argues, will have the ultimate effect of steering patients toward physicians most cost-effective for their payer but not necessarily the best doctors. Furthermore, advocates already decry the system’s “one size fits all” solutions, with the AMA calling it unrealistic for its lack of allowance for appropriate risk variance that could result in comorbidities and mitigating factors going undetected. The effects of P4P expansion will not, however, be totally negative, as other positive effects arising from greater adoption of the payment system include focusing doctors on elementary treatment guidelines and otherwise superfluous health care spending.
Full Article | Comments | Back To Top
The Dos and Don’ts of Offering Discounts
Source: Modern Medicine
Date: 01/16/2009
Point of service discounts for self-paying patients are fairly common practice in some fields. As the economic outlook worsens, physicians are more likely to encounter patients hoping that “something can be worked out.” An article in Modern Medicine examines some of the ins and outs of helping out.
The article suggests several pointers for ensuring that discounts are fair and legal. First: policies should be put into writing and consistently adhered to. Next: discounts should be tied to full payment, and care should be taken in offering them to insured patients. Insured patients are already essentially getting a discount, and further discounting of their copays could very well be a violation of your terms of service with their coverage provider.
Additionally, discount rates should be set in advance and adhered to once set. Doctors should also attempt to recognize true financial hardship so that the right people are getting discounts. One might consider a steeper discount for patients experiencing financial hardships. A good way of ascertaining who exactly fits into that category is to examine a copy of a recent tax return to confirm income. Also, financially needy Medicare and Medicaid patients may be eligible for hardship discounts.
Full Article | Comments | Back To Top
Specialists Warming to Pay for Performance
Source: Managed Care
Date: 01/01/2009
Though current pay for performance quality incentive programs are limited to primary care physicians, a growing number of specialists are open to the pay structure. This is the conclusion of a new survey examining specialist compensation attitudes.
The survey, from members of Health Care Future Consulting and Jefferson Memorial College, examined attitudes towards pay for performance among cardiologists, hematologists, oncologists, gynecologists, obstetricians, and orthopedic surgeons, questioning them on their preferences regarding pay for performance and how they would like to see it implemented.
Sixty-eight percent of respondents favored adoption of programs paying physicians for technological upgrades such as EHRs and ePrescribing. Forty percent displayed favorable opinions of P4P with regards to clinical performance and patient satisfaction. No majorities agreed P4P was best for their particular specialty, but majorities agreed on P4P’s overall ability to encourage the practice of evidence-based medicine.
The study’s authors claim the survey provides evidence that specialist attitudes toward P4P are changing and that specialists must be an important voice in the ongoing debate over compensation structures. They further contend that managed care organizations must work to engage specialists and bring them into the discussion on the future of P4P and physician compensation overall.
Full Article | Comments | Back To Top
A Lawyer’s Guide to Legalese: Clauses That Can Cost You Money
Source: Physicians News
Date: 02/03/2009
In medical practice, physicians often encounter documents—physician employment agreements, buy-sell agreements, LLC operating agreements, practice sale agreements, etc.—that are written in legalese, the inscrutable language of the lawyerly. These documents are generally negotiable, though, and as such should be examined carefully to ensure you’re maximizing your possible returns and minimizing risk to your practice or yourself. An article in the February issue of Physicians News explains some of the more commonly occurring clauses and what you need to know about them.
-Merger Clause—This clause pins down the exact nature and terms of the deal in question. This is what people are talking about when they say “get it in writing”: a note indicating that the deal in question supersedes any preexisting, non-contractual understandings and sets the real rules for the operation of the relationship.
-Evergreen Clause—This auto-renewal clause can hurt you if you don’t remember the deadline for termination. For example, if a three year contract requires 180 days’ notice for termination and you remember this with 179 days left on the contract, you’re roped into another three years. This can be fixed by the inclusion of a mid-contract termination clause wherein either partner may leave the contract with notice and not be held to it unwillingly.
-Notice Clause—This clause requires that official notices (such as employment termination) be written and delivered either in person or by a nationally-recognized courier. If this is not the case, the termination will not be final, even with verbal notice.
-Cause Termination—This clause outlines specific events that will result in the termination of an employment contract. Because most reasons for termination—bad behavior, inadequate skill sets, etc.—are not specifically covered by “cause,” a common remedy is to insert a clause permitting “termination without cause” if necessary.
-Venue—This clause is more important than one might think. In the case of litigation, this clause determines in what county or state the matter will come to court. Try to ensure that it’s on your home field.
-Attorney’s Fees—While this clause won’t necessarily hurt you (in fact, it can work to your benefit, should you prevail in a case), it is generally reason to be more cautious in pursuing legal action. Should you file a weak case and lose, you’ll be required to pay the other party’s attorney fees in addition to any other damages.
-Survival of Representations and Warranties—An important aspect of purchase agreements, these clauses determine how long any promises a seller makes shall apply after the termination of the agreement. The longer the survival period, the longer the seller has to make sure any warranties are still honored. For sellers, it is wise to negotiate as short a period as possible; for buyers, as long a period as possible.
Knowing the basics of legalese is quite helpful when negotiating contracts that affect yourself personally or your medical practice. As they say, “to be forewarned is to be forearmed.”
Full Article | Comments | Back To Top
EHRs May Reduce Medical Liability Risk, Study Shows
Source: American Medical News
Date: 01/15/2009
Besides increased efficiencies, quality, and safety, another reason has presented itself to encourage physicians to adopt electronic health records (EHRs): decreased medical liability. This is the finding of a study funded by the Agency for Healthcare Research and Quality and the Massachusetts eHealth Collaborative.
The study, a survey of 1,140 Massachusetts physicians, found 6.1% of respondents using EHRs had paid liability claims. Among doctors not using EHRs, that number was 10.8%. Additionally, 5.7% of doctors actively employing EHRs reported a “closed claim,” compared to 12.1% among doctors less frequently employing EHRs.
The study’s authors believe EHR systems cut liabilities by reducing diagnostic errors, improving follow-up and patient communication, and improving guideline adherence. They also provide for a clearer documentation of patient medical history. Additionally, the study’s authors call for further research investigating the effect of EHRs on liability. At least one carrier in Massachusetts, Connecticut-Massachusetts Insurance Company, already offers discounts of 5% for doctors using EHR systems. It is believed that such offers, more widely adopted by coverage carriers, could help encourage adoption among physicians.
Full Article | Comments | Back To Top
State to Debut Controversial Medicaid Program
Source: Star Bulletin
Date: 01/23/2009
Beginning in February, the state of Hawaii will launch a controversial managed care program that has seen lawsuits and accusations of criminality thrown into its path in attempts to stop it.
Last year, the Department of Human Services transferred a $1.5 billion Medicaid contract to two for-profit mainland U.S. firms—UnitedHealth Group, Inc and WellCare Health Plans, Inc. The move raised concerns on the islands, with competing health plans joining physicians’ and patients’ rights groups in protest. UnitedHealth Group and WellCare have also been accused of fraud in the contiguous states, drawing further complaints from citizens. Representatives of the new program claim that mainland accusations of fraud have nothing to do with the functioning of their island operations, citing a desire to move forward from here.
The new program will cover about 39,000 aged, blind, and disabled Medicaid recipients. Affiliates of the program have already recruited more than a thousand physicians and health care workers, though some complain that the new program does not pay enough to cover the cost of care.
Full Article | Comments | Back To Top
APA Helps Psychiatrists Improve Patient Safety
Source: Psychiatric News
Date: 01/16/2009
With a focus on improving preventative care in psychiatry, the American Psychiatric Association has published a free handbook, available on its website. The book examines six events – aggression, elopement, drug or medication errors, falls, medical co-morbidities, and suicide – with a focus on helping psychiatrists develop and implement systems to reduce or prevent such incidents.
Particularly with psychiatry, mistakes can be more difficult to assess than more procedure-focused care such as surgery. Psychiatrists often operate in teams that require medical coordination, interactions with family, social workers, and other doctors. The chapters on each event detail examples of unsafe care, discussions of missteps, and future prevention ideas. Instead of criticizing medical professionals, the book aims to improve processes in each system that contribute to the end mistake.
Through the use of patient vignettes describing cases in which safeguards failed, the manual particularly highlights communication as an important way to overcome the discussed treatment errors. There are brief discussions and analyses of failures as well as summaries of remedying steps. Based largely on existing knowledge, the handbook authors claim it is not meant to be used as original research, but as a summarizing and integrating resource. It is hoped that the manual will go a long way in improving the communicative abilities of readers, patients, and families.
Full Article | Comments | Back To Top
Adoption and Mental Illness
Source: Psychiatric Times
Date: 01/26/2009
Though a representation of adoptees in mental health treatment is well established, a recent study by researchers at the University of Minnesota reveals more linkages between adoption and mental illness.
The study, a comparison of a random pool of 540 Minnesota-born adolescents with a representative sample of adoptees—514 international and 178 domestic—examined subjects between the ages of 11 and 21.
Common adoptee disorders included oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder (ADHD), conduct disorder, major depressive disorder, and separation anxiety disorder. The occurrence of ADHD or ODD was twice as high in adoptees. Also, consistent with past research, this study found that domestic adoptees have a higher rate of externalizing behavior disorders than their international counterparts.
The study assessed participants using the Diagnostic Interview for Children and Adolescents-Revised (DICA-R) and the Structured Clinical Interview for DSM-III-R, both of which had been updated to cover DSM-IV criteria. Mothers of participants also received a modified DICA-R assessment, to help assess their children. This study’s methodology improved on prior studies and is the first to examine a population-based sample of adoptees using DSM-IV disorders.
Full Article | Comments | Back To Top
|
|
|
|
|
Payer & Reimbursement Issues
|
|
|
| |
|
|
Insurers Share Doctors’ Financial Pain, Worry About Networks
Source: American Medical News
Date: 02/09/2009
The insurance companies realize physicians are likely to have cash flow problems in the face of the financial downturn. Doctors shouldn’t think that will result in greater payments from insurers, though. This assessment summarizes the results of a November 2008 study.
The survey, conducted by CSC, a business consulting firm, questioned 30 executives in November of 2008, asking them how they thought the economic downturn would affect other business partners. Seventy-three percent of respondents predicted the downturn would have effects on partner solvency, while 54% indicated concerns about network stability. Another 31% predicted a decline in quality of services and care.
In the face of this, though, experts predict that doctors shouldn’t expect much in the way of help in reimbursements from their insurer partners. Critics call the companies short-sighted, forecasting only one or two years ahead in terms of their own budgets.
The insurers counter that their Pay for Performance programs are a financial boost for well-rated physicians. Further, they tout real-time claims adjudication and online eligibility checks as a way for physicians to better anticipate income, insuring collection of the proper co-pay from patients. Physicians, according to experts, hold such little leverage against payers due to their small market share compared to the payer. The dynamic between insurers and physicians in a recession will still depend very heavily on the individual market, just as in good times. Still, payers are not very likely to approach physicians with the proposition of paying them more.
Full Article | Comments | Back To Top
Health Plans: Disrupt and Prosper
Source: Managed Care
Date: 01/01/2009
Along with the rest of the United States, the health care system faces difficulties during this recession, but unlike other industries, the problems have been growing since the beginning of the new millennium. From 2000 to 2007, health care premiums continued to rise to a 98 percent increase overall, despite only a 23 percent increase in wage earning over the same period. As costs continue to increase and wages plateau, what can managed care organizations do to cut costs?
Consultants from Innosight contend that amidst the current financial difficulties, the payer business model needs to re-examine itself and make adjustments to succeed. The current business model used to deliver medical services combines too many different business processes within a single hospital. If payers can work efficiently to coordinate care, prevention and consumer involvement, they will ease managed care’s future.
To overcome the prevalent overlapping expenses, payers should look to the example of integrated insurance companies like Kaiser Permanente. By investing in innovative practices like electronic medical records (EMRs) and preventative care, Kaiser Permanente has avoided costs that its competitors have not. Additionally, payers should prepare to woo individual subscribers as employer health care becomes increasingly legislated and prohibitively expensive. At the same time, EMRs, which are part of a proposed stimulus package, will help payer organizations more efficiently coordinate subscriber care, client and physician payments, and pay-for-performance initiatives.
Managed care organizations need to assess their organization and business units, target points for integration, and follow opportunities offered by the still-shifting market of participants and consumers. The authors point out success stories: with flexibility, Pfizer and the State of Florida have formed a partnership to provide residents with the right drugs without bloating the state’s costs or complicating Pfizer’s payment structure.
Full Article | Comments | Back To Top
How to Bill Like a Lawyer
Source: Physicians Practice
Date: 01/01/2009
A physician isn’t like a lawyer. He can’t always bill for every aspect of practice that takes time, such as the time spent consoling and counseling a patient after a serious diagnosis… or can he? An article in Physician’s Practice reveals some ways of maximizing the financial return on your time.
The article reveals that the key to “billing like a lawyer” is the use of time-based billing—a separate path from normally used E&M codes. Time codes’ sole criterion for selection is time. The codes make it easier to generate financial returns on counseling sessions and other time-intensive aspects of practice.
This only works under certain circumstances, though:
-More than 50% of billed time must be spent with the patient on counseling or coordination of care;
-Time spent by ancillary service providers cannot figure into the coding;
-The time must be documented; and
-The description of the counseling and discussion must sound plausible.
Additionally, time codes can be used in billing for prolonged services such as initial exams of patients with long and complicated histories and clinical issues. Also, treating patients with whom routine procedures take longer due to their conditions—e.g. morbid obesity, unexpected adhesions—qualifies for Modifier-22, which allows for additional compensation under Medicare. Patient discharges, if exceptionally lengthy, can also be time-billed. Furthermore, patients requiring ongoing oversight qualify for time billing.
Some physicians don’t like time billing, believing it to be an automatic trigger for an audit. Though with proper usage and documentation, this is an easily avoided possibility. Properly utilized, time billing is an ideal way to lend a listening ear to patients while at the same time shoring up your bottom line.
Full Article | Comments | Back To Top
Healthcare Expenditure Growth Rate is Decelerating
Source: Modern Medicine
Date: 01/06/2009
The U.S. health care spending rate in 2007 decelerated to its lowest level in ten years, according to representatives of the Centers for Medicare & Medicaid Services.
The study, released by CMS-Baltimore representatives along with colleagues, examined Medicare and Medicaid program data, the Census Bureau’s quinquennial Economic Census and Service Annual Survey, and numerous other private and public sources. The study found that the national health expenditure growth rate declined by .6% from 2006 to 2007, down from 6.7% to 6.1%. More than half the slowdown is said to come from a decline in retail prescription drug spending’s growth rate, which was at its lowest rate since 1963.
The study’s authors contend that the most recent economic news is likely to have an effect on these figures when they are reviewed later, even though health care tends to remain largely insulated from the economy. Still, the authors caution that the interaction between health spending and the economy needs to be closely watched.
Full Article | Comments | Back To Top
|
|
|
|
|
Credentialing, Licensure, Quality Management
|
|
|
| |
|
|
Yes, We Need a Checklist
Source: Health Leaders Media
Date: 12/22/2008
On the average person’s desk is likely a list of things to do for the week or the day. And people generally try to get through as much of the list as humanly possible. These lists keep lives organized and functioning--so can using them save lives in the operating room? A study in the New England Journal of Medicine says “yes” and a columnist for Health Leaders Media wonders why these findings haven’t led to greater implementation of checklist protocols in hospitals around the nation.
The New England Journal of Medicine study found a 19-point surgical safety checklist based on World Health Organization guidelines resulted in a decline in death rates of nearly 50%. At the same time, inpatient complications were reduced from 11% to 7%. The study was large and international in scale, spanning multiple hospitals across eight countries.
Why then, the author asks, aren’t these procedures more widespread? A perceived overlap between existing institutional procedures and WHO guidelines may be partly to blame, as some administrators perhaps believe they have most of the bases covered. The author argues, though, that it only takes one oversight for patient death; so that’s no excuse. Stubborn organizational and cultural rules are also partly to blame, but these shouldn’t stand in the way of improved patient care.
The president and CEO of Healthcare Improvement’s National Forum asked each hospital to implement the WHO’s standards recently. A close look at what’s keeping administrators from doing so might be what’s needed to get the ball moving on that front.
Full Article | Comments | Back To Top
Report Says Major Investments Result in Fewer Hospital-Acquired Infections
Source: Healthcare Finance News
Date: 01/22/2009
Major investments in efforts to provide safe and high quality health care pay off, if the results of a Pennsylvania Health Care Cost Containment Council report are to be believed.
The report, entitled “Hospital-Acquired Infections in Pennsylvania,” compared infection rates among Pennsylvania hospitals for calendar years 2006 and 2007. The report showed a significant decrease—7.8—in the infection rate per 1,000 cases. Also in decline were mortality rates for patients both with and without infections.
Administrators cite the technological, infrastructural, and workforce investments the Pennsylvania system has made over time as the primary driver of the improvements. They also warned, though, that continued funding and support was necessary to maintain and expand these improvements.
Full Article | Comments | Back To Top
California Hospitals Graded on Death Rates
Source: Los Angeles Times
Date: 01/22/2009
A new study by California state officials aims to shed some light on the quality of care in California’s hospital system, with inconsistencies boldly noted. An article in the Los Angeles Times explores the study’s results.
The study looked at 2006 and 2007 mortality rates in California hospitals. Overall, 35 hospitals in 2006 and 25 in 2007 were found to have better mortality rates than the state average on at least one indicator, while 98 and 94 were found to have worse than the state average on at least one indicator in 2006 and 2007, respectively.
The study, to be posted soon on the Office of Statewide Health Planning and Development website, has already run into criticisms. Hospital administrators claim it contains erroneous data, with one hospital claiming the study falsely attributes 15 deaths to their gastrointestinal care department.
State officials counter these accusations by claiming every effort was made to ensure accuracy in the data and that the hospitals themselves were required to sign off on the accuracy of the data they submitted previously. State officials claim there are plans to eventually expand the study, and they plan to update the data yearly.
Full Article | Comments | Back To Top
Quality Reports for Hospitals Inconsistent
Source: American Medical News
Date: 01/12/2009
The competing systems of hospital quality reporting are incompatible and contradictory to the point of confusion, according to a new study published in the November/December issue of Health Affairs.
The study, based on a comparison of results for nine 250+ bed general hospitals in the Boston area across five leading hospital quality reporting services, found that results varied widely by service and by institution.
Hospitals could receive widely variant ratings in services evaluated by different companies. Two hospitals with top rankings for coronary artery bypass graft surgery received fourth and last places for the same procedure when evaluated by a different company. Even within companies, similar variances occurred between departments, as hospitals received different ratings within the same hospital for different services.
Critics of the rating systems claim that they make it difficult for patients to judge quality and difficult for hospitals to know what measures to improve for which services. Proponents claim that the variation in rankings is normal and critics put too little faith in the average consumer’s ability to judge. The American Medical Association and the American Hospital Association have both called for increased standardization in rankings, with the AMA having debuted its own 200 quality improvement metrics for public reporting.
Full Article | Comments | Back To Top
Lax Needle Use in Clinics Raises Alarm
Source: Wall Street Journal
Date: 02/04/2009
Health care professionals generally adhere to proper procedure regarding the use and disposal of hypodermic needles. An incident in Las Vegas, however, suggests their protocol regarding syringes may be in need of fixing, according to an article in the Wall Street Journal.
The controversy stems from recent outbreaks of diseases such as hepatitis after medical staff failed to follow proper procedure regarding disposal of medical syringes after use. The article highlights in particular a 2008 incident in Las Vegas in which six people contracted hepatitis C from reused syringes and medication vials at two endoscopy clinics. The incident resulted in the urging of sixty thousand patients to undergo screening for possible contamination.
A study published in the Annals of Internal Medicine reviewed hepatitis outbreaks in the US from 1998 to 2008. It found evidence of 33 outbreaks in 15 states over that period. The Centers for Disease Control and Prevention is working now with the Safe Injection Practices Coalition to inform more health workers on proper safety guidelines and alert consumers as to how to protect themselves.
Full Article | Comments | Back To Top
IBM, Google Health Aim to Blow Medical Records Wide Open
Source: The New York Times
Date: 02/05/2009
Google, Inc. continues to demonstrate its innovation with its most recent move: Google Health and IBM, along with the Continua Health Alliance, have created a software platform that allows medical data to be collected from at-home medical devices and transferred to online health systems. The Continua Health Alliance, made up of small medical device makers and other companies, includes names such as Nokia, Intel, and Panasonic.
At a time when electronic medical records (EMRs) have been introduced as part of a proposed stimulus bill, Google Health’s entrance into the field signals the future possibilities for health care in the U.S. It is hoped that the technology can be shared to support “an entire ecosystem of complimentary [sic], competing and interoperable health data services.”
The organizations’ press release suggests that the system can be used to manage chronic diseases, overall health and wellness, and elder care, in addition to the “standard consumer benefits” of shared, online health information.
Full Article | Comments | Back To Top
Seeing the Light With CPOE
Source: H&HN Magazine
Date: 02/01/2009
Like other information technology advancements set to revolutionize the world of health care, computerized physician order entry (CPOE) holds much promise in terms of efficiencies and decreased errors. As is also the case with most information technology advancements, most hospitals still have yet to adopt a CPOE system. An article in the February issue of H&HN Magazine examines the benefits and best practices necessary if your hospital is considering implementing one of these systems.
According to studies, only 17% of hospitals have adopted CPOE systems. Experts claim the real quality improvements from the system only arise with a change in organizational habits and policies. Foremost in the necessary changes, they advise the construction of a broad-based, cross-functional forum of clinical leaders from around the hospital. This forum will be charged with the development of a standardized, evidence-based group of order sets for the new system. These forums will lay the groundwork for future implementations of CPOE. Experts add that these forums would be well advised to utilize existing information from earlier CPOE adoption attempts as well as information sharing with peers.
With the protocols in place, it is necessary to set the levels at which the system will alert particular physicians to problems in their orders. Too many alerts can prove annoying and result in increased ignoring of the system. Some organizations turn off most alerts except the most critical ones. Others turn off most alerts for physicians, but leave alerts on for the pharmacy to gain warning of adverse drug interactions.
The settings for these should be determined by individual organizations, but it is important to note that vendor codes do not cover every imaginable occurrence. At times, a hospital may need to add its own codes to the system it was provided.
For instance, Piedmont Hospital realized that its system didn’t have an alert setting for warning against blood thinners for recent epidural catheter patients. In combination, the two could result in catastrophic bleeding around the spinal cord. In rectifying this omission, Piedmont added even more value to their system, which says a lot considering that the system has already resulted in a 30% reduction in sepsis mortality and a 90% reduction in hospital-acquired deep vein thrombosis.
Full Article | Comments | Back To Top
|
|
|
|
|
Physician Practice Management
|
|
|
| |
|
|
2009 Tax Tips That Will Save You Money
Source: Medical Economics
Date: 02/05/2009
The benefits of tax planning should be meaningful to every physician. To manage your tax bill in 2009, this article offers some advice. Foremost, good tax planning starts with the physician, despite having a tax professional. To begin, physicians should have their personal tax situations assessed; review the practice’s business set-up, accounting methods, and tax strategies; create and use tax-reducing strategies; and monitor state, local, and federal tax charges and changes. With effort, good tax planning and record keeping can be used to grow the practice.
Recent changes affecting physicians include benefits related to the 2008 stimulus package, which applies to businesses’ equipment costs and increased depreciation allowance. While states debate adopting federal tax breaks aimed at businesses, the article advises remembering that medical practices can deduct state, local, and taxes paid on their federal return.
The article also reminds readers that to capitalize on any changes in tax law, amended tax returns can be prepared and filed up to three years after an original return is filed or two years after the tax is paid. Tax extensions are also available, which also enable extra time to process how changes can affect the final tax bill.
Full Article | Comments | Back To Top
How to Save Money by Improving Your Inventory Management
Source: Medical Economics
Date: 02/05/2009
As the U.S. economic crunch continues, physicians look to reduce costs. This article discusses the benefits of paying more attention to inventory management. As an opening example, an Ob/Gyn practice began using an inventory-tracking system that allowed more transparency into office and medical supply use. By streamlining the ordering process and using the system, the practice saw supply costs drop 6% while patient visits increased 4.5% over a year and a half.
With administrative costs so high, the article recommends implementing the following tips in your practice:
-Develop good working relationships with vendor representatives.
-Comparison shop: know other vendor prices and don’t be afraid to ask for matching prices from your main vendor.
-Reduce the number of vendors, and solicit bids from the remaining to make sure your practice is getting good pricing.
-Take note of ordering practices: consider ordering online, in bulk, or paying sooner to avoid additional charges.
-Use word-of-mouth to find a trustworthy and knowledgeable vendor.
-Keep monitoring practices simple: clipboards in supply rooms can help monitor supply use.
-Sometimes a computer program is not the best answer; they can be overly complex or inefficient.
-Learn the best time to reorder supplies based on remaining supply and delivery time. Bulk ordering isn’t always best.
-Examine historical usage to gauge seasonal needs like flu or tetanus shots.
-Card indices with supplier information, orders placed, cost, and arrival date can help information continuity and track important supplier data.
Full Article | Comments | Back To Top
The Physician’s Guide to Medical Volunteering
Source: Medical Economics
Date: 01/23/2009
The day-to-day grind of modern medicine can leave physicians wondering why they chose medicine in the first place. An article in Medical Economics claims to have just the solution if the drone of paperwork and long hours has left you in need of a recharge in your love of medicine: volunteer work.
Numerous organizations around the country and around the world offer the opportunity for willing physicians to treat the millions of people worldwide suffering from acute and chronic conditions but unable to regularly access health care due to conflict, poverty, or natural disaster. A sampling of the top programs, their time commitments, and areas of service is provided below.
-Doctors Without Borders—A two-year commitment puts you in areas riven by wars, epidemics, and natural disasters. A $1,300 monthly stipend and per diem are provided.
-DOCARE—A two-weeks or less commitment puts you into remote villages--mainly in Guatemala, treating indigenous peoples, but also possibly in Ecuador, Mexico or El Salvador.
-Care Kenya—Two-week excursions from November to December place you in a freestanding Kenyan clinic treating leprosy, malaria, typhoid, HIV, and tuberculosis, among other afflictions.
-Project Hope—Typically a month-long commitment sees volunteers transported via Navy vessels to disaster areas around the world. Previous missions included post-Katrina assistance and post-tsunami aid in southeast Asia.
-Flying Doctors of America—A seven-to-ten day mission, which can include physicians’ spouses and children. Missions typically visit third world countries to treat the poorest of the poor.
-Remote Area Medical—Missions at least a month in duration provide no-cost medical, dental, and vision assistance to remote areas of the United States.
Although these medical missions do not offer the same income earning potential as other temporary practice opportunities, many physicians favorably report that the non-monetary benefits make it well worth their while to include volunteer work in their future plans.
Full Article | Comments | Back To Top
|
Complimentary copy only,
click for free subscription. |
|
|