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Physician Compensation

 


Special Report: Health Care Reform and Physician Compensation
By J&C Research Associates

 


Shawn Strash, FACHE
– Chief Executive Officer with Oro Valley Hospital ... Click Here

Editorial for January 2010

Physician Compensation and Contribution to Medical Facilities’ Bottom Line

It’s the start of a New Year and decade. We can only hope that in the coming months and years the major changes occurring in the health care field and challenges facing individual practitioners will be addressed suitably and in the best interest of all parties.

In this month’s edition of the Jackson & Coker Industry Report, we focus on physician compensation from two perspectives. First, our Special Report takes a look at physician compensation from the standpoint of proposed health care reform.  Not until some final, reconciled Congressional bill passes will we know more precisely what’s in store regarding physicians’ earning potential.  But even at this juncture, some key questions deserve attention.

Secondly, using updated compensation data gathered by an independent research firm, Jackson & Coker presents the “2010-2011 Provider Contribution to Operations Percentage Calculator.”  This convenient tool enables hospital CEO’s and administrators to view current annualized compensation figures and input their own contractual adjustment percentages and immediately view customized contribution results for their particular facility.

In a time when hospital finances are strained, it’s helpful for administrators to adjust their physician compensation models to meet industry trends, while keeping a close eye on what can be expected in terms of revenue generation from different service lines.

Cordially,

Calvin Bruce
Managing Editor

Calculating Physicians’ Financial Contributions to Medical Facilities

         

   Charles Evans, FACHE, has remarked on the usefulness of the calculator:

“I believe that the contribution calculator is an outstanding way for administrators to gain a perspective quickly and easily as to the direct financial impact of an additional physician on their organization.”

What are doctors worth in terms of revenue generation for their medical services?  Jackson & Coker has made available to the medical community the “2010-2011 Provider Contribution to Operations” calculator that is useful in answering this question.  

Accounting for contractual adjustments percentages, hospital CEOs and other administrators can use this online tool to calculate average annualized revenue matched against average annualized compensation (updated for 2010 with fresh research data).  This information is helpful in updating physician compensation models, planning for seasonal staffing shortages, and creating new service lines.

Another consideration when calculating anticipated revenue concerns “the cascading effect” of revenue generated by interrelated hospital departments. 

Edward McEachern, VP of Marketing for Jackson & Coker, explains:  “For example, when a hospital’s emergency department is adequately staffed, those physicians refer some patients to the operating room for surgery; the surgeons in turn request anesthesiology and pharmacy services, and so on.  If any of the links in that chain restrict the patient flow, all of the following revenue centers will be adversely impacted.  Therefore, the value of an individual physician must be viewed as part of a total revenue stream and not as a single billing entity.” 

  Risk Management Tip of the Month: Ensure that your prescription pads are secure at all times and are not accessible to patients.   

FEATURE ARTICLES

Survey: Most Hospitals Use Social Media, but Few Have Formal Plans

Smartphones Becoming Clinical Tools

Hospitals See Some Economic Recovery

Physicians Must Adapt, Evolve in 2010

Body Scan Detects Cancer

Hospital Mergers Loom as U.S. Overhaul Fails Centers

F.D.A. Aims at Doctors’ Drug Pitches

Senate Committee on Aging Holds Hearing on Industry-Supported CME


Additional Categories

Industry News

Staffing & Recruitment

Employment & Compensation

Medical - Legal Matters

Medical Specialty Focus

Payer & Reimbursement Issues

Credentialing, Licensure, Quality Management

Healthcare Technology

Physician Practice Management


 
Industry News

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Survey: Most Hospitals Use Social Media, but Few Have Formal Plans
Source: iHealthBeat.org
Date: 02/01/2010

What’s your institution’s relationship with social media? Could you sum it up as “It’s Complicated”? If so, you’re not alone. A new study finds that, while hospitals are quick to jump into the social media pool, most aren’t really certain what to do once they’re in there. Greystone.Net, a web services firm serving hospitals and health care organizations, recently conducted a survey of more than 100 clients, asking them how they use social networking sites. The survey found that, while nine out of ten hospitals and health systems reported using social media, only a third have a formal social media plan in place. Further findings from the study found high hopes among hospitals for the applicability of social media to their operations, but little in the way of real progress in implementing the tools. Nine of ten respondents wanted to use the sites–mainly Twitter, YouTube, and Facebook–to attract new patients, but most were struggling to achieve their goals. What’s more, critics of the study say that it reflects the experiences of hospitals that would be predisposed toward using social media, which means the less tech-savvy institutions are likely faring far worse. These critics argue that many institutions likely aren’t putting real thought into how they can use these tools to expand their influence and outreach. For their part, Greystone representatives note that a formal plan to improve media interactions is key when jumping into the social web. Otherwise, you wind up with a plethora of technological outreaches with no real goal or direction behind them.

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Smartphones Becoming Clinical Tools
Source: American Medical News
Date: 12/21/2009

Looking for a way to justify that Droid purchase beyond being able to check Facebook between patient visits? A few innovative uses of smartphone technology could very well see your phone being used in a clinical setting, and not just for idle web browsing. Recent surveys have shown a strong majority of physicians, more than 60%, use smartphones. The number is expected to grow to more than 80% by 2012. The power of the platform, in combination with this widespread use, opens the door for innovators to bring new technologies to a wide user base. And what offerings are available so far? For one, there is OsiriX—a radiological viewing program that now has a mobile component. A study using the software on iPhones found that physicians were able to accurately diagnose appendicitis using the iPhone version nearly 100% of the time. The technology isn’t slated for FDA approval, but its makers believe doctors will use it anyway. And it’s not just software offerings. Some technology makers envision using cell phone cameras in conjunction with microscopes to allow for cell-based analyses of body fluids. Designers of such technology estimate that it will cost around $20 and be available later this year. The technology isn’t meant to totally replace existing, full-size imaging and lab equipment. Rather, the makers claim it will be most useful for field physicians who are likely too far away from labs and imaging services to make use of them in a timely fashion. With the increasing speed of cell phone networks and the exponentially growing power of smartphones, though, they envision a day where complex imaging results can be delivered through the devices.

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Hospitals See Some Economic Recovery
Source: American Medical News
Date: 01/11/2010

Are things looking up for the hospital industry? A new report claims that is exactly the case, as hospitals hope to emerge from the economic downturn even stronger than they were when it began. The report, produced by the Thomson Reuters’ Center for Healthcare Improvement, analyzes the finances of more than 400 hospitals and compares those numbers to the hospitals’ figures for 2008. Researchers found that the median profit margin for hospitals had increased from just over a third of a percent in 2008 to 8% by the second quarter of 2009. Hospitals were also found to be more financially stable, with more in the black and more reporting higher days of cash-on-hand. Analysts credit the improvement in hospital fortunes to reduced labor costs, shorter patient hospitalization terms, and improvements in hospitals’ borrowing options and credit ratings, as well as their investment portfolios. The stock market rebound has seen the investment packages of hospitals improve, while Moody’s and Standard & Poor’s have upgraded the credit ratings of hospitals in recent months. At the same time, researchers urge caution, as the precise effect of unemployed patients on hospitals is still unknown. Hospitals are likely, as people run out of COBRA coverage, to see a spike in last-minute procedures and patients without coverage at all. Additionally, the full effect of proposed health insurance reforms remains an unknown. Finally, health care tends to be an industry that lags behind the economy on the whole; so there is a distinct possibility that any sighs of relief might be premature.

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Physicians Must Adapt, Evolve in 2010
Source: HealthLeaders Media
Date: 12/31/2009

Who knows what the future holds? Unfortunately for health care, there’s no such thing as a crystal ball. But it’s not too hard to read the signs present in the market now and see where your practice needs to be heading. First up, it’s time to reexamine hospital alignment. It’s no secret that the margins for most private practices are getting thinner. In a time of increasing bad patient debt, this trend is likely only to continue. According to HealthLeaders Media’s Elyas Bakhtiari, it has been a good idea for a while now to align with hospitals or seek employment under a hospital, but it’s more advisable now than ever before. The fee-for-service model’s days are counted, and the best way to take advantage of the coming payment system is to make sure you’re aligned with a bigger player. Also, Bakhtiari says, you will want to take a good look at the technological component of your practice. While you might say you’re prepared, thinking your practice’s EHR is enough, you’ll also want to look into increasing your web presence via social networks and expanding your use of mobile technologies. The presence of these technologies in practice is only going to increase; so it’s good to get in early. Finally, take a good look at the way you conduct your practice. Two areas in particular are appropriate to focus on in adapting to challenges in practice management.. First, look closely at your finances and contracts. The influx of patients is typically viewed as a headache for doctors; but, really, it represents an opportunity to renegotiate strongly with payer organizations. Secondly, influxes of new patients will be much more easily handled by your practice if you implement a culture of education within the practice. A partnership model in which you make patients actively informed and involved in their health makes for happier patients and improved outcomes.

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Body Scan Detects Cancer
Source: The Post and Courier
Date: 01/13/2010

A new weapon in the war against cancer has presented itself, and it arises from existing technology. Researchers at the Mayo Clinic claim to have identified a manner of screening patients for a hard-to-spot cancer using PET-CT scans. The results come from a Mayo Clinic analysis of the medical records of 56 patients with suspected paraneoplastic neurologic disorders who had undergone PET-CT scans at the Clinic. Paraneoplastic neurologic disorders occur when antibodies mistake normal neural cells for cancer cells. The cancers causing such disorders tend to be harder to spot, but the researchers found that more cancerous abnormalities were detected by the PET-CT scans than by the other screening methods undergone by the patients in the study. The researchers acknowledge the necessity of limiting patient exposure to radiation, further indicating that the technique isn’t appropriate for all cancer detection, as bladder and kidney cancers are more difficult to detect via PET-CT. For initial oncologic examination of patients exhibiting paraneoplastic neurologic disorder, though, the researchers believe their method to be the best means of detecting such cancers.

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Hospital Mergers Loom as U.S. Overhaul Fails Centers
Source: Bloomber
Date: 02/02/2010

Health care reform has stalled in Congress; so the whole industry is up in the air, no? Well, at the very least, the uncertainty over legislative measures to reform the health insurance industry has led to a boon for private health care groups. In fact, these private providers are indicating that the stalled legislation is making it more likely that they’ll be able to expand operations. The proposed health care legislation is expected to add some 30 million newly insured patients to the health care system nationwide. In order to garner support, legislators cut a deal with hospitals, in which hospitals would give up some $155 billion in cost cuts to reimbursement, while gaining $171 billion over ten years for newly insured patients. These are funds that would be vital to smaller, rural hospitals that are more likely to serve government-insured, underinsured, and uninsured patients. As smaller hospitals suffer and face economic uncertainty, though, their larger private counterparts are faring much better. Acquisition prices for some smaller centers have dropped as much as 50% over the past three years, and private health hospital chains are eager to take advantage of this financial opportunity. Private chains often have easier access to loans and funding for expansions, staff, and new technology, while their smaller peers find such opportunities dwindling. There were 52 hospital mergers in 2009, totaling $1.7 billion in value. This was actually down from the previous year, in which 60 mergers occurred for a total value of $2.6 billion. The decline, though, is likely to reverse this year as private chains see increased opportunity since the funds smaller independent hospitals were counting on appear less likely.

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F.D.A. Aims at Doctors’ Drug Pitches
Source: New York Times
Date: 01/31/2010

The Food and Drug Administration is cracking down on physicians’ role in drug promotion, citing a Miami Beach dermatologist for violation of agency rules. The citation could have an effect on pharmaceutical and medical device promotion, which relies heavily on information from drug investigators. The controversy centers around a Miami Beach physician working as an investigator in clinical trials for Dysport, an injectable, anti-wrinkle drug. Dysport is, as yet, unapproved by the FDA, but the doctor made comments to the media in 2007 regarding the effectiveness of the drug and the duration of that effectiveness, comparing it favorably to Botox. Under FDA regulations, such dissemination of information is forbidden while the product is still in clinical trials. It’s common, though, among cosmetic doctors to be a source of information on the latest cosmetic medical treatments. That’s why the FDA’s action is of some concern to media industry experts, who now wonder if the action will make doctors less likely to provide reliable information about forthcoming products. For its part, the FDA doesn’t discourage communication between physicians and the media. Rather, administration officials note that it is only against regulations to talk about products before they have been deemed safe by the agency. Recent months have seen the FDA more forceful in its handling of drug advertisements, as the Obama administration appears to have taken more of a hard line on misleading commercials and online marketing efforts.

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Senate Committee on Aging Holds Hearing on Industry-Supported CME
Source: Psychiatric Times
Date: 02/03/2010

Conflicts of interest pertaining to industry-sponsored CME came into the spotlight thanks to a recent hearing hosted by the Senate Special Committee on Aging. The hearing is the latest in a larger series of moves toward lessening the influence of industry interests in medical education. It follows the introduction of yet another piece of legislation requiring greater disclosure: House Resolution 3200. HR 3200 doesn’t just affect physicians and physician group practices, though; it requires disclosure of financial relationships for medical schools, sponsors of CME programs, patient-advocacy or disease-specific groups, and many other players in the health care world. The Department of Health and Human Services is charged with putting that information online, thus increasing its availability. In the wake of greater scrutiny of industry-sponsored symposia, professional organizations are searching for ways to educate their doctors without incurring conflicts of interest. The American Psychiatric Association, for example, is considering phasing out industry-sponsored symposia entirely at a cost of $1.5 million. Some note that it is still possible for companies to fund CME, but they will have to sacrifice a good deal of influence over the process to avoid the appearance of impropriety. This would involve setting up independent bodies to collect funds from industry players to fund CME; separating grant-making functions from sales and marketing; and establishing objective criteria for grant-making. While some critics of the recent scrutiny contend that CME is just fine as it is, noting a healthy and necessary relationship between doctors and industry players, leading organizations are moving toward reform. The Accreditation Council for CME introduced a number of new regulations, including increased scrutiny of commercially supported providers, increased probation for providers seeking reaccreditation, and increased public disclosure of CME provider information.

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Staffing & Recruitment

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Physician Recruitment Income Guarantees Ease Hiring of New Docs
Source: Physicians News
Date: 01/14/2010

Nothing motivates like money...unless it’s guaranteed money. Physician income guarantee agreements are on the rise, as hospitals are reaching across the country to secure top talent. How can you make sure your organization makes the right choices with such an arrangement? Physicians News provides some specifics. Physician income agreements are contracts in which a hospital guarantees a certain level of income to new hires in their first couple of years of practice. If the physician doesn’t reach that level of income, the hospital makes an advance on the difference. In doing so, though, it is important to make sure that such an agreement doesn’t encroach on the earnings of other physicians within the practice. Typical agreements secure loans with a private accounts receivable account. Limiting interest on the loan to receivables helps the rest of the practice avoid paying off the new recruit’s debt. With specialty physicians, make sure that the recruited physician is in a specialty wherein patients are admitted to the hospital. Otherwise, what’s the hospital’s interest in the whole affair? Also, you must adhere to Stark regulations when assigning overhead costs to a new physician’s income. Existing overhead must be added only incrementally, and initially, only those costs associated with the physician’s hiring. Non-compete clauses between the physician and his new practice group have been allowed by Stark regulations since 2007 but remain uncommon, as hospitals want their recruits to be able to continue to practice within the service area if the physician wishes to leave the practice group. If a physician leaves town before working off any salary advances resulting from the income guarantee arrangement, responsibility could lie with the practice or solely on the physician. Make sure you know which is the case in your guarantee contract. Finally, taxable income is a major concern in these sort of affairs. The responsibility for payments can rest on the organization, the hospital, or the physician. Be sure to work this out before developing or signing any contracts. These agreements are by no means simple, but if you find yourself needing to acquire a certain talent, it may well be worth the effort to go about setting one up to seal the deal.

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N.J. Faces Shortage of Doctors Caused by ‘Morale Problem’ Among Physicians
Source: NJ.com
Date: 01/26/2010

The physician shortage—coming to a health care community near you. Some areas are feeling the pinch already, and others are even more strongly affected. In New Jersey, doctors and administrators are blaming a morale problem for much of the state’s troubles in keeping physicians. Experts forecast a shortfall of 2,800 family doctors and specialists in New Jersey by the year 2020. The report comes from the New Jersey Council on Teaching Hospitals, and it cites an unappealing environment for doctors as the main cause of low morale among New Jersey physicians. The report projects a 1,000 physician shortfall in primary care and a 1,800 physician shortfall in specialty practices. The report’s authors cite New Jersey’s high medical malpractice insurance costs-- third worst in the country--as a primary cause for low morale. Additionally, physicians endure poor reimbursement for treating elderly and poor patients in addition to the usual burden of running a business. The authors warn that the physician flight will continue until the state enacts policies to ease the burden of practice on physicians, including malpractice reform, debt forgiveness, and a boost in physician recruitment funds.

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Hospitals Turn To the Unique To Combat Physician Recruitment Woes
Source: The Post-Journal
Date: 01/17/2010

The physician staffing crunch is driving many hospitals to consider options that, just a few years ago, might well have been thought radical. This according to a report out from a New York health care industry monitor. The Healthcare Association of New York released a report last month that claimed its member organizations were short on staffing needs by more than 1,300 physicians. Need was most acute in primary care, internal medicine, general surgery, orthopedics, and hospital medicine. The shortage is causing some hospitals to implement some practices they otherwise wouldn’t. WCA Hospital in New York, in particular, has taken to participating in collective recruiting, in which the hospital partners with private practice groups to recruit needed physicians, particularly in anesthesiology and psychiatry. Such partnerships are especially beneficial for rural hospitals, which are known to have a harder time recruiting physicians. Hospitals are also increasingly engaging in direct employment of physicians. This is a trend emerging as hospitals encounter recruiting difficulties at the same time that practices are experiencing tremendous economic strains. As a result, the HANYS survey found 90% of respondents having directly hired physicians. A final trend noted by the study was the increase in use among hospitals of midlevel providers such as nurse practitioners and physician assistants. In fact, many hospitals now report that these midlevel professionals are carrying out much of the work that would otherwise be done by doctors. There are even concerns over whether the demand for such providers will lead to a shortage in midlevel professionals like the one currently facing physician recruiters.

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Employment & Compensation

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Considering Locum Tenens Right Out of Residency
Source: LocumLife
Date: 01/15/2010

New physicians typically emerge from their residencies with their eye on a specific hospital and a specific practice goal. But could a sojourn in the locum tenens field give residents a new perspective on the field they’re entering? There are a number of reasons to consider a stint as a locum tenens physician. Foremost, the practice allows you to gain a new perspective. Whereas most physicians come through residencies with exposure to only one setting, physicians that enter into locum tenens employment out of residency are able to get a feel for numerous practice settings. Also, the lifestyle affords one the opportunity to see exactly what sort of climate or community best suits one’s own personality. Practicing locum tenens in an area for a month or more lets you know what it’s really like to live and work in that area. Of course, money is always a factor. In the locum tenens profession, you’re likely to earn about as much as you would in a permanent position. Additionally, your recruiter will cover malpractice insurance and housing expenses, which means you might actually come out ahead of your peers with regard to debt payment, buying a house, or starting your own practice. And, if you’re looking to spend some time decompressing before taking boards and after finishing medical education, locum tenens offers you the flexibility to work as much or as little as you’d like. In venturing into the locum lifestyle, you’ll want to prepare a solid CV with references and keep an eye on your online presence. Then contact a few agencies to see what opportunities are out there. Be clear about what you’re looking for, and don’t accept any position you’re not comfortable with; but keep your mind open, as you might find professional enjoyment where you least expect it.

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Consult Codes Are Going Away (We Think)
Source: Today’s Hospitalist
Date: 01/01/2010

If you weren’t paying too much attention, it might have completely slipped your notice amid all the sound and fury of the recent debate over health care reform. In October, the Centers for Medicare and Medicaid Services announced that it would no longer pay consult codes for inpatients and outpatients. How will this affect hospitalists, other specialists, and the bottom line? While the codes are still listed in the 2010 CPT manuals, CMS won’t pay for consult codes any longer, despite attempts to delay enforcement of the new rule. Physicians will now need to choose among other service codes, such as initial or subsequent visit codes, which will result in smaller reimbursements. While the move is expected to cut costs for the government, it represents a possible new hassle for physicians. Hospitalists, in particular, may not be too adversely affected by the lack of consult codes, as many indicate that a relatively small proportion of their income comes from consults. Subspecialists, though, now face a decision over how much control to exert over the admission of patients. Do they now take a larger role in transfer of patients, thereby meriting a larger compensation, or do they refuse to perform the consultation altogether? To some extent, this decision will depend on hospitals’ willingness to make up the difference between what the physicians expect to be compensated for a service and what CMS will now reimburse. What kind of hit will this represent for hospitals? Well, some models have a hospital medicine group performing 1,500 consultations, seeing compensation dropping from $171,000 to $123,000 for the same procedures. With this sort of financial hit waiting in the wings, one can see why subspecialty groups and hospitals are anxious over the new rule.

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Part-Time Work Appeals to Pediatricians
Source: American Medical News
Date: 01/11/2010

Thinking about cutting back on your work hours? You’re not alone, especially if you’re a pediatrician or an ob-gyn. A recently released study says that part-time work is on the rise among those two specialties—a trend that has communities and hospitals facing a staffing conundrum. Two recent surveys, one in the December issue of Pediatrics and one in the January issue of Obstetrics & Gynecology, have shown a rise in the rate of part-time work among pediatricians and ob-gyns in recent years. The ob-gyn study also found an increase in part-time faculty positions for ob-gyns in medical schools. The pediatrician survey, which covered about 1,600 members of the American Academy of Pediatrics, found an increase in part-time reportage of 8% from 2000 to 2006. The increase was accompanied by higher rates of job satisfaction and work-life balance satisfaction among part-time physicians. The study also found physicians were increasingly working to older ages, with the number of physicians practicing between the ages of 70 and 74 increasing to more than a third of respondents. Among ob-gyns, researchers found that the number of faculty positions for that specialty would increase over the next five years, especially in the part-time faculty and entry-level assistant professor positions. Researchers found that faculty are happier with part-time work, as it allows for a greater work-life balance. Experts attribute the rise in part-time physicians in part to the rise in the number of female physicians, as they tend to demand a more flexible work schedule. Additionally, the number of older physicians continues to increase, and these physicians are more likely to work a part-time schedule.

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AMA Pushes for Permanent Doctor Pay Fix
Source: MedPage Today
Date: 01/21/2010

Democrats’ efforts to pass some sort of health insurance reform hit a speed bump in Massachusetts, and the American Medical Association is working to make sure that, while the politicians are retooling, doctor pay isn’t left on the back burner. The problem is the sustainable growth rate formula, initially introduced to make sure Medicare payments remained manageable. Payments under Medicare are scheduled to undergo a 21% cut in March. The pay cut has been a long time coming, but Congress typically has acted to forestall the reduction. This time, though, the cuts are expected to expire at the end of February. It’s a yearly budgetary game that the AMA and AARP are seeking to end permanently. The continual pushing back of the cuts has amounted to $210 billion of public debt. A permanent fix to the issue was left out of the larger health care insurance reform measure that stumbled its way through Congress. The election of a Republican in Massachusetts, though, has broken the Democrats’ 60 vote supermajority. As Democrats regroup to plan their next step, the AMA is planning a public relations campaign in conjunction with the AARP and the Military Officers Association of America. In the campaign, which will target key senators in the reform effort, a repeal of the sustainable growth rate formula will be urged.

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Medical - Legal Matters

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ACC Sues HHS Secretary Over Payment Cuts
Source: DotMedNews.com
Date: 12/31/2009

Reimbursement reduction is on the menu for most specialists in the country, and at least one group is fighting back. The American College of Cardiology has filed a lawsuit against the Department of Health and Human Services, contesting the validity of the Department’s methods for determining its new payment schedule. Under the 2010 Medicare Physician Schedule, cardiologists will see 42% reimbursement reductions for echocardiograms, as well as 36% reductions for nuclear medicine tests. The ACC, citing internal polls, charges that these cuts will cause many of its members to have to close up shop and join with hospitals. The cuts won’t only affect cardiologists. Reductions are planned for specialists across the board, and the ACC may be just the first of many professional organizations to take up litigation against the reductions. The Medicare reductions are based on the assumption by DHHS that the cost of private practice in cardiology has dropped 40% in the last five years. The ACC, however, argues that the practices in the DHHS sample pool weren’t typical of modern private practices, as they didn’t have to purchase radiopharmaceuticals and other common cardiological diagnostic tools.

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Trial and Error
Source: Trustee Magazine
Date: 01/01/2010

Malpractice reform tends to be an afterthought in much of the discussion around health care reform. A number of projects are underway, though, across the nation, to try to strike some sort of balance between just patient compensation and physician protection. And the progress from these programs is promising. The programs underway focus on alternatives to the typical malpractice courts, which are said to be inefficient and unnecessarily confrontational. Near Philadelphia, for instance, hospital administrators and lawyers have instituted a pilot mediation program that focuses less on blame than on helping all parties to move beyond the medical accident. The mediation program isn’t the only approach. More than 30 states have some sort of disclosure or apology law on the books, protecting caregivers from litigation in the event of an unsatisfactory apology. Other states have capped damages on malpractice. Among these, Texas, in particular, has seen sizable growth in its physician population, though administrators are unwilling to place the credit for this solely on the malpractice damage caps. Other initiatives undertaken include a drive toward medical courts, which has caught on in a number of areas. In such a system, malpractice actions do not go to civil court, where they might be handled by a judge and decided upon by a jury unfamiliar with the particulars of medical practice. Instead, they are passed on to a court wherein medical professionals provide counsel to determine the extent of fault in a case and advise on compensation. Other states have instituted birth injury programs to compensate victims of injuries incurred during deliveries. Such programs have had, to varying extents, positive effects on states’ ability to retain doctors, but the full extent of their efficacy remains to be seen. Regardless of the legal avenues available in your area for malpractice issues, board members need to take an active role in their facilities’ safety culture and malpractice risk reduction efforts. Ensure that your organization is as transparent as possible when dealing with patients, as efforts to keep them in the dark can backfire and make an innocuous situation into a dangerous litigation.

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Legal Implications of Physician as Marketer
Source: Physicians News
Date: 01/14/2010

The last year or so has seen an uptick in the level of scrutiny of arrangements between physicians and pharmaceutical and medical device manufacturers. This has resulted in quite a few embarrassing public actions by governing bodies. To save yourself the trouble of litigation, it’s best to know the rules involving relationships with a pharmaceutical or device maker. While the drug and medical device industries have updated their codes on physician interactions, you’ll still want to defer to the law of the land. Make sure that all agreements between you and any companies are structured properly according to state and national law and ethical tenets for consulting arrangements. First, the federal Anti-Kickback Statute comes into play regarding remuneration for referrals. You’ll want to make sure any arrangements you set up aren’t just disguises for remuneration for referrals. As such, ensure that you carefully structure your arrangement so that you are not directly referring patients to your partner. Proscribed remuneration does not, though, include payments made as compensation for your services. You must make sure that the arrangement is set out in writing and endures more than a year; it covers all services to be provided; it arranges for periodic services rather than full-time; the total remuneration is set from the outset of the contract; the services involved do not involve product promotion; and the services do not exceed what is necessary to achieve the purpose of the agreement. Stark regulations prohibit you from directly referring patients to an entity to which you are financially tied. Violating Stark can result in stiff fines and exclusion from federal programs; so you’ll want to ensure your agreement doesn’t cross this regulation’s boundaries. Finally, you’ll want to consider the False Claims Act, under which you could be liable when claims are submitted based on false certification that you’ve complied with all laws. If you violate any of the previous regulations and submit a claim to the government, then you’ve violated the False Claims Act as well. In addition to these acts, you’ll want to make sure that your relationships with manufacturers do not violate the ethical standards of your state medical board. The whole business of physician consulting is a tricky field to navigate, but if you keep mindful of any possible ethical or legal pitfalls, you’re likely to make it through unscathed.

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Medical Specialty Focus

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Surgeons Still Forgetting to Remove Objects from Patients
Source: HealthLeaders Media
Date: 02/01/2010

Blame it on the stress of the job, the complexity of procedures, or just plain forgetfulness. But whatever you blame it on, California surgeons appear to be increasingly likely to leave medical objects inside of patients. The problem has drawn the attention of a number of public bodies, and now some are commissioning studies to stop the problem in its tracks. These sorts of surgical mishaps account for 18.6% of all adverse events reported by those California organizations performing invasive procedures. From 2007 to 2009, the number of foreign bodies left inside patients following invasive procedures jumped from 141 to 196. Some 70 incidents of the oversight have occurred in the first few months of fiscal 2010, which puts surgical teams in the state on track to leave 225 objects behind by the end of the year. Needless to say, administrators find this trend unacceptable. State health officials have proposed using $800,000 in administrative penalties collected from hospitals to fund a collaborative project to study the problem, noting that such adverse events result in patients staying three to four times longer in a hospital than they otherwise would have. The organizers behind the study argue that it will be essential to improving quality of care. The study will look to see the effectiveness of various methods–wound exploration, assistive technology, and so forth–on reducing the number of forgotten objects.

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fMRI May Allow Communication with Some Patients in Vegetative or Minimally Conscious States
Source: Medscape Medical News
Date: 02/04/2010

Could a whole host of vegetative patients secretly be trapped in their bodies, unable to communicate absent modern technology? A new study out from the University of Cambridge suggests that’s a remote but distinct possibility, and the technology needed to contact them exists today. The results come from a study using functional magnetic resonance imaging on the brains of patients deemed to be in a persistent vegetative state or a minimal consciousness state. The researchers examined 54 patients, finding five of whom could modulate their brain activity in a manner that would seem to indicate that they were responding consciously to verbal cues from the researchers. One patient in particular, diagnosed with a persistent vegetative state, was able to answer “yes” and “no” to questions by activating different areas of his brain. He did so through visualizing different activities while undergoing fMRI. While these findings point to possible breakthroughs in the future, the researchers are quick to point out that these are specific cases, and that the overwhelming majority of patients did not display such behaviors. They caution that doctors counseling families curious about the results should point out the rarity of these findings, and that they may not be applicable to all patients in persistent vegetative states. Further, they stress that the results do not indicate an internal stream of thought, rather the activity that is at the base of higher human functions.

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Cooley Dickinson Hospital Offers a Robotic Option for Hysterectomies
Source: The Healthcare News of Western Massachusetts
Date: 01/01/2010

Robots assisting in surgery? An increasingly common occurrence, no doubt, and a new tool in use at Cooley Dickinson Hospital has surgeons hopeful that one of the more invasive surgeries available now might just become less invasive in the near future. Hysterectomies typically involve a 5- to 7-inch incision in the lower part of the abdomen to remove all or part of a woman’s uterus. This procedure–often performed to remove cancers and fibroids–typically results in a three- or four-day hospitalization, six weeks of recovery, and an unsightly scar. Laparoscopic techniques currently reduce the recovery time and size of incision but typically are unable to accomplish all that is possible in the more invasive surgeries. The new da Vinci Surgical System, however, now adds greater capabilities to the current laparoscopic suite. The technology uses robotic instruments–remotely controlled by a doctor–to enhance the range of procedures available to surgeons using laparoscopy. Cooley Dickinson Hospital in Northampton, Massachusetts, first used the system for urological procedures and general surgery, but the staff gradually adapted it to gynecological surgical use and now perform myomectomies as hysterectomies with the system. The system bypasses some limitations of traditional laparoscopy through the use of a more natural depth of field display and a system that allows surgeons’ hand movements to be translated into instrument movements. Physicians at the center report better surgical outcomes already due to the use of the system, including decreased blood loss and quicker patient recovery. While the technology still has a prohibitive price tag, surgeons at Cooley can easily envision it becoming the standard for practice within ten or fifteen years.

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More Options for Treating Pain
Source: H&HN Magazine
Date: 02/01/2010

Is your institution doing the best it can in handling patients’ pain? Are you open to all options, or have you settled for standard opioid drugs? An article in the February issue of H&HN Magazine argues that if you’re sticking solely with opioids, you could be missing out on cost-effective ways to reduce your patients’ pain by other means. The article focuses on the cost-effectiveness of interventional and holistic palliation in conjunction with traditional pharmaceutical pain management methods. The author questioned various practitioners on palliation modalities and programs at their hospitals. She found that end-of-life and post-surgical patients tended to receive opioid care, but interventional modalities were gaining traction in some institutions, with the potential of surpassing standard opioids as the preferred method. The author found a bit more resistance to holistic pain management methods, though, as clinical staff and patients were more skeptical of their effectiveness. Furthermore, she found the primary barrier in wider adoption of interventional methods to be cost, as institutions encountered resistance from payers to cover the devices and procedures necessary to implement interventional methods. While many payers will not reimburse for holistic or interventional therapies, the author points out that hospitals are devising ways to implement the therapies into their standard practice without taking on excessive additional costs. Some hospitals are partnering with educational organizations to allow students within those organizations to achieve certification by practicing on hospital patients. Others are seeking grant money to deliver interventional pain management. While these two alternative methods have been found to reduce costs, the struggle continues to integrate them more fully into modern medical practice.

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Virtual 3D Liver Surgery System Helps Surgeons Practice for Real Thing
Source: Medical News Today
Date: 01/11/2010

Performing a surgery before you perform the surgery? Sound impossible? Not so much anymore. Add another one to the list of surgical techniques improved upon by modern technology. Researchers in Europe have developed a system by which surgeons can practice surgical techniques on a 3D image of a patient’s liver before performing the actual surgery. The system, known as Odysseus, relies on electronic reconstructions of patients’ organs to generate a 3D image. The image is built from MRI and other scans of the patient, thus giving a realistic view of the patient’s liver, complete with its larger structure, blood vessels, and so forth. Using the system, physicians are able to perform virtual surgeries on a realistic model of the upcoming patient. Furthermore, they are able to share the model with other physicians for consultations on tumors, techniques, and other concerns. While the system is widely celebrated among those that have used it, the developers say that the true impact of its use will not be known for some five years, due to the need to measure its success according to patient survival rates over that time period.

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Program Cuts Excess Radiation Exposure
Source: MedPage Today
Date: 01/22/2010

Could your patients at risk of pulmonary embolism be receiving unnecessary doses of radiation? According to a new study out from researchers at a New York medical center, the answer is yes, and there is a viable method available to reduce that exposure. The claim comes from researchers at Montefiore Medical Center in the Bronx, where a switch to ventilation-perfusion scanning instead of CT pulmonary angiography led to a decrease in average radiation dose of about 20% in patients evaluated for possible pulmonary embolism. Since the adoption of CT scanning as a second-line diagnostic method, radiation exposure levels in the U.S. have increased six-fold from 1980 to 2006. The radiation used in x-rays and other imaging methods can promote cancer; so it is wise to reduce patients’ exposure to such radiation. CT scans, in particular, deliver 20 to 40 times as much radiation as do other methods. The researchers note that the study is based on one hospital’s medical charts; therefore, extrapolating results beyond that sphere is questionable.

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Payer & Reimbursement Issues

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How to Run a Cash-Only Practice and Thrive
Source: Medical Economics
Date: 01/22/2010

Sixteen patients a day. Straight nine to five. Quarter of a million dollars a year, take-home. Impossible, you say? Meet Brian Forrest, MD, a North Carolina physician who’s doing just that in a straight-cash practice. Forrest’s secret? Well, low overhead is a part of it. His practice, Access Healthcare, is cash-only. It doesn’t accept insurance or Medicare, and doesn’t file reimbursement paperwork for patients. The lowered amount of paperwork makes fewer administrative staff positions necessary. Also, the practice saves on negotiated prices for lab work. But that’s not the only thing keeping his practice afloat. He’s also generated a good deal of community buzz due to his practice methods. He sees patients for about fifty minutes each. Prices for visits are spelled out for patients in advance, and the practice collects on 99.8% of accounts, while still charging low prices. This sort of micro-practice is one among many springing up across the nation. With the current turmoil in the health care delivery world, many doctors are willing to try anything to get away from the standard model of five minutes per patient. Forrest’s practice, then, represents possibly a model for those that are fed up with dealing with the current system. It might be catching on strongly even in his own state, where the number of physicians not accepting insurance has risen from .1% a few years ago to fully 5% last year.

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Maryland Doctors, Health Insurers Squabble Over Who Sends Patients the Bill
Source: Baltimore Business Journal
Date: 02/05/2010

While the debate in Washington over health care reform has cooled in recent weeks, a more focused debate in the Maryland State Legislature rages on, with doctors on one side and payers on the other. The argument is over assignment of benefits—or the direct assignment of a patient’s insurer reimbursement funds to an out-of-network physician. The process, which cuts down on patient confusion and billing turnaround time, is illegal in Maryland but legal in 24 other states. At issue before the legislature now is a measure that would legalize the practice, allowing physicians to be paid directly from insurer non-network reimbursements. The insurers claim that the measure would result in doctors leaving their network rolls for non-network status. The thinking is that they can charge higher rates for procedures if they’re non-network, plus get reimbursement checks directly from the insurer, a theoretical win-win for physicians and lose-lose for insurers. Additionally, the insurers charge that the measure will result in more doctors billing patients for the inflated balances on their procedures. Doctors, for their part, argue that there is no evidence that such practices are underway in states that have legalized the practice. They argue that hospitals already pressure contracted physicians to keep their rates low, and that many contracted physicians are required to be in an insurer network by their hospitals. The bill is currently making its way through both houses of the Maryland legislature, and few parties are willing to go on the record as yet in strong support or opposition.

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Credentialing, Licensure, Quality Management

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National Practitioner Data Bank–and Your Career
Source: Unique Opportunities
Date: 02/01/2010

Applying for a new job? New insurance? New clinical access within your current job? In each case, you’ll want to check yourself out online, as a national data bank exists that could seriously impact your prospects should your name be mentioned among the database’s records, which numbered over 22,000 in 2006. The National Practitioner Data Bank, established in 1986, is maintained by the Department of Health and Human Services. State license boards, hospitals, HMOs, and professional organizations are required to report adverse events in your profile, including malpractice payments, licensure actions, and adverse actions by a health care entity. Additionally, they must report membership actions and exclusions from participation in Medicaid and Medicare. Most reports to the data bank are for medical malpractice payments, while diagnosis-related cases and surgical/treatment cases make up much of the remainder. The data bank has come under fire, though, as critics charge that not all institutions are reporting equally to the data bank. Nearly half of the nation’s hospitals have never submitted a clinical privilege sanction to the data bank. Institutions such as hospitals and other health care entities are required to request information from the data bank before hiring a new physician or granting expanded privileges to a practitioner. Licensing boards may also request examination to check on doctors moving into a state. It’s a good idea to request a report on yourself if you’re thinking of moving to a new state or applying for a new job. If you find information that is inaccurate, you may file a formal complaint to have the offending institution remove the information from your profile. Be aware, though, that the data bank deals only in factual information; that is: negative information won’t change if it is only wrong on a few particulars.

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Patient Data Safety Rules Widely Disregarded, Unenforced
Source: The Center for Public Integrity
Date: 01/19/2010

Electronic medical records are the centerpiece of efforts to reform the health care system. But a new report out from the Center for Public Integrity suggests that hospitals, health clinics, and insurance firms are continually violating federal security rules regarding patient data. The report comes from a November survey conducted by the Health Information and Management Systems Society. The report found that a quarter of the nearly two hundred respondents do not conduct formal risk analyses to identify security gaps in electronic patient data. The past year saw a number of high-profile security breeches, including the loss of patient data, revelation of patient social security numbers, and numerous other cases. To date, though, no organization has been punished for violations of HIPAA’s data risk analysis provision. Administrators responsible for enforcement claim that no fines have been levied because the goal is to “nudge” providers into compliance. Furthermore, they claim the results indicate the greater need for training on data security, but do not necessarily constitute an indictment of the governing agency. Critics counter that the agency has no proactive arm ensuring compliance, relying instead on media outlets to reveal rule violations. Privacy advocates call for stricter enforcement of patient data rules, and argue for the agency to be given more power to punish noncompliant entities. They claim that with the recent focus on widespread adoption of EMR systems, the resultant increase in the amount of patient data will simply put more people at greater risk if measures are not taken now to enforce compliance with security standards.

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Healthcare Technology

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More EMRs Are in Physician Offices, but Use Still Lags
Source: American Medical News
Date: 02/01/2010

Electronic medical record adoption is up over recent years, but it’s still far below the adoption levels government representatives are hoping for ideally. This assessment is according to new numbers out from the Centers for Disease Control and Prevention. The CDC’s National Center for Health Statistics estimates that 43.9% of physicians are using full or partial EMR systems. This is an increase of nearly 10% over three years ago, and a 2.5% jump from last year. The majority of these systems, though, are partial systems, as the number of fully functional EMRs lags far behind. Just over 6% of physicians use fully functional systems. EMR adoption is a central tool in efforts to combat the rise in health care costs, as it is believed their adoption will lead to increased efficiencies, reduced paperwork, and fewer medical errors. To this end, a number of incentives are in place from various government agencies, all trying to encourage adoption of these systems. A $44,000-per-physician tax incentive was passed with the stimulus bill last year, and additional incentives are set to take effect from Medicare and Medicaid next year. Still, the adoption rate of these systems is below desired levels. Generational factors and cost barriers are keeping doctors away from the systems, though vendors do note that the financial incentives have resulted in increased interest in their products. The hospital alignment trend has helped push EMR purchases, as hospital groups have more financial leeway, but experts expect that the future will come more slowly to medical records in this country than one might hope.

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iPad, Anyone? Hospitals Looking at the Mobile Device
Source: Sacramento Bee
Date: 01/31/2010

2010 is the year of the tablet, and the newest release from Apple has stolen center stage. But could the new toy from the media-darling consumer electronics company also be the one tool your practice needs in an age of computerized medicine? Apple debuted the iPad–a tablet computer with a touchscreen interface, wireless connectivity, and no keyboard–to cheers (and a few jeers) from different corners of the technology media. But the tablet, along with its many other competitors–announced by other companies at a previous computer expo–could very well serve a vital purpose in the field of medicine. Kaiser Permanente is in the midst of a pilot project in Sacramento, wherein tablet computers’ usefulness to medical staff is being evaluated. Kaiser Permanente’s goal is to improve care and safety through the use of up-to-the-minute medical information. Tablet computers are thought to possibly represent an ideal solution for hospitals, as they are more portable than regular computers and can be more easily disinfected between uses. Current models already in use are expensive, though, with some costing up to $2,000 per unit. The ultimate goal is to fully integrate the computer into the daily life of the medical worker. Experts cite the availability of information as a key to improving outcomes in the future. The key is getting a lightweight, portable machine that can get the job done.

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Video Program Puts Docs at Bedside 24/7 at MassGeneral
Source: HealthcareITNews
Date: 02/03/2010

Have you ever worked on your bedside manner...while walking into your own home? You will, and the company that will bring this to you is testing the technology in Boston. The MassGeneral Hospital for Children is collaborating with the Partners Center for Connected Health to place videoconferencing units in doctors’ homes. When needed for a consultation, doctors are able to telecommute from home to the hospital, appearing on a portable telemedicine station next to the patient’s bed. From this point, the physician is able to consult with attending physicians and the patient. The setup also allows for camera and scope attachments, permitting the physician to inspect the patient more closely via the technology. Since the program’s launch, administrators and physicians already report improvements in quality of care, team communication, and staff responsiveness during evening and weekend hours. They claim that the technology results in a system in which doctors are always available for consultation without the wait or the hassle of returning to the hospital. The technology also aids in teaching residents, in that they are then more involved in the team approach so necessary to critical care.

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Physician Practice Management

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Are You Burning Money? Know the Signs
Source: Physicians Practice
Date: 01/01/2010

Tough economic times mean tighter belts to shore up the bottom line. But could your practice’s belt stand to be a bit tighter? Are you letting money slip through the cracks that could be staying in your practice, perhaps even keeping your staff in their positions? An article in Physicians Practice takes a look at the ways you might be burning through money without even knowing it. The first thing to know in saving money is to always negotiate. Every year, like clockwork, check back with suppliers and insurance providers. If you make noise, you might just find that you can get a cheaper rate. Don’t limit your review to medical supplies and insurance: Internet and phone service, laundry and cleaning service, bookkeeping, accounting—all of these should be regularly evaluated to see where you can save any money. Check in with your professional organization to discover any discounted rates or purchasing cooperatives that might be available. Productivity is your next goal. One missed visit per day could cost you $15,000 a year in revenue. Now do you feel like you can stay that extra half hour? Engender the same attitude in your staff by setting productivity goals. Specifically, set up a bonus structure for productivity, and your staff will start generating greater value. Next, take a look at your referrals. If you’re sending everything out for referral, you’re losing money you could be making in-house. Take a look at bringing on a physical therapist or radiologist, as such an addition might save you more in the long run than referring to outside practices. Beyond these tips, it’s a good idea to keep track of your expenses by benchmarking your practice against MGMA figures. Also, outsource benefits administration and keep an eye on overtime hours. You want your staff to work smarter, not harder. Most of all, keep looking at every aspect of your practice, always with an eye to increasing cost efficiency and stretching your dollars.

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When You Must Cut Workers’ Hours
Source: Physicians Practice
Date: 01/01/2010

It’s an unfortunate reality of the economic downturn and the health care market in general: the time may come when it’s necessary to cut your workers’ hours. But, in doing so, it’s essential that you maintain fairness and do it in a manner that doesn’t entirely sink the morale of your staff. Physicians Practice has some tips on how to put your payroll under the knife. Cutting staff hours, of course, is bound to damage office morale. As such, it’s probably a good idea to reserve this as a measure of last resort. Before reducing staff work hours, consider a salary freeze, bonus reductions, or a hold on new capital purchases. While new technology could be beneficial to the practice, it’s a better idea in the long term to keep your staff happy and functioning efficiently. If you do have to reduce hours, maintain an awareness of appearances. Walk your staff through the practice finances, demonstrating as simply as possible the way that the hour reductions will help the practice avoid laying off staff. Also, make sure that the executives in your practice are also sacrificing; nothing kills morale faster than knowing the people at the top are simply pushing the burden of hard times onto their subordinates. Be sure also to ask your practice staff for ideas on cost cutting. They’re closer to the action; so they probably know a few ways your practice could save money that wouldn’t occur to you. For instance, freezing matching 401(k) contributions, among other options, are things employees have proposed for saving jobs. In cutting hours, let your employees know they have a choice. Some might actually choose to try their luck on the job market rather than take an hour reduction, though this is unlikely with the current economy. Also, be certain to honor any and all contracts you have with employees. This may mean some employees are protected from hour reductions. If such a case arises, make it clear to employees why one worker in particular merited an exception. Finally, consider all the possible impacts of layoffs and hour reductions. Will they impact the productivity of your office? Can you get around them with pay reductions? Is a single layoff best for the office? These aren’t easy questions to answer, but if you take a hard look at your office and finances, you’re likely to find the right answer.

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Sharing Your Space: Things to Consider When Looking for an Office Mate
Source: American Medical News
Date: 02/01/2010

The economy and the financial pressures of practice are leading a number of physicians to share office space with other doctors. It’s a practice that could work out quite well for you if you’ve got some free space and a willingness to adapt to new people. As recessionary pressures have physicians looking to cut costs to a greater extent than ever these days, subletting from other physicians is becoming a more and more attractive option. In subletting room in a practice, the hosting practice gets to shore up its bottom line and not waste space, while the leasing practice gets to have space at a lower cost than a stand-alone practice. In leasing out space to another physician, though, you’ll want to follow a few rules. It’s essential to make sure that your lease agreement doesn’t run afoul of any anti-kickback legislation. For this reason, the amount of space to be leased, the hours of operation, and the duration of the lease must all be spelled out in a contract. Additionally, the rate charged for the space must be in keeping with average rates for comparable spaces. And, of course, you’ll want to make sure such an arrangement is okay with your landlord. Overall, if you’re leasing your space out, make the best of the situation. Choose tenants that mesh with your practice and whose personal styles mesh with our own. You can also use the leasing arrangement as a means of acquiring new talent, as it is not entirely unheard of for practices to bring on physicians that were formerly just leasing space. You are free, within legal limits, to refer patients to tenants you lease space to; and doing so could bring your practice closer to other practitioners while providing your patients with increased convenience and a wider range of medical care.

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Are You Sharing Too Much Online?
Source: Physicians Practice
Date: 02/01/2010

It’s no harm to vent online; many people do. But physicians have an extra layer of ethical concern they need to adhere to so as not to give away patient medical data online. It’s not enough to cover the basics: of course no one is going to reveal patient names, birth dates, or other explicit information online. But if you’re writing about a patient in a manner that leaves his identity open to guessing, you’ve likely violated your ethical responsibilities. In order to keep within bounds when discussing medical matters online, follow a few simple bits of advice. First, read what you’re sharing before you share it. Read it aloud to make sure you haven’t put any identifying information in. Next, make sure you have a professional online persona that is separate from your personal one. This makes it easier to separate your work life from your personal life, and vice versa. Also, look beyond the easy-to-spot violations. If your patient knew you wrote about her, would she be able to identify which writings? And keep an eye on other bloggers. You can learn the standards of online publishing just by seeing what the average medical blogger says, and more importantly, doesn’t say. Also helpful is to blend patients together or to draft a policy on physician Internet communications. These are really only a few suggestions, though. As with all Internet interactions, the best advice is to use common sense in posting. If you wouldn’t say it in an elevator, don’t say it in your blog. Remember that, and you should be able to stay in the clear.

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