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Calculating Providers’ Financial Contribution to Operations
What’s a doctor worth? In non-monetary terms, a physician who provides quality medical care contributes to the health and well-being of the community where he practices medicine, as well as to patient satisfaction. Furthermore, responsible patient care helps to brand the hospital or medical group as a source of efficient health care delivery.
In monetary terms, though, how valuable is the service of a full-time practitioner to specialty-specific revenue generation? One way to measure this is to compare a provider’s hourly and annual compensation with gross and net revenue production. The latest version of Jackson & Coker’s “2010-2011 Provider Contribution to Operations Percentage Calculator” is a handy tool for making this measurement.
Here is the link to the calculator and explanation of how to use it effectively.
Physician Staffing That Pays Off
Two related realities face health care administrators: the shortage of qualified physicians is intensifying and revenue from third-party reimbursements is decreasing. As a result, hospitals and medical groups are forced to tighten their financial belts and operate their facilities as cost-effectively as possible.
Physician staffing is in the crosshairs of administrators’ determining how best to use their operational budgets. Our Special Report focuses on locum tenens as a staffing model that offers workplace flexibility, continuity of patient care, relief for over-worked physicians, and uninterrupted revenue generation. In short, wise use of locum tenens providers can be measured in terms of a substantial “return on investment,” measured in both economic and non-economic terms.
As a companion article, we offer details concerning the updated Jackson & Coker’s 2010-2011 Provider “Contribution to Operations” Calculator. The online calculator enables administrators to compare hourly and yearly compensation against gross and net revenue. Based upon an updated physician population count, this handy tool instantly calibrates provider contribution to operations for different physician specialties.
Using this calculator regularly will help administrators and other decision
makers to factor in the financial contribution of providers in determining the
cost effectiveness of the locum tenens staffing model.
Cordially,
Calvin Bruce
Managing Editor
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Risk Management Tip of the Month: The Safe Medical Devices Act requires “device users” to report equipment malfunctions to the FDA.
"Risk Management Tip of the Month supplied by PRMS, Inc., Manager of The Psychiatrists' Program" www.psychprogram.com.
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The Crumbling Physician-Patient Relationship
Source:
H&HN Magazine
Date:
06/28/2010
As health care reform begins to take effect, a number of factors are going to be changing. One executive argues, though, that the bedrock of the health care industry remains the physician-patient relationship, and that that relationship is under pressure from all sides.
The first threat to the physician-patient relationship is commonly known among physicians: the threat of malpractice. Surveys of physicians have found that a large number of them are influenced in their daily practice by the threat of a malpractice suit. This leads these physicians to practice “defensive medicine,” which leads to ever-increasing medical costs. The only way to mitigate the threat is to develop a system wherein patients are fairly compensated in the event of negligence, but doctors are still protected from needless lawsuits.
The second threat to the physician-patient relationship is the interference of third-party payers. Seemingly at every turn, physicians encounter regulation, bureaucrats, or insurance clerks, having to answer to all of them. The author, instead, recommends national physician review panels in which best practice protocols and standards of care would be developed.
Third, we need to take a serious look at physician compensation models. Even though it’s been demonstrated time and again that higher costs don’t result in higher quality, physicians are still paid in a manner that rewards them for overutilization. This is an untenable position and is likely to bring down the system if nothing is done about it.
The physician-patient relationship forms the core of the health care system; so it is essential to assure that it is healthy. It’s up to all players in the health care industry going forward to make sure they agitate to improve the relationship and ensure it is a foremost concern in any future care models.
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Hospitals Make Time for Social Media
Source:
Healthcare Review
Date:
06/03/2010
Everything nowadays has a social media component; so should your health organization, also? Are there actual benefits to social networking for health care providers; and, if so, how do you take advantage of them? An article in Healthcare Review argues that the time is perfect for hospitals and medical practices to take to the Internet and stake out their space within the social media sphere.
It’s hard to put an exact figure on the value of social media, but that isn’t stopping hundreds of health care organizations from putting their individual stamps on the web to connect with potential patients, referrers, and peers. More than six hundred hospitals are currently active in social media, be it Twitter, Facebook, or YouTube. These channels represent low-cost venues for organizations to connect with patients and the communities they serve.
Most hospitals using social media right now are looking to improve community relations, customer service, employee engagement, and crisis management; yet only some are reporting positive results in those areas. This, of course, is because they forget the number one rule for taking your organization online: have a plan.
When developing a social media presence, it’s essential to have a formal plan in place stipulating your goals and how you plan to achieve them with social media. Your goal could be as simple as documenting the experience of running a health care organization or just extending a digital hand to reach out to your community. No matter what you do, you’ll need a plan. Know what you want to say and the tone you want to take online. Even with a plan, though, you’ll need a good deal of patience: you may not see the fruits of your digital endeavors for quite some time.
Even though social media platforms come and go, the wider trend is here to stay. As such, it’s likely that the role social media plays in consumer outreach is bound to expand. If that’s the case, it’s likely best for your organization to get a plan together and take the plunge. You might even find that the increased exposure helps more than you thought it would.
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Fictional Stars, Real Problems
Source:
The Wall Street Journal
Date:
06/08/2010
Patient presents with elongated canines, no pulse, low body temperature, and a strangely luminescent allergic reaction to sunlight. Diagnosis: arrested development. If case studies of the characters from the hit tween movie Twilight strike you as a bit odd, you might be missing out on a fun trend in psychiatry, the roots of which reach as far back as Freud.
Professors all across the psychological teaching spectrum are reaching for texts and films to use in classroom assignments and outside electives. The characters in works of fiction, though nonexistent, are, it would seem, much easier to work with than real-life patients. For example, they aren’t nearly as protective of their own privacy as a real person would be. And fictional characters afford students the chance to experience a wider range of disorders than they might come across in real life. Additionally, examining fake patients can help psychologists better understand the real patients that identify with the fictional ones.
Critics charge that fiction is unsuitable for real study of the human condition, as the characters are only as fleshed out as their creators want. Defenders claim, though, that even real patients lie, sometimes revealing information only when the therapist extracts it from them.
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Physicians Sanctioned in Board Exam Cheating Scandal
Source:
American Medical News
Date:
06/21/2010
One hundred thirty-nine doctors have been sanctioned by the American Board of Internal Medicine following allegations that they cheated on the board’s certification exam. Additional complaints have also been filed against five physicians by ABIM in U.S. District Court, claiming copyright infringement, misappropriation of trade secrets, and breach of contract.
These actions stem from a copyright infringement suit filed against Arora Board Review and its owners. Arora offered an exam preparation course which was taken by the sanctioned physicians. The ABIM-Arora case was settled, and Arora’s manager can no longer operate a live board review case. Arora has admitted no wrongdoing in the settlement.
Penalties for the sanctioned physicians include revocation or suspension of board certification, depending on the severity of the infraction. The physicians can appeal within two months. Additional warning letters will be sent to another 1,000 physicians who took Arora courses.
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New Camp Helps Kids with Mental Health Issues
Source:
CityBeat
Date:
06/09/2010
Cincinnati-area doctors and mental health professionals have commenced a summer camp with a special focus. This one is specially designed for children struggling with socialization, concentration, anxiety, and other mental health issues.
The camp is in its first year, and organizers say they’re looking to provide children in need with an environment in which children are not ostracized for maladjusted behaviors. The camp is best suited for ADD, ADHD, Asperger’s Syndrome, PDD-NOS, anxiety, and social anxiety-disordered children. At $2,500, the camp is pricey, but scholarships are available for children of lesser financial means.
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Violence on the Rise at U.S. Health Care Centers
Source:
MedicineNet.com
Date:
06/10/2010
They’re supposed to be places of healing, but a recent report out from the Joint Commission claims that hospitals are increasingly the setting for violent episodes. The troubling trend is undeniably on the rise, but what can hospital workers do about it?
The study—Sentinel Event Alert—looks at the number of assaults, rapes, and homicides occurring in the nation’s hospitals since 2004. The Alert notes a significant increase in all of those, with the greatest number of reports coming in the last three years.
The Joint Commission’s voluntary reporting system notes 256 assaults, rapes, or homicides of patients and hospital visitors since 1995. Of those, 110 have occurred since 2007. What’s more, experts contend that the numbers may actually be only the tip of the iceberg, as only a small percentage of violent incidents are reported.
Experts cite increases in drug and alcohol abuse as driving factors behind the trend, as well as lack of adequate care for psychiatric patients. Additionally, some point to flaws in the American health care system as a frustrating factor that could cause some to simply snap.
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Physician-Owned Hospitals: Endangered Species?
Source:
American Medical News
Date:
06/28/2010
The recently passed health care legislation is expected to increase overall access to health care within the nation, but at what cost? An article in American Medical News takes a look at physician-owned hospitals, likely casualties of health reform.
The recently passed legislation included language meant to slow the expansion of physician-owned facilities. This was inserted as a boon for community hospitals, which accuse physician-owned hospitals of cherry-picking profitable patients and leaving less profitable ones to the community system. Under the new law, organizations not certified as Medicare participants by December 31, 2010, will face restrictions on expansion. Additional regulations include capping physician ownership, ending some Stark self-referral ban exceptions, and mandating potential conflicts of interest reporting.
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Where Are All the Latino Doctors?
Source:
Newsweek
Date:
06/07/2010
Latinos make up 14.2 percent of the population in the United States, but only 6.4 percent of the students emerging from American medical schools. This amounts to a 3,000:1 Latino patient to Latino physician ratio. Whereas some Latinos may not speak English as their primary language, this represents a potential pitfall in the American health system, as a population may lack the proper number of physicians needed to adequately address its health concerns. So why the lag in Latino physicians? An article in Newsweek takes a look.
Despite attempts to increase diversity in the medical field, the percentages of African Americans, Native Americans, and Hispanics have remained relatively stagnant. The Hispanic numbers are different, though, in that Hispanics are growing as a population much faster than the other two minority communities. Race, ethnicity, accent, and English skills have been seen to be determining factors behind the lack of a primary care physician for many Latino patients.
The cost of medical school is a sizable obstacle to recruiting Latinos. Also, many Latino students lack the primary education to prepare them for medical school. Throw in sometimes shaky community support, and it’s easier to see why young Latinos are hesitant to head down the path to earning a medical degree.
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What Should You Pay Staff?
Source:
Physicians Practice
Date:
08/01/2010
The economy is tough, and that’s plain to see. What’s not so easy to determine, though, is how much a practice should be paying its staff in a tough economy. A bit of guidance from some experienced consultants can definitely help in a situation like this. Fortunately, Physicians Practice has already asked the right questions.
First, you’ll want to develop a compensation philosophy with your board of directors. Whether you’re paying top dollar to attract top candidates or loading up on entry-level applicants you can shape according to your needs, you need to pick a practice philosophy upfront to establish consistency in compensation.
Next, set a salary cap for each position and hold fast to that cap. If you’re having a hard time filling a position, check out other practices to make sure you’re paying competitively. Also make allowances for time-based raises and such. Otherwise, don’t go above the rate you set for a position.
If you find you’re overpaying your staff, your best option is to freeze salaries across the board. You can’t simply hand out raises for raises’ sake; so staff should learn to expect them in the case of additional responsibility or exceptional performance. Before freezing pay, though, make sure you’re paying competitively, as top staff won’t stand for insufficient pay.
How, then, do you motivate employees? Take a look at your benefits package. You can make up for a lower pay rate with a competitive benefits package. Most practices offer paid vacation and sick time, but fewer offer health insurance coverage, and even fewer offer employer-matched retirement plans. Beyond these, flexible schedules and free services for families are always solid motivators.
It’s essential to make sure that you’re hiring smart. Hire people with good attitudes and you’re likely to see them producing satisfactorily almost regardless of pay. Also, keep your staff in the loop. They may know ways to cut costs or improve productivity that hadn’t occurred to you at all.
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Staffing: How Will New Technologies Affect Your Need for Personnel?
Source:
Medical Economics
Date:
06/04/2010
Who needs a desk clerk when you’ve got a voice response unit, right? Same for EHRs and staff to keep track of paper records, or any of the myriad staff positions made easier or more efficient by technology. But, before you go cutting your staff rolls, you’ll want to take a look at an article from Medical Economics, which implies that the case might not be as open and shut as it appears.
Technology does tend to offer you some leeway in terms of reducing your payrolls, as these solutions tend to increase efficiency and reduce costs. It’s a dual-edged sword, though, as technological solutions often carry their own new costs as well. EHRs, for example, require data entry, which physicians often don’t have the time to do. Similar stumbling blocks exist for check-in kiosks, integrated phone systems, and other technologies. No matter the technological solution you adopt, you’re likely also taking on the need for an IT professional, or assuring that you have to train one of your staff to be able to handle the IT workload.
The key is to properly weigh the benefits and possible costs of adopting a new technology. Examine what peers and competitors are doing and see how technologies are working out for them. These technologies shouldn’t be looked upon as a short-term economic boost. Rather, look at them as a long-term operational alteration, with attendant learning curves and associated costs. That way, you’ll know if you should keep the desk clerk or move forward with the phone system.
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Employment & Compensation
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Rookie Docs May Get More Oversight, Shorter Shifts
Source:
The Seattle Times
Date:
06/23/2010
Draft regulations are in the works to reduce the number of hours worked by junior physicians. Additionally, patients would be informed of when they’re being treated by rookie doctors, and those doctors would be subject to more oversight.
These are new proposals from the Accreditation Council for Graduate Medical Education, which is considering the measures as a means of improving patient safety and reducing medical errors. New doctors in their first year of residency training programs will be closely supervised by experienced doctors. They will also operate on maximum shifts of 16 hours. Shift maximums for second-year and beyond residents would remain at 24 hours. The maximum work week for all residents would remain at 80 hours.
The draft resolution has been assailed by some critics who claim it doesn’t go far enough. Those critics want government monitoring of work-hour regulations and increased site visits for compliance checks. Others counter, though, that the regulations will stifle resident autonomy.
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Close Vote, Heated Talk on Physician Employment in Assembly
Source:
California Healthline
Date:
06/24/2010
The fight is on in California to end the prohibition on direct employment of physicians by hospitals. And if recent proceedings on the state Assembly floor are any indication, the battle is likely to be pitched and intense.
The proposal was for the establishment of a pilot project under which some health districts would be allowed to hire their own physicians and surgeons. Supporters claim that physicians are in short supply and that lifting the direct employment ban would increase physician access for rural California communities. Opponents counter that direct hiring will lead to increased corporate influence in medical practice, wherein doctors would be pressured to make cost-cutting decisions rather than patient-oriented decisions.
The debate had parties from both sides in heated contention before falling three votes shy of passing.
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A Typical Initial Employment Agreement for Physicians
Source:
Physicians News
Date:
06/04/2010
Employment contracts with physician-owned private practices tend to address a set number of issues, though the terms they stipulate on those issues vary from practice to practice. An article in Physicians News takes a look at what you can expect in contracts and standards across a number of common contract topics.
The first topic is the term of the agreement. This facet of the contract details start dates and contingencies that must be met before a start date–state licensure, hospital staff privileging, etc. Contracts typically range from two to three years with automatic renewal except in the case of notification of termination by either party. Next, contracts tend to detail the signees expected duties. Call responsibility, locations, chart review, leave of absence: these and more are necessary aspects of the duties section.
Compensation, of course, is a key component of the employment agreement. Typically physicians are paid a guaranteed salary for the first year. Thereafter, though, some are paid based on a percentage of collections, a more common arrangement for part-time positions. There ia a wide array of compensation arrangements, and it is important to carefully spell out compensation within the contract so that both parties fully understand. Also, benefit packages should be included in the contract as well as details regarding expenses.
As to non-compete and non-solicitation covenants, these are more difficult to enforce, but they are typically included in contracts for good measure. The key here is that the clauses need to be “reasonable” with regard to time and geographical restrictions in order to be enforceable. Reasonable here is dependent on any number of factors, including a practice’s draw area and expansion plans.
Deals are unique from employer to employer and employee to employee; so draft, analyze, and negotiate depending on the situation. Experienced health care attorneys are a must to ensure that the final deal appeals to all parties.
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Health Plans Consider Adding “Meaningful Use” Criteria in Physician Contracts
Source:
American Medical News
Date:
06/21/2010
For such an ill-defined term, “meaningful use” is having an awfully meaningful impact across the health industry. The term, of course, will define whether or not hospitals’ and practices’ EHRs are eligible for federal reimbursement funds. Now, though, the term is finding its way into physician contracts, as private insurers are attempting to promote EHR use.
The Centers for Medicare & Medicaid Services is currently considering a final definition of the meaningful use stipulation. Physician groups across the nation have asked for more flexible rules in order to encourage EHR adoption. Proper usage could net practices between $44,000 and $64,000 in federal incentive funds starting in 2011.
Insurers, though, are new to the discussion. Payers are, according to experts, actively involved in developing incentive plans for physicians to encourage technology adoption. These plans are making their way into contract clauses, under which doctors would be required to follow federal meaningful use standards for EHRs. The total impact of these clauses remains to be seen, but it appears even more pressure is coming to bear on doctors to get them to adopt information technology into daily practice.
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Doctors Sue Over Identity Theft Regulations
Source:
Anesthesiology News
Date:
08/01/2010
As with most intractable issues in this country, the debate over whether or not physicians are subject to Federal Trade Commission regulatory power has found its way into a court of law. The decision could come to impact the administrative workload of practices and hospitals across the nation.
The American Medical Association–in conjunction with the American Osteopathic Association, state medical societies, and other organizations–has filed suit against the Federal Trade Commission in federal court. They seek to keep the FTC from extending its Red Flags Rule to physicians.
At issue is whether or not the FTC has overstepped its bounds in declaring that the Red Flags Rule applies to physicians. Since physicians develop payment plans with patients and accept credit cards, the FTC has ruled that they qualify as “creditors,” and are, as such, subject to regulatory action by the FTC. Under the Red Flags Rule, regulated entities must comply with standards requiring them to secure customer information and identify and detect patterns, practices, and activities indicating a possible patient information breach.
While medical record theft does account for about five percent of annual identity thefts, opponents of the FTC push claim the regulatory body is unnecessarily burdening physicians with additional regulation. Medical records, they claim, are already covered under HIPAA, and the FTC’s actions simply add another layer of red tape.
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Deaf Patients Sue Jacksonville Hospital Over Lack of Interpreters
Source:
The Florida Times-Union
Date:
06/10/2010
Deaf and hearing-impaired patients aren’t receiving adequate care at Baptist Medical Center in Jacksonville, Florida, according to a lawsuit filed in federal court. Seven deaf and hearing-impaired patients have joined the suit, which alleges the hospital violated the Americans with Disabilities Act.
Lawyers for the plaintiffs claim that the experience of the patients represents a pattern of neglect on the part of Baptist Medical, a pattern that has resulted in denial of full-care services for deaf patients. Under U.S. law, a one- to two-hour response time for an interpreter is considered reasonable; but the plaintiffs claim they were forced to wait several times that.
The lawsuit doesn’t seek economic damages from Baptist Medical, calling instead for the facility to be declared in violation of the law and for the court to order an end to the discrimination.
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Health Reform Has Liability Insurers Looking at Tort Alternatives
Source:
American Medical News
Date:
06/07/2010
Tort reform wasn’t front and center for the recently passed health care reform bill, but that isn’t stopping tort reform advocates from seeing opportunities to advance the cause in the wake of the bill’s passage. Four possible alternatives to the current system look to undergo heavy testing in the coming months and years. An article in American Medical News takes a look at the possibilities for overhauling our tort system.
Early-offer plans are one alternative. Under such plans, defendants would have the option of paying an injured patient’s economic damages and attorney fees within 180 days of a claim being filed. The plan would disallow non-economic damages, and further recourse in court would be disallowed after acceptance of the plan on the part of the plaintiff.
Another option is the pretrial screening panel. With three out of four cases ending favorably for doctors, and 95 percent of those never making it to court, widespread screening panels could reduce the cost of case resolution by about a factor of ten.
Some parties are also examining the feasibility of health courts–in which cases are decided by specialized judges informed by neutral experts–and disclosure and apology programs–in which medical errors are disclosed to patients and an apology is issued for bad outcomes.
A key concern for tort reform pioneers is the stipulation within the bill that any trial programs cannot change the rights of claimants and cannot diminish attorney fees. This, of course, could have the effect of limiting the efficacy of any trials. There are additional questions regarding funding, which is subject to Congress. All the same, though, the opportunity is there, and some look forward to the chance to do some real restructuring of the tort system in this country.
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Brain Signs of Schizophrenia Found in Babies
Source:
Science Daily
Date:
06/22/2010
Could brain scans on newborns become a powerful tool in identifying persons at risk for developing schizophrenia? A new study out suggests the answer is yes. Science Daily has the details.
The new paper out in the American Journal of Psychiatry was published by researchers at the University of North Carolina at Chapel Hill and Columbia University. The researchers used ultrasounds and MRIs to examine brain development in 26 babies born to mothers with schizophrenia, a factor that raises the risk of schizophrenia to one in ten. Researchers found among boys that higher risk babies had larger brains and larger lateral ventricles, while no difference in brain size was found among girls.
The differences don’t mean that the boys will without question develop schizophrenia. They are, however, at a higher risk, and will now be tracked throughout their development by the team. The research is the first that suggests that the brain abnormalities associated with schizophrenia are detectable early in life.
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Federal Investments Aimed at Boosting Primary Care Workforce
Source:
Healthcare IT News
Date:
06/16/2010
The overall health of the country won’t get any better without expanded access to primary care. That’s why the recently passed health care legislation sets out more than a quarter of a billion dollars in federal investment with the goal of increasing the number of primary care health professionals. Healthcare IT News has the details.
The Affordable Care Act and the previously-passed American Recovery and Reinvestment Act contained much in the way of funding to encourage the growth of the primary care sector to fulfill the needs of the populace in the future. Five programs were recently announced by the Department of Health and Human Services. The programs will spend a quarter of a billion dollars to increase the number of residency slots for primary care physicians, support physician assistant training in primary care, encourage full-time nursing careers among nursing students, establish nurse-practitioner-led clinics, and encourage states to plan for and address health professional workforce needs.
Administrators cite the shortage of primary care physicians as a critical factor in the nation’s health care crisis and point out the need to promote prevention at all levels of society.
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FDA Cracking Down on Excess Radiation from Medical Imaging Devices
Source:
Natural News
Date:
06/22/2010
The Food and Drug Administration is moving to reduce patients’ unnecessary exposure to radiation during medical imaging tests. The regulatory body will roll out a three-pronged strategy focused on increasing device safety, patient awareness of risk, and the ability to make informed decisions among doctors and patients.
Computed tomography (CT), nuclear medicine studies, and fluoroscopy are all coming under examination. Those three procedures provide the greatest exposure to radiation for the U.S. population, delivering higher radiation exposure than mammography or X-rays. This exposure increases risk of cancer, cataracts, and burns.
The FDA plans to encourage appropriate justification of all radiation tests and optimization of the dosages used in such tests. Manufacturers of radiation imaging devices will now be required to implement safeguards and standardize training for device operators. The FDA will work with organizations to design patient medical imaging history cards to log all radiation tests undergone by patients. Additionally, the agency will encourage the development of a national radiation dose registry to enable monitoring of nationwide radiation exposure.
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Video Shrinks Distance to Mental Health Care
Source:
Army Times
Date:
06/14/2010
Could telemedicine provide a key tool in the battle against post-traumatic stress disorder among veterans? The Army thinks so, and programs using the technology are seeing increasing use as soldiers return home from the field.
It’s called the Virtual Behavioral Health Program, and it grew out of a pilot program in the Western Regional Medical Command. Administrators are looking to see the technology and program adopted on a wider scale throughout the Veterans Affairs Department.
Nearly one in five personnel returning from combat show signs of PTSD, though only a little more than half receive treatment, with many worried about medication side effects or the perception among their peers of their seeking help.
Now, though, telemedicine is allowing for group anger management sessions and remote counseling for troops too removed from a VA hospital or qualified provider. In fact, a majority of soldiers say they prefer that the person treating them is far away, as it heightens the sense of confidentiality. It was, in fact, the therapists in trials that felt anxious about the remote therapy process.
The program isn’t perfect, however, as there are questions about what to do regarding at-risk patients and telemedicine. Additionally, some critics counter that the bond between patient and provider isn’t as strong over the Internet. And there are practice regulations that must be overcome before the process can become widespread. In the meantime, though, a technological solution has been discovered that is helping some soldiers cope with the return home.
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Preventing Inpatient Suicides
Source:
Today’s Hospitalist
Date:
06/01/2010
Annually there are about 1,500 suicides at U.S. hospitals. Among suicides and attempts taking place in Veterans Affairs hospitals, almost half take place outside of a psychiatric unit. So what can hospitalists do to mitigate patient risk of suicide? Today’s Hospitalist looks at the issue and gives some simple solutions.
The two most common suicide routes–suffocation and jumping–could be stymied by acts as simple as making sure windows don’t open more than six inches and removing plastic bags from hospital-room wastebaskets. Simple identification of suicide hazards in mental-health units reduced 73 percent of hazards in VA hospitals. Anchor points such as doors, metal bars, and furniture are things to look out for, though experts note that patients can also use towel bars and exposed pipes to hang themselves.
Given the number of hazards that exist throughout a hospital, it’s a difficult job for hospitalists to address all the hazards present on medical wards. It’s possible, though, to reduce hazards by identifying at-risk patients and high-hazard settings and situations. Patient monitoring is essential, but this should be combined with an active effort to remove hazards from the patient’s environment.
Suicide-risk assessment is now a national patient safety goal for psychiatric unit patients, thanks to the Joint Commission. Hospitalists can do their part by adding mental-health status assessments and targeted evaluations as a standard part of admissions and transfer procedures. It’s likely impossible to prevent all suicides and attempts by patients, but by adopting a few procedures and standards, and relying on vigilance, it’s possible to go a great way toward reducing their likelihood.
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Impaired Physicians: How to Recognize, When to Report, and Where to Refer
Source:
Current Psychiatry Online
Date:
06/01/2010
Impaired physicians represent a threat to themselves, the facilities they operate in, their colleagues, and their patients. Yet recognizing and reporting impaired physicians is a challenge for those around them. An article in Current Psychiatry Online takes a look at substance abuse and what professionals need to do about it when they see it affecting the workplace.
Six to eight percent of physicians abuse drugs, according to estimates, with 14 percent of physicians developing alcohol use disorders. Physicians frequently hide their problem, though; so it is important to take note of signs of abuse, such as tardiness and absences, inappropriate behavior, interpersonal conflict, slurred or rapid speech, and other signs of chemical impairment.
It is also important to screen aging physicians for cognitive decline. In individuals older than 65, the rate of dementia is 11 percent. Nearly one in five physicians is older than 65. Some organizations undertake a 360-degree review, taking information from peers, patients, and non-physician colleagues in a confidential manner regarding skill and knowledge, psychosocial functioning, management skill, performance, and collegiality. Physicians over 65 in some systems undergo annual or biannual neuropsychological testing to screen for impairment.
Reporting impairment in physicians is the duty of any worker witnessing a physician impaired in cognition, concentration, rapid decision making, and ability to handle emergencies. In the event of serious risk to the physician or patient, workers might be required to break confidentiality in order to report professional misconduct or impairment. Anyone considering reporting an impaired colleague should learn the laws in his state to be sure of the grounds for reporting.
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Payer & Reimbursement Issues
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Handling Health Insurance Claims Instantly
Source:
San Francisco Chronicle
Date:
06/28/2010
The American Medical Association has found that most major insurers have a median response time of five to thirteen days. Real-time claims adjudication has been a dream in the industry for some time, but what’s the hold-up?
The truth is nobody has a good answer on why insurers take so long to process claims. Internally, they’re processed quickly, with the larger insurers handling more than a million claims per day. Upon pricing, though, they go into a system that sometimes benefits from delayed payment.
Still, though, some insurers are pushing for widespread adoption of real-time claims adjudication, only to meet resistance from doctors. Generalists and high-volume practices would have a hard time processing patients while at the same time taking advantage of a real-time adjudication system. Additionally, real-time adjudication depends heavily on the adoption of electronic medical records, systems which have seen slow adoption rates in the practice community.
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Tricare to Allow Civilian Employers of Military Retirees to Offer Cafeteria Insurance Plans
Source:
The Medical News
Date:
06/28/2010
Civilian employers of military retirees will soon be able to offer cafeteria-style supplemental health insurance to workers choosing to use their Tricare Standard benefit to buy coverage. Previously, employers were prevented from doing so, instead being forced to push employer-paid insurance.
Cash incentives for continued reliance upon Tricare and subsidization of a Tricare supplemental insurance plan are both still out of the question. Military families can now buy a cafeteria plan supplemental policy through an employer, provided it comes from pre-tax income and the beneficiaries pay the full cost of the plan.
The move comes as more and more companies were pushing for their military retirees to rely on Tricare rather than provide insurance. It is expected to save taxpayers $64 million per year.
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Credentialing, Licensure, Quality Management
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New Residents Linked to July Medication Errors
Source:
American Medical News
Date:
06/21/2010
So maybe July is the cruelest month, no? Such is the case, according to a study in the Journal of General Internal Medicine, which finds that inexperienced doctors are likely responsible for a spike in patient fatalities.
The study looked at nearly a quarter of a million death certificates for cases from 1979 to 2006 that involved medication errors. Researchers found that the influx of new residents corresponds with a 10% spike in fatal medications. The spike was most pronounced in counties with the greatest numbers of teaching hospitals, and counties without teaching hospitals experienced no spike in deaths.
The results lend credibility to the supposed “July effect.” Previous studies had found no such links. If there’s any silver lining to the new research findings, it’s perhaps that residents appear to learn very quickly from their errors, getting up to speed within a month or so.
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Monitoring the Home Health Monitors
Source:
H&HN Magazine
Date:
06/14/2010
Home health monitoring is often viewed as a means for elderly patients to maintain some dignity and independence while reducing the cost to public and private payers for elderly care. Home monitoring systems, though, have been a considerable obstacle to achieving the fully connected medical home. Slowly, though, that is changing.
A major barrier to the connected medical home has been the complexity of monitoring devices. Additionally, the market providing these is fragmented, and there are no standards of quality and consistency. Some groups, though, are working with manufacturers to create interoperable standards for devices.
Additional barriers to fuller home health monitoring include a lack of extensive electronic medical record systems. To get home health monitoring fully up and running will require a concerted effort on the part of providers, device makers, and even patients. But these parties, working in combination, are likely to eventually develop the tools that will allow seniors to stay in their homes while being connected to their physicians.
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Interruptions Increase Risk of Emergency Room Doctor Errors: Study
Source:
AboutLawsuits.com
Date:
06/03/2010
Nobody likes to be interrupted in the middle of their job; but apparently interruptions in the emergency room can lead to drastically higher rates of medical errors. So says a study published recently in the British Medical Journal.
The study, conducted by researchers at the University of Sydney, looked at the emergency department of a 400-bed teaching hospital, covering 40 doctors working for nearly 211 hours. They found that doctors were interrupted 6.6 times per hour, during 11 percent of their tasks.
Doctors that were interrupted failed to return to the interrupted task about one in five times. Many times they took shortcuts to make up for lost time, shortcuts that could endanger patient lives.
The researchers conclude that interruptions significantly raise the risk for physician error. The findings are in keeping with a similar study on problems arising from nurse interruptions. That study found an increase in the chances of making a mistake of 12 percent following each interruption.
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Are You Ready for a Data Breach?
Source:
Healthcare IT News
Date:
06/23/2010
Of course many parties are pushing physicians to adopt increasingly high tech solutions for practice. There are penalties and incentives in the near future for electronic medical record adoption. But what are your responsibilities regarding patient security? Is your practice ready for a data breach? Healthcare IT News takes a look at what you need to know in the event of the digital worst.
Under the HITECH Act, there are now sizable penalties for improper handling of secure material. Practices are liable for up to $1.5 million in the event of a massive data breach. If you don’t know much about HITECH, you should. The following four factors are quite important.
First, HITECH’s data breach provisions have an added requirement that an organization carry out incident-specific risk assessments to determine the risk of breach and the potential harm to individuals affected by a particular sort of breach. Data administrators should become versed in HITECH rules regarding these assessments. Next, HITECH doesn’t pre-empt state notification laws. HITECH is a national law for notification, but the specifics of data protection and notification of breaches might be different within your state.
Additionally, don’t put all your faith in encryption. Encryption is a useful tool, but it does not protect against data breaches. An insider within your organization could, for example, aid any offending party in accessing patient information. Encryption is a tool, but it is not the only tool you should rely on. Finally, realize that your practice is responsible for your business associates. If your business associate exposes information that was provided by your organization, the obligation for notification still lies with your organization.
Keep in mind the ins and outs of your HITECH obligations. In the coming years, knowledge of these regulations is likely to save you a lot of trouble in the event of a data breach.
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The Brave New World of Information Technology
Source:
Today’s Hospitalist
Date:
06/01/2010
Electronic medical record systems are supposed to save time, money, and potentially lives. The adoption rate for this technology is still rather low, though there has been an uptick in the adoption rate. So why are some hospitalists uncomfortable with the spread of the practice-altering technology? Today’s Hospitalist has the story.
The problem is largely one of contracts. Vendor contracts are keeping physicians from sharing error reports and software advances. That means that when a doctor finds a problem within an EMR, he can’t compare experiences with fellow physicians for fear of violating a non-disclosure clause. This might be workable with other vendors, but with EMRs, these issues take months to fix, and the company may not even know there is a problem without a critical mass of physicians complaining; and all the while, patient well-being is jeopardized. What’s more, physicians and nurses are, according to the contracts, supposed to act as “learned intermediaries,” noting and correcting errors in the system as they discover them.
Beyond the contract difficulties, some physicians contend that the EMR implementations are barely usable, with cramped displays and labyrinthine user interfaces. They argue that EMR-makers should put more emphasis on ease of use for physicians. Further, the focus on billing in these systems makes them ill-equipped for clinical use.
Experts contend that EMR-makers should spend a greater deal of time figuring out how doctors work daily and structure their software around that. They argue for a shortening of the software development cycle, while some are calling for physicians to flout the non-disclosure clauses in their EMR contracts and share information for the betterment of not only patient safety but the electronic medical record industry itself.
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Physician Practice Management
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A Positive Approach to Negative People
Source:
H&HN Magazine
Date:
06/14/2010
Wish you could ban bad attitudes like most places have banned smoking nowadays? Well, the chances of the FDA regulating negative people are pretty slim, but an article in H&HN Magazine takes a look at ways to cultivate a work environment in which maintaining a positive attitude is the law of the land.
First, you’ll want to make sure staff know they can benefit from managing their own productivity, as personal benefit is a great motivator. Next, clearly specify the link between organizational values and behavioral expectations. Let people know how their own behavior fits in with the larger goals of the institution. And help your staff overcome negative self-talk, which will improve their own outlooks and attitudes. You’ll need to help people deal with personal challenges by letting go of the past, and in this manner get them to not bring negative attitudes into the workplace.
Your managerial staff will need to know how to constructively confront negative attitudes. You can’t just sweep it under the rug. Conflict should be depersonalized so that conflict risk is minimized in daily interactions.
There are more hints, including the use of daily reminders, increased visibility of leadership, and the avoidance of labels and stereotypes. The idea, though, is to create an environment in which negative behaviors have no room to grow or sustain themselves. If it sounds like a dream, well, think back to the beginning of the smoke-free movement, and how far that movement has come in just a quarter-century.
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Obamacare and Its Impact on Doctors
Source:
Physicians News
Date:
06/14/2010
So what, exactly, got pushed over the finish line in the recent health care reform law? According to a commentator for the Heritage Foundation, little more than an increase in headaches for your average physician.
Under the new health care regulation, doctors will be subject to more government regulation and oversight while at the same time becoming more dependent upon government payers as the ranks of government-insured swell and newly insured patients flood practices.
In addition to rising numbers of government-insured, the plan also is likely to eventually see cuts to reimbursement for dealing with those patients. The current pay system in Medicare and Medicaid is largely unsustainable. Congress has known about this for some time, but continually puts off the reimbursement cuts for political reasons. In the coming years, though, these cuts will be unavoidable, and doctors will be seeing less money for treating Medicare and Medicaid patients.
In addition to pay cuts, physicians should get ready to see more red tape. The law creates assorted monitoring bodies and advisory boards tasked with examining clinical effectiveness of treatments. Additionally, the law extends the Physician Quality Reporting Initiative, which is focused on improving the quality of care given to Medicare beneficiaries. All of this has met with significant discontent among physicians. One survey found eight of ten physicians less optimistic about the future of medicine, while majorities indicate considering dropping out of government health programs and insurance altogether. It’s a rocky road ahead for certain.
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Patient’s Bill of Rights
Source:
Physicians News
Date:
06/23/2010
So just what did the Affordable Care Act manage to accomplish with regard to patient rights? The answers might surprise you. As Physicians News details, the Act, in combination with newly implemented regulations from the Departments of Health and Human Services, Labor, and Treasury, may do a good deal in the way of easing access to coverage for many Americans.
A fact sheet released by the Obama administration highlights four broad areas affected by the bill and the recent departmental regulations. The first is a general description of how the rules will help consumers. This includes the end of pre-existing condition exclusions and an end to pre-approval requirements from insurers.
Next, the release details how the new rules will build on other aspects of the recently passed bill. The rules will now call under review the annual premium increases common to large insurers. Insurers will also have to spend at least 80 percent of every premium dollar on direct medical care. The rules and bill also ensure that children up to the age of 26 will be able to stay on their parents’ family policies.
The Act introduces new consumer protections as well. The bill puts an end to arbitrary rescissions of insurance coverage, the lifetime limit on coverage, and strongly restricts annual dollar limits on coverage. The rules also contain measures to ensure that patients can maintain their choice of doctors, while removing some barriers to emergency department services.
The administration is in the midst of a push to improve perceptions of the bill, pointing out the ways it is projected to save money and bend the curve with regard to health care costs. Additionally, they point out the ways that the bill will improve access to care, enhance worker productivity, and head off health care-rooted bankruptcies.
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