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Advanced Practitioners vs. Physicians?
With the recent passage of health care reform legislation—and the inevitability of many more patients brought into our nation’s health system—a key question arises. Who will be treating all of these patients? The solution, some would argue, is that Advanced Practitioners (APs) – more appropriately referred to as “Advanced Practice Professionals” -- will be called upon to provide the care that overworked physicians may be unable to provide. That could be a good thing. Others view this scenario as indicative of an inevitable “turf war” that does not bode well for the medical profession.
This month’s Special Report addresses such matters in a balanced discussion. Regardless of what position an observer takes, one thing is sure: Advanced Practitioners will increasingly be viewed as indispensable in quality health care delivery.
The report quotes Susan Mesa, president of AdvancedPractice.com, a staffing firm that specializes in placing Advanced Practice Professionals in locum tenens and permanent positions…and a member of the Jackson Healthcare “family of companies.”
Other articles of note: “Government Run Health Care,” “How to Get Paid for Taking Call,” “Patient Records Legal Primer,” and “Guerilla Marketing Your Practice.”
We trust that our comprehensive array of summarized articles offers “something for everyone” in the medical profession. Enjoy!
Cordially,
Calvin Bruce
Managing Editor
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Risk Management Tip of the Month: Understand that informed consent is an ongoing communication process between the patient and psychiatrist, and not merely a form.
"Risk Management Tip of the Month supplied by PRMS, Inc., Manager of The Psychiatrists' Program" www.psychprogram.com. |
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Doctors Pursue House, Senate Seats
Source:
USA Today
Date:
04/20/2010
Feel like something was missing from the health care legislation debate? Some would say the voice of actual physicians was underrepresented as Congress undertook to remake the basis of the American health care system. To make sure that’s not the case next time around, a number of physicians across the country are running for seats in both the House and the Senate.
Forty-seven physicians–all but six are Republicans–are running for the House or Senate in the primaries leading up to this year’s midterm elections. In 2008, 30 physicians ran in the general election, up from 22 in 2006. Currently, 16 doctors serve in Congress, making up about 3% of lawmakers. The physicians have the edge as far as public trust is concerned: physicians enjoy 77% trust ratings among the public, compared to 32% for Republicans and 49% for President Obama.
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Government Run Health Care
Source:
H&HN Magazine
Date:
05/05/2010
Lost in the commotion drummed up over fears of “government run health care” was the fact that, according to CMS, we already have government run health care. It’s a trend that’s been a long time coming, was only exacerbated by the economic downturn, and only looks to accelerate in the coming years. So what exactly did the recent health care bill get us? An article in H&HN Magazine takes a look.
CMS projections don’t have the public spending numbers for health care overtaking private sector spending until 2012. Dig deeper into those numbers, though, and you’ll find that they’re based on current law and the assumption that Medicare physician payments will actually be cut according to scheduled program sustainability guidelines. Since the law underwent a drastic recent change, and since the scheduled Medicare cuts are always put off, it’s safe to assume that public sector spending will overtake private sector spending some time this year.
As to the political theatrics of the past year? Well, it turns out that’s exactly what they were: theatrics. The Republicans knew that higher taxes are going to be necessary for the increase in public spending, but still clamored for “free-market” solutions. On the other side of the aisle, the Democrats also knew that higher taxes are necessary to cover public spending; so they want to get those taxes flowing into the system early in order that their plan winds up reducing the deficit. Both sides, amid their rhetoric and bluster, missed opportunities to make choices that would have had a significant impact on the bill that emerged.
Nonetheless, a bill has passed. So what are we to do? Well, no one knows the real impact of the bill as yet, as it depends on many moving parts. No matter what the outcome, though, government run health care isn’t “coming”-- it’s already here. The challenge now is making it work.
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Doctor Fixes Heart With Remote-Controlled Robot
Source:
ABC News
Date:
04/28/2010
Physicians at a British hospital have conducted surgery on a live patient without even entering the room. It’s not magic; it’s technology, as they performed the first remotely-controlled robotic surgery to date.
The procedure involved the catheterization of a patient in a process that typically requires long hours for doctors, who have to wear heavy lead shielding to protect themselves from exposure to X-rays during the procedure.
This time, though, the surgeon was using the Remote Catheter Manipulation System, which allowed him to perform the procedure without entering the surgical theater. The catheter is outfitted with electrodes that stimulate and record the regions of the heart, which aids in identification of the abnormality. When the problem has been identified, the physician is able to ablate the abnormal tissue. Medical staff are on hand in the operating theater throughout the process.
Robotic surgeries have been on the rise for gynecological cancer, coronary artery disease, kidney cancer, and bladder cancer, but this is the first of this kind of remote-controlled operations. The surgeon performing the procedure says he has no trouble envisioning a day when physicians step into their offices on one side of the country and operate on a patient across the street, state, continent, or even around the world.
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Teaching Doctors the Price of Care
Source:
National Public Radio
Date:
05/04/2010
Much has been said by many parties when it comes to controlling health care costs. But could a real means of cost control be lurking right in front of us? A report from National Public Radio takes a look at efforts to stem the rise in medical costs that takes aim at physician education.
The idea is that physicians ought to be informed in cost-controlling methods while they are still being brought up as doctors. Any later, and it’s possible that habits will have already set in, making them harder to dislodge. A number of critics contend that medical schools are falling down on the job when it comes to instilling cost-conscious attitudes in physician trainees.
To address rising costs, the American Association of Medical Colleges instituted a policy requiring accredited institutions to educate physicians-in-training as to the financial impact of their individual decisions. The policy has been met with mixed results, as between 41 and 60 percent of institutions include some material on health care costs in student education, though they vary in the degree to which these elements are stressed.
Medical students indicate that their instruction with regard to cost control can at times get lost in the flood of information that makes up a medical education. A number of programs, though, work to give young doctors a clearer view of just how their decisions contribute to overall costs. One such program at Mount Sinai School of Medicine gives students hands-on lessons about the impact of costs on patients via clinical experience in a free clinic in a low-income neighborhood. Time will tell, though, if programs such as these have any effect on continually spiraling costs.
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What the New Health Care Bill Will Mean for Physicians in the Long-Term
Source:
Physicians News
Date:
05/04/2010
It’s no secret what the most prominent effects of the recent health care legislation will be with regard to practice: more insured means more patients. But what effect will the new laws have on your personal finances as a physician? How should you be adjusting your long-term financial planning as a result of the changing economic outlook for physicians?
The first thing to realize is that the increase in insured patients means an increase in patient load; but the increase in government-covered patients, combined with cuts in compensation, will likely mean lower incomes for practices. So your bottom line may suffer to some extent for starters. Add to that the fact that government spending has to be paid for somehow. Since the big, cost-driving government programs aren’t likely to see cuts any time soon, that likely means printing more money and increasing taxes on high wage earners. Since physicians typically take home much more than the overwhelming majority of Americans, that means your taxes are likely to increase in the coming years. Some estimate that most physicians will see a 10 to 15 percent increase in taxes over the next ten years accompanied by a 20 to 30 percent drop in compensation.
If those numbers sting a bit, know that you can take steps now to lessen their impact later. Now’s the time to make sure you’ve got a solid financial plan, and Physicians News offers some tips to get you on solid footing.
The future is likely to bring challenging and change-filled times for the medical world. By taking action now, you can make sure that you’re not in an unfortunate position in the years ahead.
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New Health Law Will Require Industry to Disclose Payments to Physicians
Source:
Physicians News
Date:
04/26/2010
Speaking fees, meals, and just about any other sort of compensation some physicians regularly receive from medical device and pharmaceutical companies will have to be reported–along with their value and the receiving physician’s name–to a publicly available site thanks to a new federal law. The move comes in the wake of similar initiatives undertaken by a number of states looking to curtail undue influence by companies on the medical profession. The ultimate goal, according to some, is to reduce the payments altogether.
Three states currently require gift disclosures. In Vermont, where reporting has been mandatory since 2002, total payments to physicians have dropped to $2.6 million, a 13 percent decline over the course of fiscal 2009. This is part of a continuing trend that has seen payments steadily declining over the past three years. Officials in Vermont also note a higher number of health care professionals that do not accept gifts. Vermont last year even moved to ban most gifts entirely, including food. Massachusetts and Minnesota, the other two states with this sort of legislation, have also outlawed many forms of gift-giving, though doctors can still accept product samples and speaking fees.
Under the new federal program, consumers will have easy access to even more information. Under the Physician Payments Sunshine Act, any payments in excess of $10 will have to be reported, beginning in 2012. In September of 2013, a searchable database of reports will be available online.
Critics contend that the law contains too many loopholes, as it only applies to physicians and teaching hospitals; not nurses, physician assistants, and other medical professionals.
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Future Doctors Tackle Stigma Surrounding Suicide
Source:
Medill Reports Chicago
Date:
05/12/2010
Should physicians be more carefully and fully instructed in suicide prevention methods? Are doctors underutilized as a line of defense against suicide among the greater populace? Administrators at Northwestern University’s Feinberg School of Medicine think so, and they’re taking steps to ensure that future physicians coming out of Northwestern know how to recognize and act upon the signs indicating a suicide risk.
Studies indicate that, shortly before they carry out the act, a sizable portion of persons committing suicide have some form of contact with a physician. Forty-five percent of suicide victims had contact with primary care providers within a month of their suicide, according to a study in the American Journal of Psychiatry.
While physicians are trained to screen all patients for depression and suicide, there is no evidence that this is an effective method. Experts recommend that doctors take up secondary prevention methods: asking about depression and suicide. This, they say, is a more effective means of preventing patient self-harm.
Broaching the topic of suicide can be uncomfortable for physicians. Still, experts contend that it is, in fact, as easy as asking, “Have you ever felt depressed?” or otherwise probing for evidence of suicidal ideation. Getting into the habit of broaching the topic with patients will make it easier to discuss possible suicide ideation in the future.
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Specialty Societies Set New Policy on Drug Company Influence
Source:
American Medical News
Date:
05/10/2010
The pharmaceutical and medical device industries continue to feel the squeeze on their interactions with health care providers. The latest round of restrictions comes as an umbrella group as the nation’s specialty societies have set new policies regarding the influence of industry figures on society administration and compensation.
Pharmaceutical company influence on health care has come under fire in recent years, with academic medical centers and physicians coming under pressure to disclose any and all payments and sponsorship received from industry. It is in this environment that the Council of Medical Specialty Societies–whose member organizations comprise some 650,000 American physicians–has debuted new policies governing interaction with industry figures. Henceforth, industry support of specialty organizations must be disclosed. The new code also bars society presidents and editors-in-chief of journals from financial stakes in for-profit health companies. Thirteen societies have signed on so far, and experts expect most member organizations will adopt the policy before the year’s end.
Proponents of the move hail it as yet another step toward ensuring transparency in industrial dealings within the health care sector. Critics counter that for-profit firms have a critical role to play within the delivery of health care today and policies such as this are unlikely to prevent any potential negative industry influences.
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When Hiring Faculty, Some Centers Look Inward
Source:
Journal of the Association of Staff Physician Recruiters
Date:
02/05/2010
Academic medical centers have a different set of criteria when it comes to recruiting physicians. In addition to clinical experience, they also have to take into account academic experience to get a good match. With this being the case, are these centers, then, ideally suited for in-house recruiters?
In-house recruiters allow an organization to bring in talent that is more likely suited to its particular culture. This is because the recruiters get to know the organization from the inside. They may constitute more of a regular financial commitment–making $35,000 to $60,000 per year–but they end up saving money for organizations that recruit multiple physicians each year–a process that can cost between $25,000 and $30,000 for each hire.
In-house recruiters also simplify and centralize the recruiting process. One person or office places ads, talks to potential candidates, and sets up visits and interviews. They also help with longer term recruitments, as physicians initially uninterested in a job may change their minds over time, having built a relationship with a recruiter.
In-house recruiters will, however, need the support of academic medical center departments. They need to become familiar with the workings of departments and the overall culture in order to find the best fits. Properly supporting them in their operations, though, is likely to pay off sizably for your organization.
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Are Your Docs Management Ready?
Source:
H&HN Magazine
Date:
05/05/2010
The health care industry is increasingly in need of physician managers. With the push toward, among other factors, quality assessment and bundled payments, physician managers are more necessary now than at any point in the past. But it’s not as simple as grabbing a head physician and putting her in charge of 450 subordinates. Managerial skills are cultivated, and successful management isn’t quite the same as successful medical practice.
Since 2000, the number of MD-MBA programs in the nation’s medical schools has more than doubled. At the same time, the membership of the American College of Physician Executives has grown sizably. In the midst of this, hospitals are increasingly realizing that they need physician manager expertise. In identifying potential managers, the process begins with hiring. Administrators should be on the lookout for managerial skill sets in potential recruits. Knowledge of budgets and insurance contracts is a must in chief medical officers and other institutional managers. Service-line managers will need administrative and people skills. And organizations cannot afford to overlook natural leaders. This sort of physician will be indispensable for guiding patient safety goals or quality improvement initiatives. If you can identify these sorts of individuals within your organization now, they will come in handy later.
Managers must at times be big on diplomacy, as they will have to go back and forth between sometimes adversarial factions within an organization. You can alleviate this to an extent, though, by training physician and non-physician managers together. This eliminates unnecessary distinctions and increases the likelihood of cooperation.
In cultivating your next generation of managers, you’ll want to instill managerial skills in all of your physician staff. Budget-reading and negotiation are essential tasks for future managers, and training all in these skills will help you identify those who excel at them. Finally, take a look at your own managerial style by hiring an executive coach. The coach’s influence may alert you to undesirable managerial traits within your own style that you might not otherwise have noticed.
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Employment & Compensation
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How to Get Paid for Taking Call
Source:
American Medical News
Date:
05/10/2010
You might not love the idea of taking call hours in your off time, but it is increasingly proving a necessity for many doctors. Taking call can provide an additional source of cash, which comes in handy in tough financial times. Be careful, though, as compensation arrangements for this sort of work aren’t just as simple as a few extra dollars tacked onto the paycheck.
Hospitals’ compensation for call hours can vary widely in price according to your specialty. Family physicians typically earn less, while subspecialists can receive thousands of dollars per day of coverage. No matter what you’re receiving, you’ll want to look over the exact payment arrangement. If your hospital does pay for call hours, they may structure that payment with an “activation fee” that is incurred whenever you are actually called in. Otherwise they may pay you for call hours in excess of a certain number of days per month. Also, pay for call hours can be put into a tax-deferred retirement account, allowing you yet another way to work today while saving for the future.
Whatever your call arrangement, you’ll want to make certain it doesn’t conflict with kickback prohibitions. Your compensation must be based on fair market rates for the work you do, and you must make certain you’re not being compensated twice for the same work. Failure to abide by these regulations could wind up costing you money in the long run, which would negate the whole purpose of taking the extra hours in the first place.
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Doctor Pooling Plan Sparks Fear
Source:
Wall Street Journal
Date:
05/14/2010
In a move that has sparked concerns over the consolidation of health care and possible escalation of costs, the Hospital Association of Southern California has proposed creating a single foundation of multiple facilities to contract with physician groups. The proposal is part of a larger trend in physician employment, even though hospitals are barred from directly employing physicians in California.
In the proposed plan, physician groups would contract with a joint medical foundation. Physician groups would be affiliated with, and have privileges at, a specific hospital. The foundation would operate clinics and centralize billing and EHRs as well.
Critics of the system claim it would allow hospital systems to control compensation and cut out unaffiliated medical groups. Proponents counter that the proposal still allows for individual negotiation of deals between hospitals and physicians.
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Hospitals’ Charity Care Knocked
Source:
The Columbus Dispatch
Date:
05/06/2010
Not-for-profit hospitals and health systems are failing to adequately inform patients about their eligibility for charity care—this according to a survey conducted by Access Project and Community Catalyst.
The report, which surveyed 99 of the nation’s hospitals last summer, found 85 percent of hospitals mentioning charity care programs to patients, but fewer than half provide applications for financial help, and only one in four post eligibility criteria for the programs on hospital websites.
Since 2003, the American Hospital Association has recommended that hospitals spread information on their charity care programs and make efforts to contact patients before referring them to collection agencies.
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Clinical Integration
Source:
H&HN Magazine
Date:
05/05/2010
How does the health care system typically work? Patient is referred from an outside practice. Patient comes into an organization to receive a treatment before shuttling off to another organization to receive a specific therapy and receiving medication from yet another provider. If that seems like a lot of steps toward patient wellness, you might be interested in clinical integration, a movement that is gaining momentum as systems try to reduce costs and maximize profitability.
Different organizations practice clinical integration to different degrees. For some, it might mean coordination of treatment around a specific ailment. For others, though, it could mean employed physicians, closed staffs, and a full spectrum health care experience for patients.
Organizations looking to integrate will have help in the coming years in the form of federal assistance. Starting in 2011, the federal government will roll out a number of programs meant to test the effectiveness of integration models. These programs will include payment bundling, increased flexibility with regard to antitrust exemptions, and assorted pilot programs meant to test payment and service delivery models with the aim of improving quality of care.
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Ending a Practice Relationship Doesn’t End Liability
Source:
American Medical News
Date:
05/03/2010
You left the practice months ago and are successfully acclimated to your new position when a summons arrives in the mail. You’re being sued for procedures you carried out at your former practice. You were covered while in their employ; so no problem, right? Depending on the type of coverage you had, you could find yourself more exposed than you would think.
Liability and exposure after physician departure come down to the coverage type. Malpractice coverage comes in two forms: occurrence-based coverage and claims-made coverage. The former covers physicians for claims no matter when they were made, if the physician was covered at the time of the procedure. Claims-made coverage, though, will cover you only when the claim is filed. Most practices maintain a claims-made professional liability coverage; so it’s best to know your options when faced with a suit.
If your employer offers claims-made coverage, you will likely want to invest in tail coverage to account for any claims that may be made for procedures you performed before leaving. In fact, it’s a good idea to take a hard look at your employment contract, as your employer may reserve the right to purchase tail coverage for you automatically, sticking you with the bill. It’s not uncommon for departing physicians to be hit with a surprise bill for coverage they didn’t know they needed.
If you’re moving to a practice that has the same insurer as your old employer, then you can likely avoid the cost of tail coverage, as there would be no lapse in coverage at all. Still, it is best to be knowledgeable as to the ins and outs of your coverage situation so you’re not caught by surprise.
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Medical Malpractice Lawsuits Drop 39 Percent
Source:
The Daily Item
Date:
04/28/2010
Pennsylvania medical malpractice lawsuits have declined steadily over the past seven years. What’s the secret? The Daily Item says the reason is twofold.
Filings in Pennsylvania have dropped 39 percent since 2003. That is a drop of more than a thousand cases a year, from 2,731 per year in 2002 to 1,674 per year in 2009. The number of cases rose in some districts, such as Columbia-Montour; however, the overall Pennsylvania rate has seen precipitous decline.
Experts attribute the drop in cases to two Pennsylvania regulations. In the first, attorneys are required to obtain a certificate of merit from a medical professional establishing that the medical procedures in a case are outside of acceptable medical standards. As a result, expert testimony is now required in all medical malpractice cases. This has had the effect of weeding out many a frivolous case before it can come to trial.
The other factor is the state’s requirement that malpractice actions can only be brought in the county in which they are alleged to have taken place. Prior to this regulation, attorneys were able to shop around for counties in which they believed they were more likely to win.
Legal officials contend that the decline in lawsuits is an encouraging sign, but not all of it is attributable to tort reform, they say. At least some of the decline is attributable to extra steps hospitals are taking to increase patient safety and improve service quality.
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Patient Records Legal Primer
Source:
Physicians Practice
Date:
05/05/2010
Managing patient records is complicated, but if you set a policy for retention and distribution of records, you can take much of the hassle out of the process. Physicians Practice has some tips on what you need to know regarding the storage, transfer, and destruction of patient records.
With regard to retention, there are more than 10,000 federal, state, and local regulations affecting records. State health officials tend to dictate defined periods for record retention as well as proper storage and means of destruction. You may, for example, be required to notify patients prior to your destruction of their records. A good rule of thumb is to retain records for seven to ten years after the last date of service. Familiarize yourself with your state’s statute of limitations on medical malpractice lawsuits, as you’ll want to retain records for patients whose service terms fall within the statute.
When it comes to record requests, tread carefully. You are required to provide medical charts to third-party payers upon request, but only from patients who are members of their plans. Improper provision of records constitutes a violation of federal regulations, which can mean serious consequences for your practice. Malpractice attorneys requesting documents must have a signed consent form from the patient in question. If they don’t provide one, you don’t provide records.
Regarding charging patients for access to updated copies of their records, you’re within your rights to charge a reasonable cost-based fee for copying. Most states allow charges of anywhere from 25 cents to one dollar per page, but you’ll want to check with your state medical society to make sure.
Proper care of records is a constantly shifting and complicated business. In the best interests of your practice, though, you must stay on top of the latest developments to ensure that you are up to date and in compliance.
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What’s Keeping Us So Busy in Primary Care? A Snapshot from One Practice
Source:
New England Journal of Medicine
Date:
04/29/2010
What would happen if you logged electronically all the things your practice spends time on during the day that don’t directly have to do with patient care? One Philadelphia primary care practice did just that, and their findings might surprise you.
Greenhouse Internists looked at their 2008 electronic health record, counting units of primary care work over the course of the year. Of the practice’s 8,440 patients, 7.2 percent were on Medicaid, 21.5 percent were on Medicare, 64.7 percent were privately insured, and 6.5 percent were on pay-for-performance plans. The practice scheduled about 119 visits per week, amounting to about the work of four full-time physicians. With no nurses or midlevel practitioners, the practice had a staffing ratio of 3.5 support staff per physician.
This look at their own operations found that much physician time was taken up not by visits, but by the administrative duties surrounding visits. Filling out forms, making telephone calls, sending emails, refilling prescriptions, reviewing laboratory reports, reviewing imaging reports, reviewing consultation reports: these all contributed to a sort of information overload on physicians, cutting down on the amount of time they spent in actual visitation. What’s more, physicians are often not reimbursed for these tasks. Following their review of operations, the practice hired a registered nurse to do “information triage” on many of the above tasks, as well as additional front-desk staff and medical assistants.
The practice’s findings illustrate the fact that primary care–a field continually in a state of flux–will in the future need to take a look at how physicians are compensated and for what. The actual work physicians do in the field is often uncompensated, but this study shows the need for sizable change in both practice design and the structure of compensation.
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Where Have the Internists Gone?
Source:
HealthLeaders Media
Date:
05/13/2010
Is there something wrong with the internist specialty? What could possibly be the driving factor behind one in six internists leaving the profession since being certified in the 1990s? An article in HealthLeaders Media takes a look.
Since the 90s, about 17 percent of general internists have left their practice mid-career, according to a study conducted by the American College of Physicians and the American Board of Internal Medicine. The study looked at internists certified between 1990 and 1995 who are no longer working in internal medicine. The study found six percent working in another medical field, with smaller percentages having left medicine or retiring. The study also found that internists are mostly satisfied with their career, but at a much lower level than their peers in other specialties.
Why are internists leaving the field? One in five indicated the long hours and limited income. But mostly, physicians are leaving the field due to a change in interest or the presentation of a better option. Researchers were surprised to find physicians going into emergency medicine treatment. They conclude that many internists are using the specialty as a stepping stone to pursue a career in a specialty with higher pay and better hours. All is not lost, though, as researchers have found that 40 percent of those leaving the profession are, in fact, open to returning at some point.
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Should All Healthcare Providers Have Geriatrics Training?
Source:
HealthLeaders Media
Date:
05/13/2010
The Partnership for Health in Aging has released a set of core competencies for health care providers that dictates 23 core competencies that it says all health care providers should have for dealing with elderly patients. HealthLeaders Media has the details on the Partnership’s plan.
The Partnership consists of more than 20 organizations representing eldercare professionals. The report emerges as a response to the Institute of Medicine’s 2008 report Retooling for an Aging America: Building the Healthcare Workforce. That report called for the training of health care professionals to deal with an increasingly older patient population. Authors of the report clam their goal is to enhance the capacity of the entire workforce with regard to geriatric care.
The report stresses six core competencies: health promotion and safety; evaluation and assessment; care planning and cross-spectrum coordination; interdisciplinary and team care; caregiver support; and health care systems and benefits.
The competencies have been left broad intentionally, so as to allow disciplines to determine individually how to incorporate them into training. The report authors, though, believe the competencies apply to, and can be implemented by, all entry-level professionals.
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Collaboration Needed to Boost Telemedicine Adoption, Report Finds
Source:
iHealthBeat
Date:
04/29/2010
The pace of telemedicine adoption is largely dependent upon the collaborative efforts of health providers, technology vendors, and insurance companies—this according to a soon-to-be-released IDC report on the matter.
The report–“Describing the Telemedicine Landscape in the United States”–is based on IDC interviews with 1,202 consumers and IDC’s own research on trends in telemedicine. The report found slow rates of adoption among the medical community, but identified promising areas as users figure out the technology.
The report found 4.6 percent of respondents reporting they had used telemedicine in receiving medical care. The rate of telemedicine use was highest among the young and the technologically savvy. Those with smartphones were three times more likely to schedule medical appointments on the devices. Nearly five percent of respondents had used videoconferencing for medical care.
The study’s authors report that reimbursement rates drive the adoption of these services. Currently, twelve states have laws mandating that payers reimburse for telemedicine services. The study authors say greater collaboration among players in the market, as well as continued state pressure on reimbursement players, is the best way of ensuring the continued technological improvement of medical services in this country.
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A Focus on Imaging: ‘The Right Scan at the Right Time’
Source:
H&HN Magazine
Date:
05/05/2010
The push is on to reduce the level number of medical imaging scans. Payer organizations are implementing new policies to curb use of radiation imaging to levels they deem acceptable. While they are encountering some resistance from physicians and hospitals, they are also coming across unexpected support.
The use of CT scans has more than tripled in the past 17 years: up to 70 million performed annually according to the Archives of Internal Medicine. Taking into account the cost of these scans as well as their potential to exacerbate the risk of cancer development–one Archives study estimates 29,000 additional future cancer cases due to 2007’s CT radiation exposure–payers are turning to automated systems that evaluate the appropriateness of radiological scans for a given situation.
Under one system, physicians enter the case data and test type into a computerized system. The system then rates the appropriateness of the scan on a nine-point scale. If the system deems it unnecessary, the payer will not reimburse for the scan. Under other systems, physicians call a toll-free number for essentially the same service.
Payers are also turning to radiology benefits managers, who walk patients through appropriateness criteria for scans and direct them to service providers. Critics charge that these representatives tend to refer patients to low-cost providers, but RBMs have proven successful at trimming overall imaging growth. One payer implementing imaging controls saw the growth rate in imaging decline from 12 percent for both CT and MRI to one and seven percent, respectively, after implementing the imaging reduction system.
Critics contend that the systems constitute an encroachment on physician and patient rights. Physicians claim that patients demand these sorts of procedures. All the same, the utilization reduction policies appear to be here to stay. Many radiologists are now moving to ensure that the scans they and other physicians are ordering are the right ones at the right time in order to reduce the need for payers to get involved in the first place.
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Patient-Centered Medical Homes: Do Subspecialist Physician Practices Measure Up?
Source:
AAFP News Now
Date:
04/28/2010
The medical home model: it’s not just for primary care practices. A number of subspecialties have the potential to operate as patient-centered medical homes, thus qualifying them for additional compensation under the recently passed health care reform legislation; but how many are taking advantage of this possibility, and which specialties are most likely to benefit from these provisions?
A new report published in the New England Journal of Medicine looked at 373 single-specialty practice areas–cardiology, endocrinology, and pulmonology–to determine the prevalence of medical home services among them. The study described in the report found that 81 percent of practices served as primary care physicians for 10 percent or fewer of their patients, and only 2.7 percent served as such for more than 50 percent of their patients. Practices of two physicians or fewer were far more likely to consider themselves medical homes than their larger counterparts.
Practices serving as medical homes stand to gain financial support from the government in the coming years, thanks to the health care reform bill. Some contend, though, that the bill lacks specifics and that serious questions–What is the standard of care? Are certain specialists more capable of medical home services?–must be answered before moving forward with the medical home model.
As it stands, though, the survey results indicate that primary care physicians have little to fear right now from specialist physicians providing medical home services.
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Payer & Reimbursement Issues
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Insurance Firm Has Incentive for Primary Care Doctors
Source:
Philadelphia Inquirer
Date:
04/30/2010
The move toward pay-for-performance reimbursement schemes continues to gain steam. This time, the largest health insurer in the Philadelphia region has announced it is introducing financial incentives for primary care physicians whose patients’ health improves.
Independence Blue Cross, which works with 1,800 general practitioners, internists, and pediatricians in the five-county region, has announced it will spend an extra $47 million per year increasing base pay and incentive programs for primary care physicians. Put in context, a physician with 850 Independence patients could see $150,000 more per year if the health of all of those patients improved. While other companies have experimented with similar moves, Independence’s initiative represents the largest of its kind in the region.
Representatives from Independence claim the move constitutes an opportunity for primary care physicians to shore up their own finances while at the same time improving patient outcomes. The plan also puts a greater emphasis on the patient-centered medical home, a model shown to have greater success in improving outcomes.
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Thousands of Physicians Eligible for Payment from UnitedHealth Group
Source:
AAFP News Now
Date:
04/28/2010
Have you dealt with UnitedHealth Group as an out-of-network provider? If so, you might be entitled to a portion of a $350 million payout from the massive insurance provider.
UnitedHealth Group recently settled a class action lawsuit in which the plaintiffs claimed the insurer profited at the expense of patients and physicians. UnitedHealth was accused of using a subsidiary company’s flawed database to determine out-of-network payment rates. It was claimed that the payment rates were skewed in UnitedHealth’s overwhelming favor.
The company did not claim responsibility in the case, opting instead to pay $350 million to patients and physicians affected by the skewed payment rate data. In the coming weeks, affected physicians and patients will begin receiving letters from UnitedHealth informing them of how to claim their portion of the settlement funds.
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Credentialing, Licensure, Quality Management
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Doctors Make Game Out of Learning Infection Control
Source:
American Medical News
Date:
04/26/2010
“Gotta catch ‘em all” might not be the first thing that comes to mind when you think of infectious diseases... Well, unless the aim is preventing them. In that case, a new learning tool devised by two self-professed mega geeks might significantly contribute to the next generation of physicians familiarizing themselves with the microbes they are likely to face in practice.
The game is “The Healing Blade,” and it is a role-playing card game not unlike Pokemon, Yu-Gi-Oh, or Magic: The Gathering. The game’s designers are two physicians who met in medical school.
The game is built around a world of sorcerers, villains, and heroines in which The Apothecary Healers–with real-world antibiotic names–battle The Lords of Pestilence–named after actual bacterial agents. In the process of playing the game, players familiarize themselves with the sort of infections they are likely to encounter as physicians as well as the medications they will be using to battle those infections. The game retails for $25, and, at a recent trade show, sold briskly to medical students who didn’t even wait to get home to start playing it.
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Credentialing Process Can Be Made Simple
Source:
Modern Medicine
Date:
05/01/2010
The credentialing process is something of a necessary headache. You can’t do anything about the necessary part, but you can spare yourself a bit of the headache. What’s important is making sure that you go through the process correctly.
To streamline your credentialing process, make sure you use your legal business name. Also, read forms entirely to make sure you don’t miss anything. Omitted information leads to rejected applications.
Be sure to complete all forms for Medicare: CMS855, CMS460, and EFT588. Failure to do so will result in a rejected application. It also helps to send in applications with a signed certified receipt, so as to verify the application reached its destination. Additionally, you’ll want to stay on top of the approval process. If your application is rejected, you’ll only have 30 days to correct the problem before you have to start over entirely.
Credentialing is important, as insurance companies won’t pay your practice without it. But follow the rules and keep a close eye on the process and it should go smoothly for your practice, ensuring that you are paid with no hassle.
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Risk Factors at Medical School for Subsequent Professional Misconduct: Multicentre Retrospective Case-Control Study
Source:
BMJ
Date:
04/27/2010
Are there identifiable factors that predispose physicians toward professional misconduct? A new study published in BMJ indicates that may just be the case.
The study examined the professional records of 59 doctors who had graduated from one of eight United Kingdom medical schools from 1958 to 1997 and had a record of serious professional misconduct between 1999 and 2004. Additionally, the control group for the study consisted of 236 doctors sampled from matching graduation cohorts.
The study found that male doctors from lower socioeconomic groups who had had academic difficulties early in their medical education were more likely to be brought under review for serious professional misconduct. Each factor–male gender, socioeconomic origin, academic performance–was independently associated with the likelihood of misconduct as well.
The study authors caution that the results are preliminary and that observers should interpret them cautiously. Most physicians with the aforementioned risk factors, they warn, will not likely be brought up under professional misconduct. The results do, however, signal potential markers for possible counseling or intervention in medical education to head off problems far before they occur.
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Regional Variations in Diagnostic Practices
Source:
New England Journal of Medicine
Date:
05/12/2010
Substantial differences in diagnostic practices exist between regions of the United States. Policymakers looking to control health care costs must take these differences into account and understand their causes before any solid policies can be implemented—this according to a study published in the New England Journal of Medicine.
The study is based on Medicare data from 1999 to 2006, in which physician and hospital services are grouped in quintiles according to geographic regions. Researchers compared diagnoses, laboratory testing, imaging, and other trends. They found that, as beneficiaries age, there were higher than average numbers of diagnoses for those moving to some regions than for those moving to other regions.
The study authors note that Medicare costs cannot be brought under control without getting better information on the specific reasons that different diagnostic standards apply in the different regions. They also note that the use of clinical or claims-based diagnoses in risk adjustment introduces biases in comparative effectiveness studies, public reporting, and payment reforms.
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2010 HIMSS Analytics Report: Security of Patient Data
Source:
HIMSS Analytics
Date:
05/05/2010
Has your health care organization had a health data security breach in the last year? If it has, you’re not alone.
A new report from HIMSS Analytics describes a growing level of awareness regarding the state of patient data security, but claims that most workplace security protocols amount to a “checklist mentality” regarding security rather than implementing comprehensive changes to workplace processes.
Chief among the study’s findings was the fact that 19 percent of respondents indicated that their organizations had experienced at least one notification-worthy data breach in the past twelve months. This is an increase of nearly 50 percent over the previous study’s findings. Forty-three percent of respondents reporting a breach indicated their organizations had experienced one breach in the past year, while 28 percent reported two breaches. Fifteen percent reported three to nine breaches, and another 15 percent reported more than ten breaches.
The survey, commissioned by Kroll Fraud Solutions, polled 250 health care organization employees familiar with the privacy and security policies of their organizations.
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Electronic Health Records and Clinical Trials: An Incentive to Integrate
Source:
Physicians News
Date:
05/14/2010
You’ve heard, of course, how the government will financially incentivize your practice’s purchase of an electronic medical record system. But is there an even better reason to get an EHR up and running?
Maybe you haven’t considered the possible impact of an EHR on your organization’s participation in clinical trials. You should strongly consider this factor, though, as clinical trials are the primary means through which new drugs and treatments are introduced to the market. Streamlining the drug trial process through wider participation coupled with efficient EHR utilization could drastically reduce the cost of new treatments and drugs.
In addition to having a positive impact on health care costs, clinical trials represent a potential financial boon for a practice. Implementing an EHR has the potential to dramatically increase a practice’s return on investment for trial participation. EHRs allow practices to quickly determine patient eligibility, improve accuracy in patient screening, and instantly access patient information--all of which streamline the trial process.
The future of medicine is in new treatments and pharmaceuticals, and the future of treatments and pharmaceuticals is tightly bound to EHRs and technology. Making certain your practice is technologically equipped is a great way to ensure that your practice benefits from future medical developments.
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Physician Practice Management
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Guerrilla Marketing Your Practice
Source:
Physicians Practice
Date:
05/05/2010
You already know that the competition is tough out there. More and more, traditional means of publicizing your practice are losing effectiveness. Successful marketing nowadays means unconventional thinking. It means modern, cheap, and effective. Guerrilla marketing is the term, and Physicians Practice has the inside story on how to make it work for your practice.
The first step is to commit to a new plan. Develop a strategy and stick to it. If your practice doesn’t have a web presence, you’re already behind. Look at free web design software or hire a professional. Be sure to have an easily searched URL (site title) so as to easily drive traffic your way.
Next, you’ll want to increase your participation in community health fairs. Get out into the public to let people know about your practice, where you are, and what you can do for them. Host events for patients to connect with you. Identify your target market and go out to meet them. Additionally, make yourself available to the media. Be accessible for commenting on health stories.
Also, recognize the potential of your staff and patients as marketing extenders. Deliver quality service, and your patients will spread the word of mouth, which will bring in more patients. You can also simply ask your patients to spread the word about your practice, if necessary. This is just the beginning, but these tactics could definitely breathe new life into your practice with just a little effort.
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My Most Frustrating Patient
Source:
Physicians Practice
Date:
05/05/2010
Sometimes in practice, you’re bound to run into a patient that forces an ethical issue to the fore. How to respond, in such a case, then? One doctor’s story from Physicians Practice shows that even when you do the right thing, you can still suffer the consequences.
The patient in question was a woman in her early 70s being treated for skin cancers. Following the removal of multiple cancers and several reconstructive procedures, the patient requested a facelift. What’s more, the patient requested that the facelift be billed to Medicare, a patently illegal act. The physician refused, and the patient quickly progressed from requesting the facelift to demanding it to threatening revenge upon the physician if he didn’t comply.
The physician stood his ground, only to find some time later that the patient had reported him to Medicare... for unnecessary surgery.
Medicare required that the physician reimburse them for the improper payment and directed him to an appeals process. Following through on his obligations, the physician entered a months-long process after which he regained most, but not all, of his compensation. It just goes to show that good deeds sometimes get punished; but the physician can still hold his head high, because–even if nobody else knows–he did the right thing.
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Handling Drug Recalls
Source:
Physicians Practice
Date:
05/05/2010
If it seems to you like every other month there’s a recall of some drug or device, you’re not too far off. Over the past five years, 4,000 recalls and safety-based withdrawals have gone out from the Food and Drug Administration, covering drugs, devices, and tools of all kinds. These events aren’t necessarily the easiest things for practices to deal with; so how can you make sure your practice is handling recalls most effectively? Physicians Practice has the details.
Drug recalls spark a wave of patient inquiries, calls, re-schedulings, and assorted other trials for practices. The first thing to keep in mind is that you will likely have guidance from the recalling company or public health official. Recalls don’t always mean patients must stop using a product; they may simply have to come in to have a device checked or adjusted. It is the practice administrator’s role to make sure someone is in charge of pulling charts to notify all affected patients immediately. This is easier with an EMR, but it is still in no way simple. It’s best to be thorough: after your own search, ask your transcriptionist to search for written references to the medication or device, and cross-check to make sure you caught everyone.
Also make sure to remove all samples of the product from your supply closet. Even before a recall, it is probably best to develop a system for handling drug samples. Keep your supply closet under lock and key. Make a note of any patient given a sample.
These sorts of actions will ensure that your practice isn’t blindsided by a recall order. Recalls can be a headache for your practice, but they don’t have to be. Taking the initiative and improving processes now will save you a lot of trouble in the future.
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Preparing for RAC Audits
Source:
Physicians Practice
Date:
05/05/2010
Considering the importance of fraud and improper payment reduction in the recently passed health care bill, it would be prudent for your practice to take a solid look at your procedures and policies. If you don’t know what RAC stands for, now is a good time to learn. Fortunately, Physicians Practice has helpful tips on dealing with RACs.
RAC stands for “Recovery Audit Contractor,” which is the means by which Medicare recovers funds improperly dispersed to an organization. These funding errors could be due to previously paid but uncovered services, faulty coding, or duplication of services. Under the Medicare Integrity Program, RACs now operate in all 50 states.
In dealing with RACs, you’ll first want to take a look at your billing procedures. Your last 30 days of billing are open for review, and audits can date back to October 1, 2007. Next, you’ll want to create a standard process for responding to RAC inquiries. Specific staff members should be assigned to fulfill audit requests, and a leader should be appointed for the process. Keep an audit log to track requests for documents, and keep accurate records for RAC-based denials.
Above all, keep in mind that the RAC isn’t out to get you. The occasional error won’t typically land you in an audit, but if your practice repeatedly misbills, you raise the risk of an audit. Keep your practice prepared for such an eventuality, though, and you’re likely to make it through just fine.
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Solving Your 9 Biggest Billing Blunders
Source:
Physicians Practice
Date:
05/05/2010
Coding. Does the word itself give you a headache? The coding process is sometimes dense and needlessly complicated, but there is hope. Physicians Practice has the rundown on the most common coding mistakes and how you can avoid them.
The first tip is to remember to note negatives. Noting negative findings verifies that you performed certain procedures. Be sure that if you performed a test to rule out possibilities, you note it and code for it.
Detailing patient history can also mean the difference between a higher code and a lower one. When you discuss options or next steps with a patient, remember to code for such consultation, and avoid the use of the phrase “noncontributory.” When you mention family history in the medical record, you’re noting that you’ve considered it. Don’t undercut your coding process with your notation.
You’ll also want to avoid selecting middle-of-the-road codes by default, as you can miss out on earned compensation. Learn the difference between lower level codes and their higher level counterparts. If you performed the duties for the higher level code, note it and code for it.
Keep abreast of new developments in Current Procedural Terminology, as slight changes within codes can mean thousands of dollars for your practice. In detailing your codes, make sure not to confuse your coders. If they’re not familiar with your specialty, be sure to take that into account when noting procedures. Avoid overly complex terminology, and use phrases that your coders will know and understand completely.
Lastly, be sure to audit your practice. At least once a year, review five notes for each of your government payers or ten notes selected at random. Audit each physician at every practice site. Compare documentation with coding and note discrepancies. That fifteen dollar difference in codes could turn to fifteen thousand dollars in the long run, and that’s sure to engender proper coding within your practice.
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