http://industryreport.jacksoncoker.com/Daily feedsen-US© Copyright 2008 JacksonHealthcarewebhelpdesk@jacksonhealthcare.comTest RSS Gen.http://industryreport.jacksoncoker.com/newsletter/images/hdr-survey.gifhttp://industryreport.jacksoncoker.com/2666Volume 56J&C Launches Latest Physician Salary Calculator The industry tool for quantifying physician ROI The Jackson & Coker Provider “Contribution to Operations” Percentage Calculator has become the industry's tool for qualifying physician return-on-investment. It allows users to take the potential revenue a particular physician specialist can generate, then compare it against the average physician salary for that specialty. Our tool is available in online and slide-rule versions. The slide-rule version presents the nationwide number of physicians per specialty. It also reports the percentages of those physicians who are board certified, international medical graduates, physicians nearing retirement and current residents.Fri, 01 Mar 2013 00:00:00 -05002667Volume 56Risks, Returns & Acquisitions Advice & Resources for Physician Practices With access to the world in your pocket, what risks exist for physicians using social media and digital domains to engagewith patients and the public? And how can you stay connected, while protecting yourself from exposure? What is the going rate for physicians in your specialty? And how much does it cost a hospital not to have you treating their patients? New research reports that hospitals plan to increase physician practice acquisitions this year. Which specialties are they targeting? This month’s edition of the Jackson & Coker Industry Report offers answers to those questions and more. Plus, learn why Arlene Macellaro was named Staff Recruiter of the Year by physicians and executives in her hospital. Hope you find valuable information to you and your practice! -Edward McEachern Fri, 01 Mar 2013 00:00:00 -05002668Volume 56 The Recruitment Insider Thomas McKeever Interviews Arlene Macellaro of Augusta Health --Designated as “2012 Staff Physician Recruiter of the Year” Recently Thomas McKeever, Jackson & Coker’s Vice President of National Sales, interviewed Arlene Macellaro, Director of Physician Recruitment at Augusta Health in Fisherville, Va., for our Industry Report’s new column, “The Recruitment Insider.” Recently Ms. Macellaro was selected “2012 Staff Physician Recruiter of the Year” by a team of physician recruitment directors and other health care executives. TM: Arlene, when did you first realize that you wanted to pursue a career in health care? AM: It was really when I was consulting for a recruitment firm while I was in the IT industry. I found it fascinating because it was something I was so unfamiliar with. I didn't have any doctors or nurses in the family and did not have any desire to be clinical in any way. It was the intrigue of that relationship between physicians and hospitals that spurred my interest. TM: It is always interesting to hear how individuals' health care careers are driven in certain directions. AM: I am confident that had I not been in IT, and not been installing the computer system, accounting system and data base system for John Downing, I would never have migrated towards health care. TM: With your very positive professional influence within health care, do you encourage family and friends to pursue a career in health care either clinically or from an administrative standpoint? AM: Absolutely. I never realized the incredible impact that both clinicians and non-clinicians make within health care. My impression prior to getting involved in the health care industry was that your impact on patients occurs if you are a doctor, or a nurse, or some type of a direct patient care provider. It was perhaps a couple of years into my first experiences within the walls of a health care organization before I truly was able to realize the incredible impact. When you are budgeting, everybody says that patient care comes first and as you look at everyone, as you look at the greeter at the front door or you look at the housekeeper -- that person directly impacts patient care. I find pretty much any role within a health care entity to be a noble profession. Even externally for independent recruiters, for folks who provide services, who provide consulting – everything is going toward the patient. I have some young interns who work with me. I have mentored physician recruiters. I have had a lot of roles within health organizations, VP, regional directors, and so I have had a lot of scope. As I'm working with new folks, especially with the interns, people that have just gotten out of school, my goal is to really stress upon them that this industry is so unlike any other. For example, I was working for Bon Secours in Port Jervis, New York, 14 years ago. I was in a hurry to get to a meeting, pounding on the elevator button, and the elevator door finally opened. I rushed in and there was a gentleman in the back of the elevator, and it became apparent that he was weeping. I stopped to attempt to assist him, when he related that his mother and father had been in an accident. Both were in the ICU and neither was expected to survive. It offered perspective on how I viewed my rough and hectic day. So it brings to the forefront that in this industry there is no one here today in this building as a patient who wants to be here, even the mom having a baby. She just wants the baby; she doesn't want to go through labor. When you are here, everybody that you are touching really doesn't want to be here. They are anxious or frightened; so your actions -- how you deal with people -- have a different meaning. In health care, once you are really in it and once you can really start to break it apart and can see the impact for yourself, the impact we all make, it's about more than just being a clinical provider. I think it is very important that it is more than a job. TM: With all the positives that you have spoken of regarding the different individuals that impact patient care – both internally within a hospital or health care system and the external organizations as well -- what have you encountered to be the biggest challenge facing your role within the last five years? AM: Well, I would say both for myself and I think for a lot of my peers that I converse with, the changing health care landscape is the biggest challenge. We can find ourselves to be rather schizophrenic, wondering on a daily basis as to whether we are adding physicians, not adding physicians, whether it is going to be an employed model, whether we are supporting the community, whether we are doing everything strictly for community need or whether there is a competitive advantage. Also, the competitive landscape changes so frequently with health system mergers. If you are going out on your path to recruit an employed pulmonologist, or an employed family practitioner, and you can't quite get your feet under you as to where they are going to go, or when they are going to go, how they are going to go, you are losing so much valuable time. There is competition, which is a major factor, but it has not impaired my ability to be successful. You just work harder, you travel further, and you use more sources. You get more creative, you know. So competition is inconvenient, but it's not a deal breaker. TM: Excellent points being made. With all the different factors that go into your successful career, how do you feel that your professional time is spent most effectively? AM: The easy answer is in the identification of candidates because you cannot be successful in this field without having the candidates, but it is so much more complex than that. You can consider candidates all day long, but if they do not have a feeling of belonging when they arrive, you're never going to get the contract. You have to be an ambassador of sorts in getting all of the players into the right place when the candidate is here. The educational component is important with the physician group practice, with the physicians themselves; so they understand that it's important for them to take time away from their patients to visit with the candidate and make them feel welcome. It’s the same for the administrators; it's just not enough to have a process. People ask all the time, what's your process for interviews? What is your process for debriefing? It's great, it's wonderful but it changes with every candidate. If you are able to get all of the people -- your CFO, your CEO, your executive directors, your marketing folks, your docs -- if you can get them to follow you down this path toward welcoming people, it's very important. One of my nominators was Fred Castello, our oncology Medical Director. I have told him he is the best recruiter I ever had, because Fred sincerely means it when he holds out his hand to a candidate, and says, "Doc, I'm Fred. Thank you so much for coming to visit us. We really appreciate the fact that you are here." And he means it. It's getting the entire team to feel that way and to convey that to the candidates. TM: It has to be such an incredible resource to have the backing not only of administration, but also the backing of the medical staff. I am sure that you have peers that are not in such a fortunate position. You spoke of trying to get people on board and not having to twist arms to garner support; however, I am sure there is still some of that going on as well. AM: It's been three-and-a-half years here. It's getting easier, but the first thing that I did when I arrived here was getting to know all of the players and being able to develop those relationships. If you don't have the support of your internal people, being successful would be very difficult. TM: Additionally, I would think the candidates can sense that broad administrative, clinical and community support as well. AM: Or, if you know that it is false, as if you have plastered-on smiles. That is disastrous. The providers are coming to this community for quality of life -- for a sense of belonging and community. TM: You are in a unique position to answer this question: Is there anything that you would change regarding the national landscape of our health care delivery model? AM: I think so much of our delivery of health care is laid out for us when you discuss quality indicators. The aspect that most greatly impacts patient care in my opinion is the providers themselves, the providers' attitudes and willingness. We can't always dictate or change the external environments that are driving care or regulations. What we can dictate to some degree, especially if we are talking about an employed physician, are the qualities and the drivers that that physician brings with them, such that they are in alignment with our mission and our desire to provide care in a certain way leading to patient satisfaction. Unfortunately, referencing doesn't really tell you that and often times you find that out once they are on-site, and then you can either change some of those things and guide them or you cannot. You need to recognize the business that you are in and remind yourself every day that you have a cancer center here, that you have an ICU here, that you have a psych unit here - and that within each of those departments, each one of those individuals that you are treating has a personal story. TM: That is an excellent point. The hospital serves as a true beacon for the community, especially the rural community hospital which serves as the life center for that town. To another point that you made regarding the providers’ commitment to their patients -- it reflects the annual studies that support trends linking overall bedside manner scores and litigation. Physicians that score highly in bedside manner indicators tend to find themselves in legal malpractice circumstances on a greatly reduced rate versus national averages. AM: I do have to stress that while this is a wonderful award and it's a great honor, receiving it would not be possible without the strong values of this hospital. One of the things that brought me here was the progressive nature of our CEO and her tireless dedication to health care. She came from an organization that was very, very physician driven. Dr. Fred Castello, whom I mentioned, and the warmth that I received from him exemplify that dedication. Also, interviews with our medical executives, our committee members, and past president – just watching how they interacted with one another to define what this organization stands for makes an impact. A beautiful building and campus are wonderful, and finding out about the financial stability of the organization, of course, with so many hospitals being in dire financial situations is also reassuring. So when I was being recruited, those are things that factored into my decision, as well as the community being geographically pleasing. I tried to look at things the exact same way that a physician would, because that's my role as Director of Physician Recruitment -- knowing I will be successful or not based upon those factors. I came to Virginia because of the organization, the institution, and the people; because I knew in my mind that the physicians that I'm going to bring in, that's what they are going to be looking at and my opinion hasn't changed over three-and-a-half years. You look at the dedication of your officers, your board, your executive team, your director team -- you look at that and you look at how they all interacted together and it worked. And that is how a community gets impacted. You just have to take good care of people and treat people with respect, and that makes life a whole lot better. So, yes, the hospital definitely is a big thing for the community. They love their hospital and their providers. We have patients that come on Sunday after church for lunch in our cafeteria. Why do they come for lunch at the hospital? Because it's their sense of community – it’s their hospital. TM: Certainly in the medical community for as large as the industry is, it is also very small. So when you speak with physicians who have been here for a couple of years who know someone they went to school with or had worked with previously and having that external referral source, speaks to the quality of your patient care and the sense of community that exists here, and that also has to be a wonderful advantage for you. You mentioned the mentorship that you have provided to younger recruiters. Is there one bit of advice that you would give to an individual considering a career as an in-house physician recruiter? AM: Do it because you have a heart for it, not for accolades or money. You are going to do it because you want to be a part of something that makes a difference in the community. And if you find those other things, that's cake, but you have to know why you are doing it. TM: I believe that advice is applicable to many aspects of an individual’s personal and professional life. Given your obvious career success and now hearing the history behind the choices that you have made professionally, is this a role that you would like to stay in, or do you have other professional aspirations within health care? AM: For twenty years I have been doing some form of recruitment. People have asked me that question at different levels, and I have made a choice over these years to stay in some form of physician integration, physician alignment, business growth, market growth, because I love the physician-hospital relationship. So as far as my health care aspiration goes, it is to remain in a senior role within physician integration and alignment. I am, however, all of 58 and I will be retiring, you know, and then my aspiration, honestly, is to go play golf with my husband and continue my ballroom dancing. I've worked since I was 13, and so I would say my long-term aspiration is retirement. My short-term aspirations are to continue to build service lines for Augusta Health and to keep our physicians in place. It's kind of fun when I look back on my time over the last couple of decades. I have been a practice administrator and held operational as well as strategic roles. In the early years of my health care career, when I started new practices we called the employed practices “the E word.” We didn't even want to say the word back in the early '90's and sometimes for good reason. Now it is a given. I fondly remember starting the first “E-practice” in Port Jervis, New York. It was with a Locum Tenens pediatrician who was taking ED and OB call. We were paying a great deal of money; so I had an empty medical office building and a Locum. I said, “Okay, what can we do with this?” And we turned it into a multi-specialty group over the years. I was only in my position for two months when the health system sponsors had just decided they didn't want to be in health care anymore, and we were on the block to be sold. So you are not getting any money and that's where we started. I had to convince administrators and the system that it was not only okay to do this, but the only way that we were going to survive. We had seen a great deal of physician attrition and heavy-duty market competition. At the time, and for this practice, we went to Staples. We had no money; so we went out and we bought a scheduling book and pencil sharpener (rotary, of course). We had a pencil and a Locum Tenens physician. We acquired forms, exam tables and furniture from different private office practices who agreed to give us their “hand-me-downs,” and I called it “practice on a shoe string.” Four years later, I remember driving down the road, and there in front of me was our billboard. It had nine young, attractive primary care doctors on it and they were ours. We built the practice on a shoe string, so it was so incredibly gratifying. At the end of the day, guess what, the hospital is still open. How cool is that? The hospital was able to remain open. It was probably one of the most gratifying things I have ever done. I also recall fondly that one of the people I mentored was a young office manager that I hired who ended up taking my job at Bon Secours upon my departure nine years later as the Director of Physician Recruitment for the local system. So, it was incredibly gratifying. TM: When you think about those communities, those facilities are also a major employer for those specific areas; so it is such a huge benefit for any community to retain their health care delivery systems. Are there any distinct trends that you have noticed in the last 12, 24, 36 months within physician recruitment? AM: Yes -- the huge competition for primary care physicians. Everywhere I go my competitors are with me. We go to the same events; so we see each other often and we are all talking primary care. I see less availability of the kinds of physicians that I'm looking to recruit. The most desirable are the physicians who are three to five years out with a nice long career in front of them. So the biggest thing is the competition and lack of availability of those that you would target. TM: That is an excellent point and aside from supply-and-demand issues and the need for more primary care providers, are there any other areas of concern that you hear from other recruiters across the country when you talk to them? AM: The salaries are certainly challenging, and I think that is definitely the nature of a competitive market that has supply-and-demand issues. You know that you are spending more of the money than they want to spend and you are just hoping that the practice will be able to sustain them. That is a big concern because no one wants to recruit someone that you are going to unwind in two or three years. Locally we have health systems that are paying more than we are and that definitely has been a driver, increasing some of our salaries. I see it more with our group practices that are unable to compete because they are having to pay sometimes six figures above what they are making themselves as shareholders to be able the grow their practice. In business, as we all know, that does not happen, but it is happening in health care. TM: You just wonder if that is a sustainable long-term model. AM: Your hospitals as well as your physicians are being heavily impacted by major cuts in reimbursement, or by RAC audits, including declining numbers for in-patients and declining numbers for surgery. It is truly a national trend, and we are being put into a business model that would probably not fly in any other industry aside from health care. TM: If you were to give physician recruitment firms and the industry in general one bit of advice, what would that be? AM: My first thought is that I view recruitment firms as our partners in certain routes. Everybody needs to make a living out there – it’s the free enterprise system -- and I respect their needs to go out and acquire business. But I will also tell you I get twenty phone calls a day from recruitment firms, and it is tough. So from an in-house recruiter to firms, I will say that being extremely respectful of our time is greatly appreciated. And I absolutely respect the work they have done, because I have come out of their world. I will also tell you that there have been times that I could not have fulfilled my need without working with the people outside, especially when we are talking locums. They have helped us to sustain our ICU, and I see the mountains that they move as well. We are on equal plains with what we do, and it has to become about building the relationship. TM: There is so much information out there available from physician recruitment firms. Is there one bit of survey documentation that you are not seeing within the marketplace that you would like to see in the future? AM: I don't think so. There are a number of organizations -- from ASPR, NAPR, ACHE and from folks like yourself -- that have been kind enough to provide surveys so that we really do have good quantifiable data, which is extremely important. Additionally, another source that has been so incredibly valuable is some of the recruitment blogs that exist. The folks that sponsor those have just been such an incredibly valuable resource to me. TM: Arlene, as we conclude your “2012 Recruiter of the Year” spotlight interview for The Recruitment Insider, what do you find most rewarding about your successful health care career? AM: It's about people; it really is -- individuals like Pat Judson, our new oncology Medical Director. Getting to know him and his wife, and knowing the impact he'll bring to this community year after year and knowing what that means, that is what it is truly all about. TM: On that note we will conclude. Thanks, Arlene, for your time and for the insights you have shared with our readers. AM: My pleasure. ---Fri, 01 Mar 2013 00:00:00 -05002669Volume 56Risk Management in the Age of Social Media And Digital Technology By Randy Mink & Calvin Bruce The principles of effective risk management for health care organizations have not changed over time. However, the tremendous growth and influence of social media and digital technology have placed a new burden on doctors and other health care providers who want to “engage” with their patients but are advised not to do anything that risks malpractice exposure. Some hospitals have a strict policy against their doctors and other medical staff using social media to interact with patients. Their rationale is perhaps justified when one considers the stiff penalty for a single HIPAA violation amounting to upwards of $50,000. [1] More commonly, hospitals of all sizes and prominence – including the Cleveland Clinic, Dartmouth-Hitchcock, Johns Hopkins, Mayo Clinic and Yale-New Haven -- recognize the benefits of their medical staff communicating with patients and the broader community via social media outlets. [2] The importance of safeguarding Protected Health Information can never be minimized, or course. Yet these institutions maintain that, with proper training, their hospital staffs can advance the organizational mission to promote quality health care delivery and community-focused health education. This article addresses some of the complexities associated with risk management as a key organizational concern at a time when tech-savvy doctors overwhelmingly embrace social media and digital technology and incorporate such into their practice of medicine. Let’s begin with discussion of what a comprehensive risk management program is intended to accomplish. The Objectives of Risk Management The term “risk management” can be defined as “the identification, assessment, and prioritization of risks… followed by coordinated and economical application of resources to minimize, monitor, and control the probability and/or impact of unfortunate events.” [3] As it pertains to hospitals and medical practices, a robust risk management program covers such matters as patient safety and confidentiality of information, insurance, enterprise safeguarding, maintenance of continuity of operations, loss prevention, professional liability and other insurance coverage, as well as minimizing the possibility of potential or actual litigation. A responsible risk management program focuses on the following critically important tasks: -Maintaining adequate insurance is a top priority. This includes property and casualty, professional liability, Errors & Omissions, enterprise risk management, and “umbrella” coverage in adequate claim amounts that protect the interests of the organization. -Educate health care providers and other hospital associates on what constitutes “at-risk” behavior. This mandate covers the discharge of professional duties as well as informal interaction with other hospital personnel, patients, their families, and members of the community. As the old saying goes, “An ounce of prevention is better than a pound of cure.” Educating personnel on how to avoid circumstances and situations that can lead to at-risk behavior (including all forms of “conversation” with patients) is at the heart of risk management. -On behalf of the hospital or medical practice, minimize malpractice and other litigation exposure. This covers everything from a patient slipping on a wet floor, to an elderly physician performing an imprecise procedure in the OR, to a clinician divulging confidential patient information to colleagues. The risk manager is obligated to put into place educational initiatives and operational standards that reduce all forms of malpractice exposure. -Protect the hospital’s interests when it faces a lawsuit. An effective risk management plan cannot altogether preclude the possibility of a hospital or medical group being sued. According to a New England Journal of Medicine study, it’s been estimated that 75 percent of Pediatricians, Family Practitioners and Psychiatrists will be sued at some time in their career. That’s why even the thought of facing a lawsuit is so emotionally burdensome to most physicians. [4] Clearly, there are certain steps that a risk manager can take to educate the hospital staff and minimize liability exposure – but only to a certain degree. With reference to social media and the use of digital technology, a certain level of risk management control is more tenuous than ever before. The Influence of Social Media Over the past 3-4 years, social media has made an indelible impression on the medical community. An article entitled “Hospitals Make Time for Social Media” discusses the factors that prompt hospitals to embrace social media as a means to connect more effectively with patients: “Despite the perceived risks involved with participating in social media, hospitals recognize that an increasing number of patients look to the Internet for health information long before they pick up the phone to make an appointment with a physician or visit a hospital’s ER. By using social media to provide accessible and accurate information online, hospitals can establish themselves as experts and ultimately attract more patients and even enhance their recruitment efforts.” [5] Perhaps the best indication of this widespread influence of social media networking is seen in the number of hospitals that manage SM sites and the breadth of involvement in social networking. In September 2012, social media “guru” Ed Bennett last updated his popular list of U.S. hospitals that have developed SM platforms. On a state-by-state basis, the list identifies by name the hospitals and health systems that maintain YouTube, Twitter, Facebook, LinkedIn, and Four Square platforms. At last count, 1501 hospitals managed a combined 6194 blogs and SM accounts. [6] Bennett’s site also provides a directory of over 1200 “Twitter doctors.” It lists the physicians’ screen names, full names, geographical location, number of tweets to date, as well as the number of “followers and following.” Social media blogs are another popular means for physicians and hospital executives to connect directly with colleagues and indirectly with patients. Lists such as “the Top 100 Physician Bloggers” and “the Top Academic Medicine Bloggers” are commonplace nowadays. Mainstreaming Social Media Established in 2010, the Mayo Clinic Center for Social Media perceives that its mission to “improve health globally” is advanced by the effective use of social media tools both within the Clinic and through deeper involvement in social media by other hospitals, healthcare professionals and patients. In fact, “Mayo Clinic believes individuals have the right and responsibility to advocate for their own health, and that it is our responsibility to help them use social media tools to get the best information, connect with providers and with each other, and inspire healthy choices.” [7] What is significant is that a prominent hospital places the relevance of social media networking in the broader context of educating and enabling patients to take ownership for maintaining a healthy lifestyle and making wise choices that promote their health. One other benefit of social media to hospital operations deserves mention. Emergency preparedness is an ongoing concern. While role playing hypothetical emergency scenarios is beneficial, having in place social media tools for actual rapid-response communication is vitally important. Suppose, for instance, a fire breaks out in the OR that interrupts surgeries in process. Aside from being a potentially public relations crisis, the emergency situation demands quick response and minute-by-minute communication of what the hospital staff, patients, their families and the public need to know. Precise, accurate messaging is called for, and social media fits this role precisely. [8] The Influence of Digital Technology The tremendous impact of digital devices on the practice of medicine is discussed in a HealthLeaders Media article entitled “Healthcare Workers Wonder: How Did We Ever Live without Our i-Devices?” [9] From computer notebooks to iPads and iPhones – as well as BlackBerry, Android, Nokia and Palm devices – many doctors and other healthcare providers find the use of mobile devices indispensable in their medical practice. It’s been said, in fact, that the smartphone is the doctor’s new black bag, especially considering the myriad apps that are available. “There’s an app for everything” is not just a marketing slogan. Over 15,000 medical apps are available to doctors and other healthcare providers in such categories as: -Medical symptoms -Medical encyclopedias -Pill ID and other drug information -Medication adherence -Monitoring bedside vital signs -Disease management tracking -Diagnostic / lab tests -Medical risk factors -Interactive images -Alternative medicine -Women’s health. Mobihealthnews has published “An Analysis of Consumer Health Apps for Apple’s iPhone 2012.” The report mentions some of the more popular apps that are available for clinicians, patients and consumers who use iPhone, BlackBerry, Android, Nokia and Palm devices [10]. Additionally, the iPad links to medical education tools, podcasts, electronic health records, office scheduling, insurance verification, e-prescribing and streaming video. This product makes the interface of digital devices and mHealth apps a “virtual medical office.” Interestingly, a 2012 survey of over 3,000 doctors by the market research firm Manhattan Research disclosed that “physicians’ devices and digital media adoption are evolving much faster than anticipated, especially when it comes to tablets.” [11] One particularly interesting survey finding is that doctors who are immersed in digital technology often rely on more screens for more information access. Specifically, physicians who regularly use three screens (desktops / laptops, tablets and smartphones) tend to go online more frequently during the workday and actually spend more time with their digital devices than doctors who typically use one or two devices. That can be a drawback, though. Challenges Associated with Digital Devices Some of the challenges that face doctors who use mobile devices extensively concern reliability, privacy, security, and payment for time spent online in the treatment of patients. Another not-so-obvious challenge is that use of mobile devices can be extremely time consuming. With the 24/7 communication capability afforded by digital technology, tech-savvy doctors really never leaves their medical office. The possible result is that devotion to medical practice can lead to a serious work / life imbalance. [12]. The growing, widespread usage of medical apps is not just a reflection of tech-savvy healthcare providers who want to be on the cutting edge of digital technology. The government of Great Britain has announced: “Doctors will be encouraged to prescribe smartphone apps to help patients manage conditions ranging from diabetes to depression.” [13] The intent is to make apps free or very affordable for patient use in order to empower patients and reduce office visits. Perhaps it can be said without hyperbole that the revolutionary development and impact of digital technology has changed the face of medicine around the globe. One of the most promising aspects of this development concerns e-prescribing. According to an article entitled “mHealth Apps Prescribing Will Change Health Care,” there’s evidence that “the mHealth industry is envisioning these apps to become integral parts of healthcare practice, being touted to improve efficiency, decrease medical errors, and improve patient outcomes.” [14] Admittedly, that’s a pretty tall order. Should Apps be Certified? Given doctors’ increasing use of medical apps in their practice, should apps be certified? A posting on the popular physician blog KevinMD argues in favor of medical app certification. The author points out, “Right now health and medical apps are the Wild West. People want to know if the apps they download meet standards which protect them and their devices.” [15] Five chief benefits of medial app certification are discussed in that blog posting. For instance, from a marketing standpoint, certification will offer a competitive advantage. An app that is certified and meets all professional standards “jumps to the forefront of the quality line, focusing the marketing message on the more ‘sexy’ elements.” [16] The benefits and ongoing challenges facing doctors who are devoted to digital devices are addressed online at a site called “iMedical Apps.” Geared to medical students, residents and practicing physicians, the site showcases what’s available on the market according to medical specialty, links with a site that explains the implications for meaningful use, and hosts forum discussions on timely topics related to mHealth. Cautionary Advice from the Perspective of Risk Management The social media and digital technology revolution is here to stay. No longer do doctors need to be physically present to assess a patient’s condition and review with the floor nurse what the patient’s monitoring devices indicate. “Mobile technology has made it possible to bring the patient’s bedside to the physician’s smartphone or tablet.” [17] This is not a one-sided proposition, though. Portals and mobile tools enable patients to access their own health records and communicate with their providers in “real time.” Furthermore, social media outlets enable patients to disseminate in the blogosphere their reaction to the medical treatment they receive. If patients question the appropriateness of a certain medical procedure, or are dissatisfied with how they were treated during their hospital stay or office visit, nothing prohibits them from airing their gripes on Twitter or Facebook without delay or impunity. Risk managers should clearly communicate to doctors and other health care providers sound guidelines for participation in social media and for use of digital devices in their medical practice in order to minimize the incidence of at-risk behavior. AMA Guidelines Concerning Social Media Several years ago, the American Medical Association (AMA) published social media guidelines for physicians: http://www.ama-assn.org/ama/pub/news/news/social-media-policy.page. More recently, at its 2012 meeting, the AMA announced guidelines for “Professionalism in the Use of Social Media.” http://www.ama-assn.org/ama/pub/meeting/professionalism-social-media.shtml Some of the main guidelines deserve special mention: -At all times respect standards of patient privacy and confidentiality. -Separate personal and professional online content. -Maintain proper boundaries associated with the physician-patient relationship. -If colleagues post content that appears unprofessional, promptly inform them. -Recognize that any online activity or content can reflect negatively on one’s professional reputation. [18] Clearly, doctors should be a depository for sound medical knowledge, not a party to online chit-chatting with patients. The informal nature of social media networking can lead to relaxed attitudes when dealing with patients, but there are dangers inherent to “following” or “liking” patients. In a word: “Don’t.” Aside from exhibiting professionalism online, it’s also important for doctors and health care personnel to use digital devices in an appropriate fashion that supports the objectives of risk management. There’s no doubt that digital technology can increase efficiencies, but it also poses certain risks for healthcare practitioners. The Downside of Digital Devices For one thing, smartphones can be a distraction in clinical settings. “Doctors who carry mobile devices are often hit with a flurry of texts, e-mails, Facebook messages, tweets and other notifications that automatically pop up on the screen… And because the majority of smartphones and tablets are personal devices that belong to individual doctors, the problem can be hard for hospitals to control.” [19] An article published in Modern Medicine explains another drawback: smartphone usage can increase incidents of health data breaches. [20] Such breaches can occur when data residing on the devices is accessed directly, or data stored in Electronic Medical Records [EMR) systems at health care organizations is accessed through a digital device. In any case, serious violations of HIPAA and HITECH laws are at issue. Bear in mind, health data breaches can occur “accidentally.” The possible causes include: loss or theft of a digital device, third-party problems, unintentional user actions, and technical glitches. One solution is to use software that encrypts the phones; another is to formulate hospital or group practice policies regarding mobile phone use, particularly relating to security measures such as password protection and antivirus software. [21] When used properly, smartphones and other mobile devices connect doctors and patients electronically, monitor vital signs, facilitate treatment plans, regulate pharmaceutical protocols through e-prescribing, and provide encyclopedic medical knowledge for practitioners and patients alike. In fact, smartphones may even reduce medical liability exposure. “Can a Doctor’s Smartphone App Thwart Lawsuits?” is the title of an intriguing article that appeared in Health Leaders Media. [22] It mentioned how a certain doctor who was concerned about lawsuits associated with defensive medicine developed a mobile phone app to legally record conversations with patients. Recording patient-doctor conversation makes both parties more accountable. There’s no doubt as to what medical advice the physician gives to the patient – as well as the spoken commitment of the patient to follow such advice. Taking such steps can, hopefully, “derail potential litigation.” Conclusion The expansive popularity of social media and the proliferation of mobile technology offer both new opportunities and challenges to physicians and other healthcare professionals. From the standpoint of organizational risk management, though, certain guidelines and precautions should be observed. What providers do on their own time – and of a personal nature – is of less concern than how they participate in social media and employ mobile devices in their clinical setting. Everyone benefits from SM participants and smartphone users who respect official protocol, exemplify professionalism at all times, and favorably represent the healthcare organizations with which they are affiliated. Randy Mink serves as Vice President of Risk Management for Jackson Healthcare, the parent company of Jackson & Coker. Calvin Bruce is Senior Staff Writer for Jackson & Coker and Managing Editor of the Jackson & Coker Industry Report. Endnotes [1] Sherman, Michael. “Making Social Media Communication Work within HIPAA Guidelines.” Dreamgrow Social Media Marketing Resources. May 29, 2012. http://www.dreamgrow.com/making-social-media-communication-work-within-hipaa-guidelines/ [2] See Ed Bennett’s exhaustive list of hospitals involved with social media. “Hospital Social Media List.” http://ebennett.org/ [3] Definition of “Risk management” found on Wikipedia. http://en.wikipedia.org/wiki/Risk_management [4] Pho, Kevin, M.D. “Reducing the emotional impact of medical malpractice.” Posted on KevinMD blog on Jan. 17, 2012. http://www.kevinmd.com/blog/2012/02/reducing-emotional-impact-medical-malpractice.html [5] Melhuish, Robin and Calvin Bruce. “Hospitals Make Time for Social Media.” Healthcare Review. June 3, 2010. http://www.healthcarereview.com/2010/06/hospitals-make-time-for-social-media/ [6] Ed Bennett, loc. cit. [7] From “Mayo Clinic’s Social Media Philosophy.” http://socialmedia.mayoclinic.org/about-3/ [8] Morrison, Mike. “Social media key to hospital emergency preparedness.” Hospital Impact. March 28, 2012. http://www.hospitalimpact.org/index.php/2012/03/28/why_hospital_emergency_preparedness_need [9] Shaw, Glenna. “Healthcare Workers Wonder: How Did We Ever Live Without Our i-Devices?” Health Leaders Media. June 22, 2010. http://www.healthleadersmedia.com/content/TEC-252821/Healthcare-Workers-Wonder-How-Did-We-Ever-Live-Without-Our-iDevices.html## [10] See “An Analysis of Consumer Health Apps for Apple’s iPhone 2012,” Mobihealthnews. July 11, 2012. http://mobihealthnews.com/research/an-analysis-of-consumer-health-apps-for-apples-iphone-2012/ [11] See “Docs’ Use of iPads Becoming Mainstream,” Physicians News. May 11, 2012. http://www.physiciansnews.com/2012/05/11/docs-use-of-ipads-becoming-mainstream/ [12] Katz, Paula S. “Mobile devices offer advantages, challenges.” ACP Internist online. April 2012. http://www.acpinternsit.org/archives/2012/04/technology.htm. [13] Wardrop, Murray. “Doctors told to prescribe smartphone apps to patients.” The Telegraph. Feb. 22, 2012. http://www.telegraph.co.uk/health/healthnews/9097647/Doctors-told-to-prescribe-smartphone-apps-to-patients.html [14] Scher, David Lee, M.D. “mHealth Apps Prescribing Will Change Health Care.” Blog posting. June 3, 2012. http://jmarcboure.wordpress.com/2012/06/03/mheath-apps-prescribing-will-change-health-care-june-3-2012/ And Terry, Ken. “Online Program Lets Docs ‘Prescribe’ mHealth Apps.” Information Week. June 25, 2012. http://www.informationweek.com/healthcare/mobile-wireless/online-program-lets-docs-prescribe-mheal/240002542 [15] Scher, David Lee, M.D. “Why health and medical apps should be certified.” KevinMD blog site. No date provided. http://www.kevinmd.com/blog/2012/07/health-medical-apps-certified.html [16] Ibid. [17] Lewis Dolan, Pamela. “Everything in medicine is going mobile.” Amednews.com. March 26, 2012. http://www.ama-assn.org/amednews/2012/03/26/bisa0326.htm.. [18] Commins, John. “AMA Releases Social Media Guidelines to Physicians.” Health Leaders Media. Nov. 11, 2010. http://www.healthleadersmedia.com/content/TEC-258909/AMA-Releases-Social-Media-Guidelines-for-Physicians## [19] See “Smartphones blamed for increasing risk of health data breaches.” American Medical News. Dec. 19, 2011. http://www.ama-assn.org/amednews/2011/12/19/bil21219.htm [20] Dolan, P.L. “Smartphones may increase risk of health data breaches.” Modern Medicine. Feb. 1, 20112. http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=758897 [21] Ibid. [22] Cantlupe, Joe. “Can a Doctor’s Smartphone App Thwart Lawsuits?” Health Leader’s Media. June 21, 2012. http://www.healthleadersmedia.com/page-1/PHY-281549/Can-a-Doctors-Smartphone-App-Thwart-Lawsuits Fri, 01 Mar 2013 00:00:00 -05002670Volume 56Hospitals to Increase Physician Practice Acquisitions This Year Fifty-two percent of hospitals plan to acquire physician practices in 2013 compared to 44 percent that made such purchases last year—according to a new survey by Jackson & Coker's parent company, Jackson Healthcare. The nationwide survey of 118 hospital administrators found that opportunity, rather than strategy, was the overwhelming reason hospitals are acquiring physician practices. Seventy percent of acquisitions in 2012 began with physicians approaching the hospital to sell their practices. The study also found that hospitals acquired specific practices over others, with family practice, general internal medicine, OB/GYN and other primary care leading the list.Fri, 01 Mar 2013 00:00:00 -05002671Volume 56Risk Management Tip of the Month: We are hearing of DEA audits more frequently. Here are two resources for you to review so that you can be prepared should DEA agents appear at your office or clinic: Physicians' Clinical Support System-Buprehorphine document, "How to Prepare for a Visit from the DEA Regarding Buprenorphine Prescribing PCSS-B Training. " Tip provided by PRMS, Inc., Manager of The Psychiatrists’ Program. Fri, 01 Mar 2013 00:00:00 -0500