Jackson & Coker

Exclusive Survey-Expenses: Rising Costs Hit All Physicians --Industry News--

Fri, 07 Dec 2007 00:00:00 -0500

According to a survey issued by Medical Economics, the cost of running a medical practice continues to escalate due to increases in general expenditures like payroll, energy costs, office facilities, and malpractice and healthcare premiums. Other line item expenses vary depending on the type of practice. The following indicates the median annual cost for primary care practices, excluding bonuses or retirement/profit sharing contributions: Family practitioners: $235,000 General practitioners: $180,000 Internists: $200,000 Ob/gyns: $360,100 Pediatricians: $266,300 All primary care: $240,000 Ob/gyns and pediatricians, the two physician groups with the highest costs, generally use midlevel providers more frequently than their internist colleagues, thereby increasing their payroll expenses. With regard to pediatrician practices, immunizations are largely responsible for the high operating costs. Pediatricians’ median drug supply costs are $82,800 according to MGMA, compared to internists, who pay just over $8,000. Low reimbursement rates coupled with storage costs on vaccines mean that pediatric practices sometimes fail to break even on immunization costs. With regard to location, inner city physicians spend less and make less compared to their urban, suburban and rural peers. Conversely, suburban practices, with generally higher expenses, have to rely on higher patient volumes to offset more expensive facilities and higher rental rates. Suburban practices also add to their expenses by keeping longer hours to satisfy the schedules of commuting families.

Limits Weighed on Physician-Owned Hospitals --Industry News--

Sun, 09 Dec 2007 00:00:00 -0500

The recent debate surrounding Medicare pay reductions has reignited political interest in the politically contentious topic of physician-owned hospitals; namely, the question of whether physicians should be able to own the hospitals to which they send their patients. Senator Charles E. Grassley of Iowa, the top Republican on the Senate Finance Committee supports the reforms due to the allegedly negative effect that physician-owned “specialty hospitals” have on community hospitals. According to the senator, specialty hospitals “pass the buck” on emergency care and “cherry-pick based on profits rather than patient needs.” Traditional hospitals complain of lost business and conflict of interest, while the backers of physician-owned hospitals say they promote competition and improve the quality of care. Congress imposed a temporary moratorium in 2004 on establishing new physician-owned hospitals amidst lobbying pressure from both sides. The moratorium has since expired, and interest in the topic reemerged in August when the House passed a Democrat-sponsored measure that would limit physician investment in existing doctor-owned hospitals to 40 percent, and individual stakes to no more than 2 percent, while banning the creation of new physician-owned hospitals. The issue is unlikely to receive congressional action before the New Year.

Looming Medicare Pay Cut Forces Tough Decisions on Participation --Payer & Reimbursement Issues--

Mon, 31 Dec 2007 00:00:00 -0500

The narrowly avoided Medicare pay cut would have forced physicians to make a difficult decision before the New Year. In the event of a Medicare pay reduction, which may still happen in summer 2008, physicians that continue to participate in the Medicare program would endure a 10.1 percent reduction in medical fees from Medicare patients. Under the recently tabled Medicare package, physicians who opted to not participate in Medicare (non-PARs) could still see Medicare patients for a reduced fee by accepting “assignment” on a per-patient basis. Doctors who did not accept assignment would receive the Medicare rate and could balance-bill patients up to 15 percent more. Thus, non-PARS could receive up to 9.25 percent more in payment than participating doctors for the same service. However, non-PARs who did not accept assignment would not receive Medicare reimbursement directly from insurance carriers. Instead, Medicare would reimburse the patient directly and physicians would then invoice the patient for the full amount of payment, co-payment, and the balance-billing charge. Physicians with costly medical services could find themselves in dire financial situations if only a few patients failed to pay.

Real-Time Payment: What’s Holding it Back? --Payer & Reimbursement Issues--

Fri, 07 Dec 2007 00:00:00 -0500

Real-time claim adjudication (RTCA) has been in existence for several years, but few insurance plans have offered it. Recently, however, higher deductibles have increased the need for patients in high-deductible plans to know how much treatment will cost; moreover, healthcare providers want to collect payment at the time of service. To address these concerns, Humana, United Healthcare, and BlueCross BlueShield offer real-time claim adjudication in some states. Despite the growing need for RTCA, efforts to implement the practice have been thwarted by staffing problems and complex information exchange processes. Most problematic is that RTCA creates a dual data entry requirement under most current office practices. Practice management systems cannot transmit claims individually to particular insurance agencies, and RTCA is only offered on health plan websites. Therefore, practices that use RTCA have to enter claims twice: once on insurance websites and once in local databases, which effectively doubles the workload for support-staff. Even in the event that insurers could integrate systems to reduce the need for dual data entry, the time it takes for physicians to complete charge-tickets, deliver them to the billing office and have the data entered supersedes any time saved during the RTCA process. To address this matter, BlueCross BlueShield of South Carolina introduced the “superbill” feature, which permits practices to upload their top 100 procedures and diagnoses into the system, thereby reducing data entry time. Similarly, United Healthcare has introduced patient cards and card readers that can quickly transfer benefits and eligibility information. Nonetheless, RTCA still constitutes a meager percentage of the claims filed to health insurance agencies, even among payers that offer developed RTCA services.

Physicians Fight AETNA Over Caps on Out-of-Network Pay --Payer & Reimbursement Issues--

Mon, 14 Jan 2008 00:00:00 -0500

Aetna, one of the country’s leading providers in health insurance and products, angered many physicians nationwide recently by declaring that it will cap the amount of reimbursement paid to out-of-network doctors at 125% of Medicare. In some cases, such as Pennsylvania, in a mass mailing to doctors, Aetna declared that 125% was in accordance with the “maximum state mandate rate.” The Pennsylvania Medical Society, however, does not have a set rate as such. Physicians are also upset that Aetna has already informed patients that they will not pay “any bill a doctor might send to make up for costs and fees lost as a result of the insurer’s cap.” Organized medicine is complaining that this tactic is not only unfair, but is also within violation of a prior settlement agreement with physicians as part of a class-action lawsuit. This agreement declared that Aetna can not “disparage” nonparticipating physicians and also that each EOB can decide the amount for which a physician may bill a member. The AMA is in strong opposition to Aetna’s new policy, and AMA officials are fighting to regain immediate and full reimbursement to physicians for charges billed since Aetna introduced the cap.

FDA Approves Fewest Drugs Since 1983 --Industry News--

Tue, 08 Jan 2008 00:00:00 -0500

Business and financial outlet Bloomberg recently reported that the Food and Drug Administration (FDA) approved only 19 new drugs for all of last year, the lowest total since 1983. These recent numbers confirm the struggles and difficulty of drug companies to come up with new products. Of the 19 newly FDA approved drugs, 17 of them are molecular entities, meaning they are entirely different and innovative drugs. The other two approved drugs were biotech drugs. The companies with most approvals this past year were Novartis and GlaxoSmithKline, each receiving two approvals a piece. Many industry insiders blame the decreased approvals on tougher regulations and standards by the FDA. The FDA, however, defends its standards and claims that they have not altered their requirements at all. There are many hypotheses within the industry as to why there has been such a decrease in drug approval rates recently but none that are widely agreed upon or seemingly accurate. One of the more popular arguments from doctors is that the pharmacy industry has become too overpopulated and bloated as well as too bureaucratic and risk averse. It is also possible that the industry has shifted its efforts away from novel drugs and more towards modifying pre-existing medicines in order to fully maximize sales during this apparent research drought. It is also probable that the majority of the more simplistic drugs have already been found and that drug researchers will need a major scientific discovery or breakthrough before they can come up with any fresh and relevant drugs.

Be Careful What You Promise --Medical - Legal Matters--

Fri, 04 Jan 2008 00:00:00 -0500

When it comes to medical lawsuits and malpractice claims, it is very possible that the natural inclination of physicians to comfort and relieve their patients of pain and anxiety can, in reality, do the medical professional more harm than good. Doctors must be careful when they make simple assurances to their patients that they are not promising more than they can deliver, as lawsuits are derived primarily from two things: a patient with unrealistic expectations and a less-than-ideal medical outcome. There is limited opportunity for physicians to account for unexpected and undesirable results, but they are in complete control over their patients’ expectations. That is why it is so important for a doctor to keep these expectations realistic and not overly assuring. Lawsuits can be triggered by overly optimistic guarantees about outcomes or by downplaying potential risks. For a patient to claim a lack of informed consent, they only have to establish and prove that “he or she wasn't informed of the risks and alternatives that a reasonable person would have considered to be important in deciding whether to undergo the proposed treatment.” Likewise, in order for a patient to claim a breach of warranty, they only have to show that he or she “relied on the doctor's representations…in consenting to the procedure, and those representations turned out to be wrong.” This means that the patient does not have to prove any form of negligence on the doctor’s part, but simply that the outcome was not consistent with the representations and warranties with which they consented or if “the patient wasn't told about common risks and complications.” Even if a physician exceeds the standard of care, overly optimistic analysis or assurance can prove very costly in the long run. Although it is not required for physicians to go over every possible risk with a patient while proposing procedures, it is important that they thoroughly account for all of the major hazards and potentially adverse outcomes. Calming a patient’s anxieties is fine as long as the comforting is regulated enough to maintain reasonable expectations. It is more important for a patient to understand the procedures, and although things usually go as planned, there is always the possibility for adverse reactions and there are never any guarantees. This way, the patient should never be left with unreasonable expectations or a sense that any procedure is infallible.

U.S. Lags in Halting Preventable Death --Credentialing, Licensure, Quality Management--

Tue, 08 Jan 2008 00:00:00 -0500

Of the 19 industrialized countries surveyed for a recent study, the United States was the worst at stopping preventable deaths from occurring in people under the age of 75. If its preventable death rate matched or was comparable to those of top-ranked countries, the study concludes that the U.S. may have been able to spare an estimated 101,000 deaths annually. Not only did the U.S. receive the worst ranking in the survey, the study also showed that the country has the slowest rate of improvement. Using data that had been compiled by the World Health Organization, the researchers compared the preventable death rates of 19 countries between 1997-1998 and 2002-2003. The study defined preventable deaths as deaths in “people younger than 75 with treatable cancers, bacterial infections, diabetes, stroke, heart disease, and surgical complications.” The figures from 1997-1998 show that the United States was not the worst country in halting preventable deaths, but because of very little improvement in this category, the U.S. fell into the last position by 2002-2003. In that span, the United States only improved by a 4% rate of decline, compared to the 16% average rate of improvement in the other countries. Here is the full list of how the 19 countries ranked in their preventable death rates for 2003-2003: 1. France 2. Japan 3. Australia 4. Spain 5. Italy 6. Canada 7. Norway 8. The Netherlands 9. Sweden 10. Greece 11. Austria 12. Germany 13. Finland 14. New Zealand 15. Denmark 16. U.K. 17. Ireland 18. Portugal 19. United States

Healthcare Spending Reached $2.1 Trillion in 2006, CMS Says --Industry News--

Tue, 01 Jan 2008 00:00:00 -0500

Figures recently released by the Centers for Medicine and Medicaid Services put American healthcare spending at $2.1 trillion dollars for 2006. The figures indicate price and spending increases in virtually every aspect of the healthcare industry. The growth of spending indicates an accelerating pace of increase in healthcare spending which outstrips overall economic growth and the national rate of inflation. The CMS report also portrays a growth in out of pocket spending of 3.8% as well as increases in private health plan premiums (up 5.5%) and overall prescription spending (up to $216.7 billion).

Medicare Spending Rose 19% in 2006 --Industry News--

Tue, 08 Jan 2008 00:00:00 -0500

According to a recent report in Health Affairs, Medicare spending for 2006 increased at a faster rate than it had in the previous twenty-five years. In 2006, health care spending amassed $2.1 trillion, accounting for nearly 16% of the American economy, an increase of 6.7% from the year before. This rise in Medicare spending is due in large part to an increase in prescription drug benefits for the disabled and elderly. In contrast, Medicaid spending dropped 0.9% in 2006 to $176 billion. This is primarily because over 6 million senior citizens switched from Medicaid to Medicare programs in 2006. These numbers indicate that health care spending is still increasing faster than the rest of the economy and that the cost of medical services continues to grow at a faster rate than the average income of Americans. The total amount of spending on drugs rose 8.5% in 2006, a rise from the 5.8% increase in 2005. Total prescription drug spending for 2006 was nearly $217 billion. However, the authors point out that roughly 63% of all prescriptions administered in 2006 were for generic drugs, compared to only 56% in 2005. The report also illustrates that just about a third of all US health spending is consumed by hospital care alone (31%). The 31% spent on hospital care can be broken down into physician services (21%) and prescription drugs (10%).

Medicare to Require Physicians to Use New ID Numbers on March 1 --Industry News--

Mon, 14 Jan 2008 00:00:00 -0500

Beginning on March 1st, all physicians who bill Medicare electronically will also have to provide their national provider identifier (NPI), as well as any other former IDs that they may have been using. In the recent past, the Medicare program has allowed physicians to file with just their older, “legacy” identifiers while they wait to attain their new NPIs. This policy was to insure that the personal data attached to all of the numbers on the NPIs were not mismatched. After May 23rd of this year, physicians will be required to make all of their electronic claims to Medicare and other health care payers using only their NPIs. This deadline entails that all identification discrepancies have to be handled and corrected by then. All physicians that file claims electronically must comply with these issued deadlines, however, these deadlines do not apply to any physician who files paper claims. Many physicians are against the transition to the new identification policies and deadlines because of the ineffectiveness and disorder already created by the NPIs. In September of 2007, the Centers for Medicare & Medicaid Services requested that carriers stop accepting claims from any physician whose information did not match between their new NPI and their older identification numbers. This created several problems for physicians, including failed Medicare payments. Despite recent efforts made by the American Medical Association and the Medical Group Management Association, CMS will not likely postpone or retard the set deadlines for establishing a highly desired NPI-only system. The CMS claims that the majority of Medicare claims being filed by physicians electronically are being processed without incident and that only roughly 10% of all claims continue to be devoid of an NPI. The CMS claims that when they made the orders in September to reject any mismatched filings, the subsequent rejection rates were rather low. Still, the AMA and MGMA insist that those effects were significant. Although the majority of the problems between the physicians and their carriers are being adjusted in a timely fashion, many physicians still continue to experience troubles with their electronic claims and payments.

Physicians Gain New Tool to Better Manage Acute and Chronic Pain --Industry News--

Wed, 09 Jan 2008 00:00:00 -0500

Some physicians are getting a beneficial new tool for managing chronic pain. The Federation of State Medical Boards Research and Education Foundation (FSMB) is offering a new handbook to all physicians. The FSMB is a national non-profit organization that represents seventy medical boards of the United States and works to ensure and improve “the quality, safety and integrity of health care by developing and promoting high standards for physician licensure and practice.” The handbook, Responsible Opioid Prescribing: A Physician’s Guide, is intended to further assist doctors in handling their patients’ acute or chronic pain. The book offers actual explanations and practical strategies that “address issues of undertreatment of pain, risk of prescription drug abuse and improved patient care.” As funds are raised, FSMB is offering medical boards, on a state-to-state basis, print copies of the book to be distributed to physicians across the United States. It is estimated that upwards of 750,000 physicians across the country will receive one of these handbooks. The guides can also be customized from state-to-state to include particular state-specific statutes, policies, and rules and regulations. The handbook is based on FSMB’s Model Policy for the Use of Controlled Substances for the Treatment of Pain. The book covers a wide variety of topics, including recommendations for: Ensuring effective patient evaluation Creating a function-based treatment plan with actionable patient goals Obtaining a written patient-physician agreement that includes informed consent and significant patient education Overseeing periodic review that focuses on progress toward functional goals Making specialist referrals and managing difficult patients Creating and maintaining clear, consistent, transparent and detailed documentation Remaining up-to-date on federal and state controlled substance policies

FCC Dedicates $417 Million to Expanding Rural Telehealth Systems --Industry News--

Mon, 17 Dec 2007 00:00:00 -0500

In November, the Federal Communications Commission allotted $417 million over a three-year period to the expansion of telehealth services in rural communities across the United States. The effort, as part of the Rural Health Care Pilot Program, will fund construction of statewide or regional broadband telehealth networks in 42 states and three U.S. territories. The FCC had originally planned to allocate $100 million over two years but expanded the program after receiving more applicants than anticipated. The pilot program will now help fund telehealth connections for more than 6,000 physicians, health professionals and facilities. Rural physicians typically lack the high speed internet access necessary for telehealth services. Basic internet service exists but cannot support the high bandwidth necessary to transmit medical records, radiological readings or video conferencing. The funds will be used to install or develop a range of services, including higher speed computer connections, fiber optic cable installation, and high-speed internet at the homes of on-call physicians. The effort is expected to dramatically improve telehealth capabilities of rural physicians across America.

Tax Credits for EMRs --Industry News--

Mon, 03 Dec 2007 00:00:00 -0500

A new AMA policy on health information technology attempts to address physicians’ cost concerns surrounding electronic medical records. While there is a clear push for physicians to adopt EMRs, many cannot pay for the technology that private payers and government agencies are requesting. While EMR use has been growing steadily, widespread use would require financial help for doctors, especially those in small practices. Consequently, the AMA approved a policy calling for a full, refundable federal tax credit or equivalent financial mechanism to cover physician practices for the costs associated with purchasing and implementing clinical information technology. In fact, Health Affairs reported that in 2005, initial EMR costs averaged $44,000 per physician with an additional $8,500 of annual costs. With Medicare payments set to drop, it is only reasonable to help physicians mitigate information technology costs. Accordingly, the AMA has encouraged Congress to make sure physicians are not disproportionately burdened with the cost of developing and maintaining a national health IT network benefiting all sectors of the industry. They feel a federal tax credit program would encourage physicians to adopt the technology.

CMS Readies Test of New Assessment Tool --Industry News--

Mon, 17 Dec 2007 00:00:00 -0500

Centers for Medicare and Medicaid Services (CMS) will begin testing the new Continuity Assessment Record and Evaluation (CARE) system, a tool designed to determine post-acute care payouts, in 2008. The three-year system demonstration will take place in 10 to 15 markets, representing roughly 150 providers across a variety of healthcare organizations. The current CMS tools used to gauge Medicare payment – IRF-PAI, MDS and OASIS – are incompatible with one another and utilize different measurement scales. CARE will address the current incompatibility issues and lack of centralization by using standardized data formats and a single web-based application for claims submission. According to a CMS White Paper on the new system, CARE is also a potential vehicle for all healthcare providers to standardize patient data while incorporating changes in evidence-based medicine. The three-year trial period will be used to measure treatment and outcomes of patients in post-acute-care setting in four domains: cognitive impairment, medical, functional, and social/environmental factors. Starting in January 2008, providers can submit reports directly to CMS via internet. CMS will eventually develop interoperable systems that will permit physicians to upload stored patient information and reduce data entry time. In response to the disclosure of CARE, the American Hospital Association noted that the tool has the potential to streamline hospital discharge planning but that general acute-care hospitals will suffer a massive resource burden from the cost and time required to conduct sufficient reporting.

Physician Recruitment in the Wake of Stark III --Staffing & Recruitment--

Sat, 01 Dec 2007 00:00:00 -0500

The Centers for Medicare and Medicaid Services published their final rules regarding physician self-referral prohibition in September of 2007, making drastic changes to the Physician Recruitment section. Stark, the name by which the regulations are best known, holds that funds paid directly to a recruited physician by a recruiting hospital with the purpose of inducing the physician to relocate his practice to within the geographic area served by the hospital are protected if the following four conditions are satisfied: The arrangement is set out in a signed written agreement. There is no condition in the arrangement that the physician refer patients to the hospital. The funds paid to the physician are not based on the volume or value of any actual or anticipated referrals by the physician or other business generated between the parties. The physician is permitted to establish staff privileges at other hospitals and to refer business to any other entity. The Stark rules were amended to clarify and loosen regulations on what constitutes a “served geographic area” around a hospital to include all contiguous zip codes within that area. Previously, under-populated areas and areas from which a hospital drew a low percentage of its clientele were disallowed from inclusion. The regulations governing the necessary distances to which a physician must relocate his practice when recruited were also modified to clarify policy. Alterations were also made to policies loosening restrictions on the recruitment of physicians in rural and small communities.

Bringing in Rural Physicians --Staffing & Recruitment--

Tue, 01 Jan 2008 00:00:00 -0500

The national health worker shortage is acutely felt in underserved and understaffed rural areas. An article in the January issue of Trustee addresses the problem and offers a few solutions for rural hospital and practice administrators. Over the next fifteen years, demand for physicians will outstrip growth as the “baby boom” generation ages and becomes eligible for retirement. Physician, nurse, and practitioner shortages will be felt more and more, and attracting doctors to rural areas is a crucial consideration, as some thirty million Americans live in these underserved areas. This is not solely a crisis, however. The authors view this as an opportunity for trustees to step up their interactions with their hospitals in order to aid in recruitment. A number of helpful hints for recruiting are provided. Trustees looking to attract doctors to rural areas must be willing to: Interweave physician and family into the community. Physicians moving to a new area will need to feel welcomed in order to make them more likely to stay. Provide aid in envisioning life in a given community. Letting potential staff know the possibilities of an area is essential in helping them to imagine their life there. Provide aid in social integration. Top board members must be ready and able to take a personal role in welcoming new staff. Outreach is essential. Top staff need to step up recruiting efforts at medical schools. Administrators are advised to look at their best doctors and use them to recruit heavily at the schools that they come from. Play up the benefits of rural remoteness. Administrators can turn remoteness into a positive factor by demonstrating the hospital’s commanding regional market share, the range of possibilities open to a recruit, and the financial benefits of leveraged contracts with payers. Allow doctors a range of freedom. Administrators must be ready to allow recruited doctors to practice medicine the way they want to, within the bounds of safeness and regulations, of course. Realize the possibly disadvantaged position of the hospital with regards to location and incentivize appropriately. Work-life balance, payment, and other benefits must be made as enticing as possible to lure recruits.

Pilot Program Aims to Train Spanish-Speaking Doctors --Staffing & Recruitment--

Thu, 18 Jan 2007 00:00:00 -0500

A pilot program at the University of California–Los Angeles targets the surplus of medical-school graduates from Latin America to address a shortage of Spanish-speaking doctors in the United States. A record influx of Latin American immigrants into the U.S. has left clinics and hospitals across the U.S. to grapple with Spanish-speaking patients. Poor communication can result in millions of dollars annually in unnecessary testing, emergency room visits, delayed or inaccurate diagnoses, or noncompliance with medical instructions. UCLA’s pilot program prepares participants for U.S. medical board exams and issues a stipend to medical school graduates of Latin American countries. Upon completion of their residency, participants are required to spend at least three years in medically underserved areas in the United States. Prior to starting the program, most participants had been working in the U.S. as X-ray technicians, nursing assistants, or healthcare volunteers. The program will complete its first year in February 2008 with only 14 participants. Administrators plan to replicate the program at other University of California campuses, and according to the chairman of the Department of Family and Community Medicine at the University of Texas Health Sciences Center in San Antonio, the Texas system is also considering implementing similar programs to address the state’s shortage of Spanish-speaking doctors.

Reaching Out to Different Cultures --Staffing & Recruitment--

Sat, 01 Dec 2007 00:00:00 -0500

Understanding and accommodating diverse cultures is a successful and beneficial approach to dealing with the issue of diverse patient populations. So says the chairman of the Health Financial Management Association in an article in the December issue of HFM Magazine. The author cites the outreach efforts of the New York Downtown Hospital, a 150-bed hospital in Lower Manhattan. Fully 80% of the hospital’s inpatients are Chinese. Of these, a sizeable amount are immigrants with insufficient or non-existent English skills. In response, the hospital has brought on translators and a number of staff of Chinese descent. The hospital also engages in outreach programs, offering health screening and health education opportunities at community fairs in Chinatown. The policy of outreach has yielded great benefits. The Chinese community in Lower Manhattan now has much improved access to health care. The hospital has increased its market share of inpatients in that region as well and reports a greater number of births among the Chinese community as the hospital has increased its connections with a fast growing segment of the population. The chairman cites the New York Downtown Hospital as a great example of an organization making a real difference in its community through the use of genuine outreach, proclaiming it an example for all to take to heart.

Partner or Employee: How to Decide --Employment & Compensation--

Thu, 01 Nov 2007 00:00:00 -0400

In today’s private practice world, the road to partnership is sometimes shorter than ever. But is taking on a partnership role in a practice the safest career move? An article in Medical Economics examines the possible benefits and pitfalls of partnering up. The authors point to a number of benefits to partnership. Becoming a partner in a firm can lead to a sizeable boost in income, and there is also the benefit of a greater deal of autonomy on the part of a partnering physician. Partners are furthermore better able to build up equity in a firm, and—in the event the firm is sold or brought under another hospital—the partners are able to share in the rewards and profits of such a transaction, whereas a physician who is solely an employee cannot share in these benefits. However, a number of detractors to the partner status are also inherent. Partnership requires a buy-in, and the financial stake taken in a firm comes without guarantee of repayment or profitability. If the practice goes under, that money is lost. Besides the heavy financial risk, there is also often a heavier workload. This can lead to added stress and decreased morale if things aren’t going well. Partnership also requires a greater deal of administrative work, which may not sit well with physicians looking solely to practice and leave paperwork to others. Lastly, there is no guarantee of a retirement package or a buy-out from the practice, as these things must be negotiated separately. Keeping these factors and possibilities in mind, a physician is more fully able to weigh the pros and cons of partnering up. It is ultimately up to the individual to decide if partnering with a particular firm is the best career choice.

10 Things You Should Know About Locum Tenens --Employment & Compensation--

Tue, 01 Jan 2008 00:00:00 -0500

An article in the January 2008 issue of Locum Life offers helpful hints to physicians looking to become locum tenens practitioners. The authors asked industry experts, seasoned locum tenens physicians, and registered nurse anesthetists for their insights on locum tenens as a practice alternative. Their answers shed a good deal of light on the practice. Locum tenens practitioners generally fall into three categories: recent graduates, physicians between jobs, and retired or semi-retired professionals. Locum tenens is attractive to physicians due to the range of experience available in such a practice. Locum tenens professionals need to look for staffing firms that will provide regular pay, malpractice coverage, and credentialing assistance. These things can be set up by a physician on his own, but the use of a staffing firm generally makes for an easier and more pleasant experience. Locum tenens need to take the initiative in the credentialing process in order to ensure that it is properly completed. Locum tenens professionals are able to practice in a variety of settings in both governmental and commercial roles. Movement between these two spheres is limited by regulations, of course, but navigation between them is both doable and advisable for a richer locum tenens experience. Locum tenens should utilize their staffing firms to secure transportation and housing arrangements. Practitioners should be sure to be aware of key aspects of their contract arrangements with regards to the practice. All contracts should be thoroughly reviewed to ensure job stability and proper compensation as well as the absence of conflicts of interest. Practitioners should be aware of the contractual obligations of working in a given facility. Locum tenens professionals can be successful if they keep an open mind as to positions, career paths, tenures, and compensation packages available to them due to their particular status.

Pay is Up; Profit Still Elusive --Employment & Compensation--

Fri, 12 Jan 2007 00:00:00 -0500

Physicians around the country saw another increase in their compensation in 2006, and productivity jumped up as well, according to numbers released by the American Medical Group Association. An overall increase in compensation was recorded, with an average increase of 4.8% for physicians. The two highest increases were reported for pulmonary disease and infectious disease specialists, which reported 11.5 and 9.6% growth respectively. Productivity was also reported to be up 7% across the industry. Despite these numbers, physician groups appear to be operating at a loss in all regions of the US except for the West. Western groups reported an average profit of $17,317 per physician, while groups in the South reported a loss of $6,049 per physician. This loss is likely attributable to capital expenditures on information technology, the payer system, and patient education. The study was based on physician group responses to a mailed survey. There were responses from 222 physicians groups across the country.

Physicians Challenge Lawyers’ Meritless Liability Suits – And Win --Medical - Legal Matters--

Mon, 03 Dec 2007 00:00:00 -0500

The American Medical Association reports a series of favorable court rulings is changing physicians’ battle against frivolous medical liability lawsuits. Over the past six months, numerous courts throughout the U.S. have chastised attorneys for gratuitous behavior including suing the wrong doctor, refiling a claim against a physician even though the plaintiff's expert withdrew his testimony the first time around, and having no expert testimony against one doctor, yet failing to drop the case. While not trying to prevent legitimate claims, doctors are hoping these victories will send a message deterring lawyers from filing those that are baseless. Furthermore, there is the hope that the rulings will encourage trial judges who see abusive conduct to take action while demonstrating to physicians that the system is not completely stacked against them. Furthermore, proactively challenging meritless cases is a way to reduce the frequency of bad claims and curb rising liability insurance costs. Dr. Jeffery Segal, founder of Medical Justice - a company that sells insurance policies giving doctors legal resources to combat frivolous claims - pointed out that when a client physician receives notice that a patient is considering filing a lawsuit the doctor believes is frivolous, the company sends a letter to the lawyer that the physician may counter-sue. Segal explained that as a result, only 11 percent of these instances then materialize into a lawsuit. Trial lawyers agree that punishment may be justified when an attorney completely eschews responsibility by pursing a case. However, they feel this conduct is rare because there is no moral or economic incentive for plaintiff lawyers to file frivolous cases as they take on the often expensive and complicated negligence suits in bad faith.

AG: $600 Million in Medicare Fraud Prosecutions Just a Start --Medical - Legal Matters--

Sun, 14 Jan 2007 00:00:00 -0500

The South Florida Medicare Fraud Strike Force quadrupled the number of individuals charged with filing false claims in 2007. The disrupted schemes amounted to more than $600 million in fraudulent claims. In 2005, South Florida had 10 percent of the nation’s Medicare patients with HIV/AIDS, but accounted for $2.21 billion of the nation’s $2.31 billion in HIV Medicare drug claims, according to the Department of Health and Human Services. Prior to the creation of the task force, the US attorney’s office for the Southern District of Florida charged 58 individuals in 53 cases in 2005, as compared to 197 people in 120 cases in 2007. The attorney’s office works in conjunction with the FBI, CMS and the Florida Department of Health. Prosecutions have been primarily focused in two areas: durable medical equipment and HIV infusion therapy to administer drugs. The legal action has allegedly acted as a deterrent for false medical claims in other medical practices.

Employers Tell Workers to Get Healthy or Pay Up --Medical - Legal Matters--

Tue, 04 Dec 2007 00:00:00 -0500

U.S. companies are increasingly using financial incentives to motivate workers to kick unhealthy habits, such as obesity and smoking. Employers that rewarded employees for participating in wellness programs are now opting to penalize those with bad habits that do not. Indeed, employees at some companies who are overweight, smoke, or have high cholesterol that choose not to participate in supplementary wellness programs will now be required to pay more for health insurance. Some employees' insurance deductibles could rise by as much as $2,000. While employers want to see results, consultants and lawyers agree that interfering with workers’ lifestyles through financial penalties risks lawsuits or may even violate the Americans with Disabilities Act.

$200+ Million Verdict: It Started with a Midlevel’s Mistake --Medical - Legal Matters--

Fri, 07 Dec 2007 00:00:00 -0500

Last year a Tampa jury awarded $217 million, including $100 million in punitive damages, to a man whose cerebellar stroke was misdiagnosed as sinusitis and who consequently suffered irreversible neurological damage. The verdict, one of the largest malpractice awards in U.S. history, stemmed from a medical group’s improper use of an unlicensed physician assistant, a purportedly negligent doctor and infighting between the medical group and the malpractice insurance agency. The physician, Dr. Austin, and the physician assistant, Mr. Herranz, were both employed through a medical group, Frank, Favata & Hulls, MDs, which was contracted with the hospital to manage its emergency department. Herranz recorded the patient’s history and symptoms, and Austin misdiagnosed “sinusitis/headache” based upon the information provided in the report. Dr. Austin did not repeat any exams. The medical group would reveal 16 months later that Herranz was an unlicensed physician assistant, which Austin was unaware of at the time. The medical group also held Austin and Herranz accountable for the misdiagnosis. In the verdict, Herranz and Austin were each found 25 percent liable for compensatory damages, while the medical group was accountable for the other 50 percent. The malpractice insurer, ProNational Insurance, refused to settle the case for $2 million prior to the trial, which spurred Austin and the medical group to sue the insurer for not making reasonable attempts to settle, thus leaving Austin and Herranz personally exposed for compensatory damages. Medical Economics recommends that in cases with multiple defendants, the possibility of an excessive verdict exists, and that physicians should therefore hire individual counsels to provide protection beyond that offered by the malpractice insurance agency.

2007: The Year That Was in Radiology --Medical Specialty Focus--

Sat, 01 Dec 2007 00:00:00 -0500

For imaging professionals, 2007 was a year filled with political, social, and industry happenings that will have effects for some time to come, according to a piece in the December issue of Advance. 2007 was the year in which the “baby boom” generation—the nearly 80 million Americans born between 1946 and 1964—first began to be eligible for social security and retirement benefits. The oncoming wave of boomer retirees are 50% more likely to need an imaging procedure than are younger Americans. This will inevitably lead to a surge in work and demand for imaging technologists. Last year also squarely placed healthcare at the forefront of American political discourse. The author points out an upcoming health worker shortage which is bound to have an impact on the industry and must be addressed if improvements are to be made in the American system. The past year also saw the rise of teleradiology: an innovative communications technology allowing for review of imaging results from remote locations over the internet. In the future, this is likely to lead to a revolution in imaging, as smaller hospitals are able to employ off-site professionals that would otherwise be unavailable to them due to cost or geography. The author, taking all these factors into account, presents a generally positive view of the year that was and a brightly optimistic estimation of what is to come in 2008.

Writing About Patients: the Perennial Dilemma --Medical Specialty Focus--

Sat, 01 Dec 2007 00:00:00 -0500

What are the ethical implications of writing for press about a psychiatric patient? An article in Psychiatric Times addresses the ethical dilemma facing doctors caught between informing their peers and preserving patient privacy with an eye toward striking a balance between these two essential duties of psychiatrists. The article examines the plusses and minuses of obtaining patient consent before publication. It is argued that, while informative for the psychiatric community, publication of certain cases can, if insufficient in protecting the patient’s identity, run the risk of setting back treatment program progress or even bringing about relapse in particularly on-edge patients. The author argues that, while publication of cases is a beneficial act for the psychiatric community, patient confidentiality must remain the highest ethical concern. Therefore, all means should be taken to ensure that publication of the article does no harm to the patient in question. The article concludes that clinical publishing decisions must be made after fully taking individual case characteristics into consideration. This consideration must decide the appropriate level of confidentiality to be used or the degree of forewarning a patient should have about the publication of the study.

Increasing Rates of Emergency Department Visits for Elderly Patients in the United States --Medical Specialty Focus--

Fri, 07 Dec 2007 00:00:00 -0500

In 2005, the Centers for Disease Control and Prevention reported an increase in emergency department visit rates per 100 people. The greatest increase in visit rates was among individuals 65 years and older. Given that older ED visitors typically require longer lengths of stay, are more likely to be admitted, and compose a growing percentage of the American population, the increase in ED visits may have a significant effect on ED crowding. If the trend continues, annual ED visits in the US for 65 to 74 year-olds could almost double from 6.4 million to 11.7 million by 2013.

Studies Show Increasing Strain on Emergency Departments --Medical Specialty Focus--

Wed, 12 Dec 2007 00:00:00 -0500

According to a study released by the Center for Studying Health System Change, a difficulty in receiving payments from uninsured patients contributes to an increased reluctance among specialists to work in emergency departments. The study results are based upon visits to 12 health facilities in representative metropolitan areas across the United States. Payment issues and a greater risk of malpractice lawsuits have spurred many specialists to open private practices. Hospitals have attempted to lure specialists to work in emergency departments through higher compensation, but such methods have led to an increase in costs for patients and insurers.

Payer Trend: ‘Tiering’ Physicians and ‘Steering’ Patients --Payer & Reimbursement Issues--

Sat, 01 Dec 2007 00:00:00 -0500

An article in the November/December issue of Family Practice Management examines the controversial practice of “tiering and steering,” wherein payers rate the efficiency and quality of practices based only on claims data. This data is later shared with patients and has the potential to negatively affect the bottom line of practices. Tiering and steering—also known as “physician profiling” or “economic credentialing”—has, as of recent, become a computerized method of physician cost-efficiency analysis by which a growing number of payers analyze physician claims data, compare it to that of their peers, and use this information to create tiered networks of physicians toward which they can then steer specific patients in order to save on payer costs. While the practice has a generally positive effect on payer finances, there are possible flaws in the system for physicians. For one thing, the system doesn’t necessarily take into account the number of episodes of care that could have been prevented by primary care, such as complications due to diabetes or congestive heart failure. These profiles of doctors are typically constructed on tiers based on differences in care costs among physicians, but without proper input, they can fail to provide a true glimpse of the cost and quality of care provided by a particular practice. Doctors are advised, in light of the system, to retain as much pertinent data on their practices as possible. Retention of such data would allow them to counteract any negative or incomplete information a payer may generate to classify a practice. This sort of capability can be instrumental in challenging an inaccurate rating from a payer, ultimately improving both the reputation and bottom line of a practice.

You Can Negotiate with Health Plans --Payer & Reimbursement Issues--

Fri, 04 Jan 2008 00:00:00 -0500

While doctors, especially those in small practices, can sometimes feel overwhelmed and helpless in negotiations with health insurers, there are a number of useful tips and guidelines for how to bargain with major health plans for better compensation. Due in large part to insurance industry consolidation, competition among insurance providers has become more limited. With this said, many physicians have much more bargaining power than they may believe. The first significant suggestion is for doctors to go right after health insurers because, if nothing else, simple negotiations can prove that lowball reimbursement is nothing more than an inadvertent mistake. Depending on a doctor’s location, specialty, and the size of one’s practice, insurers will do whatever it takes to keep them happy. In any negotiations, it is critical that one comes thoroughly prepared. When dealing with health insurers, it is rarely cunning debating and gamesmanship that thrive but rather commonplace information – more specifically, dollar figures for billing codes. It is important for a doctor to compare what private payers tend to pay for their top codes in order to identify any inconsistencies in how they are reimbursed by individual payers. Comparing fees and payer reimbursements can often develop more bargaining points. Preparing for a negotiation is essentially the same as developing a compelling argument. Whether a physician wants an insurer to collectively raise its rates or increase them on a selective basis, there needs to be a convincing reason for them to do so. A physician can, for example, make the claim that their practice is necessary for its market. Although this may not work in metropolitan areas due to the plethora of practicing physicians, this argument should be more effective in rural and suburban markets. A physician should also make it clear to an insurer that they improve the insurer’s bottom-line and can be viewed as a money saver. One should always have an answer or follow-up question prepared for any possible line that the insurers might throw out. This is all a part of being exceedingly prepared so that nothing can disrupt the negotiation. Finally, the subtext of any good negotiation should be the threat of walking away. Any doctor negotiating with a health insurer should make it understood that they are willing to walk away from any deal and will not be bullied.

Insurers Seek Bigger Reach in Coverage --Payer & Reimbursement Issues--

Wed, 19 Dec 2007 00:00:00 -0500

The insurance industry revealed on December 19th a series of steps that would permit more US citizens, even those with serious health problems, to obtain affordable healthcare premiums. The proposals, approved by America’s Health Insurance Plans (AHIP), would make it harder for insurance agencies to cancel or deny coverage to people with pre-existing medical conditions, while simultaneously limiting the premiums that could be charged to those people. The proposals are meant to address the 47 million Americans without health coverage and reflect a readiness among insurers to extend coverage beyond the healthiest Americans. Nevertheless, AHIP still recommends that states cover the most costly individuals while private insurers offer policies to everyone else. Political analysts regard the AHIP proposals as an attempt to counter mounting political pressure from Congress and Democratic presidential candidates. The move is also a means of maintaining relevance in any state legislative processes in order to prevent another highly regulated approach like that adopted in Massachusetts. States, however, are not likely to accept the proposals given the high cost of insuring the least healthy Americans.

Docs Spared Medicare Cut by the Senate --Payer & Reimbursement Issues--

Wed, 19 Dec 2007 00:00:00 -0500

Physicians will likely evade a Medicare pay cut for January 2008 after the Senate approved a deal to table a 10.1 percent pay reduction. Instead of a Medicare cut, physicians will receive a 0.5 percent pay raise ($6 billion) from Medicare and the matter will be postponed for six months until the summer of 2008. The temporary Medicare pay package still requires approval from the House and the President’s signature, both of which are likely to happen.

Stricter Requirements Sought for Relicensure as Medical Boards Draft Proposal --Credentialing, Licensure, Quality Management--

Mon, 31 Dec 2007 00:00:00 -0500

State medical board leaders are considering plans to augment requirements for the maintenance of physician licenses. In most states, physicians can presently maintain licenses by avoiding disciplinary actions and by completing a minimum number of hours of continuing medical education. The Federation of State Medical Boards (FSMB), however, is now considering new requirements that would render the continuance of physician licenses a process similar to the maintenance of specialty certificates. According to a draft report issued in November by FSMB, the federation recommends that physicians applying for relicensure participate in self-evaluation and practice assessment, demonstrate continued competence in areas like patient care and medical knowledge, and complete exams in practice areas. Physicians have challenged the proposal as an unnecessary duplication of the specialty board certification process, which already demands medically specific knowledge. The new requirements will be voted on at the FSMB House of Delegates in May 2008. Public comments are accepted on the proposal until January 7, 2008. The final report will be submitted to the federation’s board in February of next year.

Fight over Physician Quality Ratings Moves to Massachusetts --Credentialing, Licensure, Quality Management--

Mon, 31 Dec 2007 00:00:00 -0500

Group Insurance Commission (GIC), the Massachusetts state employee health insurance program, recently mandated a tiered system of physician rankings to imitate the model used in New York state. In November, GIC began accepting proposals from health plans to create networks covering 250,000 state employees and potentially another 330,000 municipal employees. In April, the commission released its first network-based physician quality ratings. But, amidst the expansion of the GIC network, physician unrest spurred the Massachusetts Medical Society (MMS) to condemn the commission’s tiered networks. Allies of MMS included state legislators supporting House and Senate bills that would govern standards for tiered network and BlueCross BlueShield of Massachusetts, which refused to submit a plan proposal to GIC. According to physicians in the state, the GIC health plans sent notices to physicians informing them of their ranking. The notifications offered no explanation or opportunity to appeal the rankings, which are based largely on cost of care instead of quality of care.

Study Finds Gaps between Doctors’ Standards and Actions --Credentialing, Licensure, Quality Management--

Tue, 04 Dec 2007 00:00:00 -0500

A study funded by the Institute on Medicine as a Profession published in the Annals of Internal Medicine uncovered notable gaps between physician ideals and practice, particularly in the areas of self-regulations, financial conflicts, and conserving limited resources. Nearly half of all physicians do not report incompetent or impaired colleagues even though 96 percent agree such people should be reported. Moreover, nearly half failed to report at least one serious medical error they observed. Researchers found large gaps between physicians’ adopted attitudes and what they actually practice. They agree that failing to report incompetent physicians affects the welfare of patients and should be brought to their attention. The study's authors and a panel of experts said that not all the findings were negative and that some must be understood in context. For instance, the fact that doctors nearly unanimously agree on standards means they do not need to be convinced that these issues are important. However, the experts agreed that physicians are trying to do the right thing and note that a renewed focus on professionalism, not simply more regulation, is necessary.

Can Patient Flow Analysis Reduce Patient Wait Times? --Healthcare Technology--

Mon, 01 Jan 2007 00:00:00 -0500

A study published in BMC Health Services Research utilized patient flow analysis (PFA) techniques at two clinics to identify inefficient areas of the care process and measure intervention effectiveness, with results suggesting that PFA is a valuable tool in increasing the efficiency of hospitals. The experiment first observed the normal routine of two clinics, one handling chronic pain and the other devoted to anticoagulation. The study’s authors performed a patient flow analysis on both clinics and devised interventions meant to improve the flow of both clinics by eliminating redundancies and restructuring inefficient elements. Interventions involved the relocation of laboratories, the restructuring of nursing staff, and the inclusion of increased numbers of clinical support staff in the anticoagulation clinic. In the chronic pain trials, the researchers altered policy to improve clinic triage, moving paperwork review issues to the beginning of the visit and allowing patients to get to see a doctor faster. Results suggested that the PFA and interventions led to sizeable decreases in patient wait time. The chronic pain clinic showed a mean visit time that was 25 minutes shorter than before the PFA. The anticoagulation trial resulted in a 39 minute (66%) reduction in total visit time for patients. The study’s authors believe that their results evince the efficacy of Patient Flow Analysis as a corrective tool for hospital organizations. They contend that PFA can function as an effective substitute for outside consultants, allowing clinic staff familiar with patient care processes to develop a greater sense of ownership, aiding in the resolution of problems and improving the clinical experience for all involved.

Illinois-Based Health System Brings EMR to Community Physicians --Healthcare Technology--

Mon, 07 Jan 2008 00:00:00 -0500

Provena Health has developed plans to provide an electronic medical records system (EMR) to its affiliated physicians. The 1,800 physician health system in Illinois and Indiana will host Misys EMR and Misys Tiger practice management software from Provena Saint Joseph Medical Center in Joliet, Ill. Provena is hosting EMR software as a way of encouraging a widespread adoption of EMR among its affiliated physician group (Alliance Health), as well as to cut costs associated with implementation and support. The Misys software products being utilized by Provena Health are provided by Misys Healthcare Systems based in Tampa, Fl. In addition to the EMR for physician practices, Provena Health has also purchased Misys Homecare, which the Catholic Health System will use among its network of home care nurses. Alliance Health also intends to implement Misys Payerpath software designed for billing and transactions. Such an integrated system would enable physicians to more precisely document care delivery and any subsequent results. This system will also prepare them for pay-for-performance initiatives. Provena is a health system that operates out of Illinois and Indiana and “includes six hospitals, 16 long-term care and senior residential facilities, 28 clinics, five home health agencies and other health-related activities.”

Cancer Patients Gain from Reporting Symptoms Online --Healthcare Technology--

Fri, 30 Nov 2007 00:00:00 -0500

A study published in the Journal of Clinical Oncology by researchers from the Memorial Sloan-Kettering Cancer Center suggests that having cancer patients report to doctors on their symptoms and side effects online may improve their care. As cancer care becomes increasingly complex, office visits become more compressed, making it challenging for clinicians to assess and classify symptoms. Furthermore, cancer therapies are highly toxic, so early detection and timely treatment is vital. Researchers agree that the online self-reporting option is beneficial because it allows all patients, even the sickest, to alert clinicians to crucial symptoms in real time. The study assessed over a hundred lung cancer patients that were presently receiving outpatient chemotherapy. These patients were provided access to a secure Internet patient reporting system referred to as Symptom Tracking and Reporting (STAR), which was developed by researchers at the Memorial Sloan-Kettering Cancer Center. Patients were able to use computers in waiting room kiosks and at home to report cancer symptoms and chemotherapy-related side effects. The study found that 98 percent of patients found STAR easy to use, 90 percent said it was useful, and 77 percent believed it improved the quality of their discussions with clinicians.

Minnesota Insurer’s Web Sites Allow Members to Post Comments About Physicians --Healthcare Technology--

Wed, 19 Dec 2007 00:00:00 -0500

Multiple Minnesota health insurance companies have launched websites that encourage consumers to post comments regarding their experiences with healthcare providers in the insurer’s networks. The sites include BlueCross BlueShield of Minnesota’s healthcarescoop.com, Medica’s mainstreetmedica.com and Health Partners and Preferred One. The ability to post comments is part of a statewide effort by Minnesota’s healthcare organizations to provide information to consumers of healthcare. The Minnesota Department of Health condones the action as a way for physicians to gauge patient satisfaction. An executive from BlueCross BlueShield Minnesota says that the decision to post consumer comments stemmed from prospective patients who wanted ratings and descriptions of actual patient experiences with network doctors.

HealthCare Survey --None--

Tue, 01 Jan 2008 00:00:00 -0500

Interests Survey --None--

Tue, 01 Jan 2008 00:00:00 -0500

Legal --None--

Tue, 01 Jan 2008 00:00:00 -0500

Willing To Relocate Survey --None--

Tue, 01 Jan 2008 00:00:00 -0500

Jan Newsletter --None--

Tue, 01 Jan 2008 00:00:00 -0500

Index --None--

Tue, 01 Jan 2008 00:00:00 -0500

Prices Spike in 2007 --Industry News--

Mon, 21 Jan 2008 00:00:00 -0500

Looking back from the new year, many analysts are now confirming that 2007 was in fact a year characterized by above-average prices for a wide variety of healthcare services. When compared with economic indicators for non healthcare-related goods, in particular, it appears that consumers paid substantially more for medical care. In relation to the Consumer Price Index (CPI), hospital prices increased by 8.3 percent from January to December 2007, compared with a CPI increase of 4.1 percent for non healthcare-related goods and services. Using the Producer Price Index (PPI) as an indicator, hospital prices rose 3.1 percent in the same time period. For individual physicians’ offices, prices rose 4.2 percent using the PPI, up from a 1.1 percent increase in 2006. Using the CPI, prices rose 4.1 percent, over twice as high as the 2006 CPI increase of 1.7 percent. According to Joseph Kowal, an economist at the Bureau of Labor Statistics, prices were “high no matter how you look at it for physicians.” Over the past calendar year, internal medicine prices rose by 11.1 percent, general family practices prices rose by 6.4 percent, and multispecialty practice offices increased by 7.4 percent. Unaffected by price spikes were obstetrics/gynecology, pediatrics, and general surgery. Given worries of an oncoming recession, analysts insist there is “no immediate cause for alarm,” as healthcare costs should stabilize over the next few years.

Quick Clinics and Health Kiosks Are Taking Off at Airports --Staffing & Recruitment--

Mon, 11 Feb 2008 00:00:00 -0500

Onsite medical clinics have recently been appearing in airports across the country in hopes of drawing travelers to receive small-scale medical care while waiting for their flights. Originally initiated to address medical issues of airport and airline employees, clinics and medical kiosks have recently been drawing in broader crowds of passengers and are providing them with flu shots, diagnostic testing, and medical identification. The University of Illinois at Chicago Medical Center has been conducting clinics at O’Hare International Airport since 1995. The clinics began issuing flu shots at a single kiosk and provided the majority of their services to busy airport and airline personnel. Recently, the medical kiosks have been utilized more readily by traveling passengers and have been placed throughout four terminals in the airport; the kiosks are now in the process of expanding their services year-round. Future airport clinics are set to include diagnostic blood testing services where patients can receive their test results once arriving at their destination via a secure website. The clinics are also aiming to provide patients with a health identification card listing the important details of their medical history.

The Profit Potential of Hospital Labs --Industry News--

Tue, 01 Jan 2008 00:00:00 -0500

Are hospital laboratories a “necessary evil” cost center for organizations, or do they hold the potential to actually increase hospital revenues and contribute greatly to the bottom line? An article in the January issue of HHN Magazine contends that the latter option is not only a possibility, but an easily attainable outcome. The article proposes that—since a hospital lab structure is typically 50% fixed-cost and 50% variable cost—a doubling of the amount of tests run in a lab can result in a cost reduction of 25% on all tests run. This increased workload results in increased revenues for the hospital, a greater utilization of already purchased facilities and equipment, and an overall increase in capital. The authors put forth the main criteria necessary to turn hospital labs into revenue generators: Control billing: Making sure the billing functions of the lab are up to date, efficient, and sufficiently supplied with capital to allow growth will ensure that the billing services department is fully capable of collecting fees from participating physicians as needed. Since the lab will be operating at a greater volume, leaving the increased billing needs up to the regular hospital billing department could introduce unneeded inefficiencies. Maximize advantages: Laboratory outreach on the part of a hospital puts it in direct competition with commercial labs. Hospitals must maximize their organizational advantages—staff doctors, community standing, quicker response times—to ensure competitiveness.

Medical Tourism Taking Flight? --Industry News--

Thu, 24 Jan 2008 00:00:00 -0500

Despite the potential appeal of receiving medical care at significantly discounted rates, a recent study titled “Health Care Benefits: Eligibility, Coverage and Exclusions,” found that only 11 percent of organizations surveyed include medical tourism as a benefit. The study, conducted by the International Foundation of Employee Benefit Plans, examined the benefits policies of a variety of US companies, industries, and regions. According to one observer, the difference in prices for procedures in the United States versus offshore facilities with strong healthcare credentials can be more than 50 percent. However, a number of obstacles stand in the way of medical tourism’s widespread adoption, primarily including the unwillingness of patients to leave the comfort of friends and relatives to undergo major medical procedures. Another potentially significant obstacle concerns insurance carriers. Current healthcare networks are unlikely ready to accommodate offshore medical care, and insurers are reluctant to be the first to move forward on this issue. Nevertheless, the study concludes that medical tourism as a healthcare benefit has strong potential in promoting the highest quality care at the best price, once “real and psychological” hurdles are cleared.

HHS’ New Year’s Resolutions --Industry News--

Mon, 21 Jan 2008 00:00:00 -0500

Coming into the final year of the Bush Presidency, there are many issues of concern to healthcare professionals in the following months. Topping the list of concerns is a comment by Health and Human Services Secretary Mike Leavitt that suggests the Medicare Advantage program, a proposal to increase Medicare payments to physicians, will most likely not come to fruition. President Bush promised that he would not levy a tobacco tax to pay for the Medicare Advantage program, and many are left wondering how Medicare physicians will be paid. “It’s really unlikely the Hill is going to accept the president’s budget if there’s deep cuts to hospitals,” argues Chip Kahn, president of the Federation of American Hospitals, but economic indicators suggest that there could be a growing gap for hospital funding in the near future. Should HHS not find a suitable arrangement in the next few months, Medicare physicians could feel the full brunt of a 10 percent reduction in physician funding that is scheduled for July 1 of this year, with the additional 5 percent cut taking place on January 1, 2009. The physician funding problem will not be easily fixed, and the Congressional Budget Office argues that a full overhaul of the existing scheme will cost the federal government upwards of $262 billion over the next 10 years, in addition to the $70 billion in higher costs for Medicare beneficiaries. All eyes are fixed on Congress’ actions over the next year, and healthcare professionals are awaiting the release of President Bush’s fiscal 2009 budget request for HHS, expected to come in early February.

Med Schools Adjusting to Millennial Students --Industry News--

Tue, 01 Jan 2008 00:00:00 -0500

A new generation of medical students is making its way into American medical schools and changing the status quo as they come. A recent article on the American Medical Association’s news page, amednews.com, explores the impact of the so-called “millennial generation”—young Americans born between the early 80s and the early 2000s—on medical education in this country. The primary effect of the Millennials has been a shift toward collaborative learning in medical education. Millennials are a tech-savvy and group-oriented generation and are more likely to embrace team-based learning. Consequently, schools are developing more collaboration-intensive structures for instruction. Students now frequently collaborate with older students and students from nursing and physical therapy fields. The result is a more interconnected generation of future doctors who are almost certain to have a transformative effect on American medicine in the years to come.

Are You Recruiting a Disruptive Doc? --Staffing & Recruitment--

Mon, 01 Oct 2007 00:00:00 -0400

Over the past few years, statistics have shown a stark increase in diagnoses of mental health problems among physicians, including psychopathology, personality disorders, and behavioral abnormalities. Since medical recruitment potentially samples a number of physicians suffering from mental illness, it is important to be able to distinguish traits in a physician’s behavior as potential disruptions to medical practice. In order to aid in trait identification, one psychologist who specializes in organizational behavior and healthcare consultation offers recruiters some warning signs to watch for when screening potential candidates for medical positions: Inappropriate Anger -How does the candidate speak to others? -Does he use intimidation or unnecessary sarcasm when conversing? -Does he criticize or scorn authority to whom he should be showing respect? Inappropriate Words/Actions -Does he use untoward racial, economic or socioeconomic comments? -Does he make sexual comments/innuendos or portray seductive or aggressive behavior? Inappropriate Response to Patient Needs and Staff Requests -Does the candidate respond to pages with respect and concern or with impatience and rigidity? -How does the candidate respond to changes in his schedule? -Is he able to readily adapt or does he show irritability when things do not go according to his plan? Overall Measure of Candidate’s Behavior -Pathological – Has the behavior surpassed the boundary of “normal”? -Persistent – Is there evidence that this behavior has happened frequently elsewhere? -Pervasive – Does the behavior carry across settings and with various types of people?

Job Sharing: Flexibility Has a Price --Staffing & Recruitment--

Fri, 18 Jan 2008 00:00:00 -0500

As a reaction against increasing time constraints for private practice physician offices, some doctors are turning towards job sharing models with varying levels of success. Instead of searching out part-time jobs, more and more doctors simply split their time in an office and on-call with another physician. Since the 2 doctors are effectively employed in the same position, there are many difficulties with this arrangement, though some have found all of the rewards of being a physician with the flexibility of part-time employment. In a successful example of job sharing, two female physicians in a private practice in South Carolina alternate three and four day workweeks, with each physician spending about 20 to 25 hours in the office. With 3 children each, this agreement allows them to spend more time with their families than a traditional practice. Likening job sharing to a marriage, Medical Economics recognizes that physicians must be in similar places in their lives, and have a lot in common professionally and personally. Doctors who are familiar with one another’s work and have similar management styles are the best candidates for job sharing, as both partners will be required to do the exact same work at different times throughout the week. There are some downsides to job sharing. Medical malpractice insurance policies are the same price as for full-time physicians, though job sharers only take in 50 percent salaries. Income is lowered considerably, and physicians with relatively fixed scheduling caps may have difficulty working extra hours to earn substantial funds beyond what covers overhead. Additionally, doctors with different expectations about what job sharing entails will most likely result in a failed business venture. The article warns of one sharing practice that failed when two doctors could not cooperate on a variety of simple organizational tactics. For doctors with the need to reduce their working schedules and a willing and agreeable partner, job sharing can be a unique way to continue practicing medicine with the flexibility of a much less demanding job.

How Doctors are Paid Now, and Why It Has to Change --Employment & Compensation--

Sat, 01 Dec 2007 00:00:00 -0500

Despite the growing popularity of pay-for-performance programs among health plans, most doctors are still paid on a fee-for-service basis. The American College of Physicians, along with other professional groups and health plans, has begun to criticize these payment practices, claiming that they devalue crucial services such as doctor-patient discussions, while over-rewarding expensive procedures and larger volumes. These groups also claim that fee-for-service plans are increasing pressure on primary care doctors to shift into specialty fields in search of higher pay. According to a 2007 survey conducted by the Medical Group Management Association, primary care physicians reported an average 4 percent increase in income while specialists saw a 6 percent rise on average. Some specialty fields have seen even larger increases, as infectious disease specialists experienced a 9 percent average rise, and pulmonary disease specialists reported an increase of more than 11 percent. Analysts warn that these incentive structures could cause a shortfall in primary care physicians in coming years. As a solution, the ACP is recommending a new compensation plan that would combine risk-adjusted capitation with pay-for-performance programs, along with fee schedules to ensure that doctors are still compensated for the volume of work they perform. With this in mind, WellPoint, Aetna, the Blue Cross & Blue Shield Association, Cigna, Humana, MVP Health Care, and UnitedHealthcare have joined the Patient-Centered Primary Care Collaborative in an attempt to advance this new physician compensation approach.

New County Program Reimburses South LA Doctors for Indigent Care --Employment & Compensation--

Tue, 01 Jan 2008 00:00:00 -0500

A new reimbursement program is now available from the Los Angeles County Department of Health Services for nine private hospitals affected by the closure of the Martin Luther King Jr.-Harbor Hospital. Under the PSIP-Impact Hospital Program, the county is paying 100% of Medicare fees for as many as six hospital days’ length of stay. This service is being provided to those patients who enter the surrounding private hospitals from the area previously served by the MLK hospital. The new program is simple for doctors as it requires most of the patient screening to be conducted by the hospitals. The hospital simply has to verify that the patient came from the geographic area relative to the MLK hospital and is a resident of Los Angeles County. The MLK-area hospitals received notice of the new program in November, and seven of the nine potential hospitals had already signed on by early December. Funds are readily available to physicians residing in the participating hospitals.

Oops, Did I Do That? --Employment & Compensation--

Fri, 01 Feb 2008 00:00:00 -0500

Can an unedited cover letter cost you a job? Could an innocuous comment knock you out of the running for a dream position? An article in the Winter 2008 issue of Unique Opportunities Magazine says yes. The most common mistakes candidates make in job searches are often the easiest to avoid. In the article, a professional recruiter for hospital organizations lays out what these mistakes are and how to avoid them: -Be careful with the send button. Electronic communication, while convenient, is also instant and permanent. It must be thoroughly edited and proofread before sending. Typos and unspecified letters are a definite turn-off for recruiters who are tired of reading badly edited cover letters. -Be polite. Much as it seems evident on its face, apparently it needs saying: do not threaten or otherwise be rude to recruiters or potential employers. Not only does it lessen one’s chances of getting that particular job, but one never knows when or where that recruiter may pop up again. -Money shouldn’t lead. Leading off recruitment letters with salary range restrictions reflects badly on the applicant. Money is important, of course, but such talk can always come later, once the applicant and recruiter have a better idea if the applicant is a fit for the job. -Be consistent. A candidate who constantly changes geographic, compensatory, or professional demands comes off as inconsistent and unreliable. Recruiters notice these things and do not remark kindly upon them. -Tailor a geographic target. The recruiter recommends keeping an open mind as to geography. Don’t just stick to one city and pursue a position there with blinders on. A fair look at surrounding areas may show you something you didn’t even know you wanted.

Smarter Scheduling Puts You In Control --Employment & Compensation--

Fri, 18 Jan 2008 00:00:00 -0500

How doctors schedule their patients’ appointments can make or break a steady flow into a private physician’s office, and Medical Economics analyzes 4 popular scheduling practices employed across the country. Dividing each hour into blocks of 15 or 30 minutes is the standard approach, though it fails to account for no-shows or patients arriving to the office late. With minimal flexibility, this strategy is most likely to lead to substantial backups throughout the day. More popularly, many offices schedule multiple patients for the same time and hope that within the given time frame, all patients can be treated. This approach, known as wave scheduling, works well in the case of a no-show or general tardiness, but problems arise when every patient shows up at the scheduled time. Medical Economics suggests using a modified wave schedule where two or three patients are front-loaded at the top of the hour while the remaining slots within the block are given to individual reliable patients. Open-access scheduling, where large numbers of slots are left open for same- or next-day appointments, is also an option. This allows doctors to treat patients more immediately, and works best when only a portion of the day, say 40 percent of the time slots, are left open for patients seeking immediate medical help. Clustered and group visits, where doctors can treat multiple patients with the same medical issues, can work, though there are significant privacy issues that need to be considered. The most successful practices employ some mix of these strategies, and the authors reiterate that there is not a turnkey solution that can work at all practices. Understanding what approaches work best for each individual practice is crucial, and having a qualified full-time scheduler who knows what works best is equally important.

Locum Tenens 101 --Employment & Compensation--

Tue, 15 Jan 2008 00:00:00 -0500

Currently seen as a sustainable career alternative to those in the medical field, locum tenens is becoming a readily accepted form of medical provision. In order to educate providers on how best to transition from traditional medical practice to locum tenens, experts in the field have outlined preparatory steps to make the transition easier. First, medical providers should seek out medical staffing agencies to determine what is expected of locum tenens candidates. Staffing agencies often require a full education and employment history, licensure verification, and a criminal and drug background check of potential candidates. They might also review medical malpractice claims and may require the candidate to complete a clinical skills assessment to determine clinical aptitude and competence in a given field. To complete the staffing registration process, most agencies require at least three professional references to verify clinical abilities and professionalism in medical practice. Experts recommend that candidates apply with more than one agency to increase options for medical placement. Upon being matched in a potential position, a locum tenens candidate should find out as much as possible about the location of the work to determine if the position is suitable. Information collected should include the name and location of the position, shift schedules, patient demographics, and housing accommodations to name a few. Lastly, prior to beginning a career in locum tenens, it is recommended that candidates speak to other locum tenens providers who have had extensive practice in the field. By learning about locum tenens experiences first-hand, future candidates can make an informed decision as to whether or not this is a suitable career.

Research in Hospice Possible, Even Helpful --Medical - Legal Matters--

Mon, 04 Feb 2008 00:00:00 -0500

Is it ethical to conduct clinical trials with hospice patients? The increasingly data-driven nature of medicine brings this question to the forefront, and a recent article on the American Medical Association’s news site contends that such research can have a beneficial effect while maintaining ethical standards. The article puts forth that knowing what constitutes the “best possible care”—the creed and purpose of hospice care—is not in fact possible without research and comparison of results. For example, research into cardiac disease yielded the discovery of beta blockers as an effective method of treatment. Furthermore, the authors contend that hospice patients aren’t universally non-functional and helpless, as they are often perceived to be. Many are cognizant and capable of making treatment decisions on their own. Proper and full education of hospice patients as to their treatment options and possibilities for research participation is, according to the article, in full keeping with established ethical norms. The authors propose novel rearrangements of placebo trials in order to minimize any ethical concerns that can arise from the use of placebos, such as a case wherein patients in one arm of the research receive the shorter-acting morphine solution plus a placebo in pill form, while patients in the other arm get the longer-acting pill plus a placebo in solution form. This way, participants and providers are adequately blinded to the intervention, ensuring that the data obtained is unbiased and applicable to future patients. Finally, the article contends that the ethical hurdles of hospice research are not insurmountable. Well-designed trials can provide valuable research data while maintaining the highest ethical standards and upholding patient dignity.

Your Risks When Practicing Telemedicine --Medical - Legal Matters--

Fri, 18 Jan 2008 00:00:00 -0500

Given growing trends in telemedicine, Medical Economics provides several suggestions for physicians looking to protect themselves from problems with licensure, conflicting state laws, and malpractice insurance coverage. Since telemedical doctors usually evaluate patients across state lines, there are many legal issues at stake. While some states offer limited licensing for physicians practicing telemedicine, it may be necessary to gain licensure for every state in which potential patients live. Additionally, if a patient living in a different state files suit, the laws of that particular state will most often apply. Doctors should familiarize themselves with malpractice laws in other states and make certain that their malpractice insurance covers operations in other states. Standards of care are becoming increasingly uniform, but doctors still need to recognize the potential problems that interstate practice can cause. There are as yet too few cases of major telemedical disasters to establish standardized practices at the national level, and there is very little evidence of doctors practicing telemedicine internationally. Given the novelty of the industry, doctors looking to practice medicine remotely need to exercise legal caution whenever possible.

Dispatch from the Pharmasphere: An Industry’s Fault Lines on Display --Medical - Legal Matters--

Fri, 01 Feb 2008 00:00:00 -0500

An Annals of Emergency Medicine correspondent reports on business practices at global pharmaceutical companies, noting that big pharmas keep a detailed database of doctors’ habits. Information kept on MDs includes how they prescribe (does the doctor have a “heavy pen”?), what they publish (are they a “Big Kahuna” or an “up-and-comer”?), and even how they feel about pharmaceuticals (do they have a sense of “industry affinity”?). Accordingly, this information is used to find doctors who are the best candidates for distribution of new prescription drugs and treatments. The report underscores a growing concern that pharmaceutical companies see doctors as sales agents, and pharma-friendly doctors see these companies as “The Bank.” Complaints about this data-gathering practice range from philosophical to legal, where significant privacy laws regarding the distribution of personal information differ across various jurisdictions. Yet, the report argues, there is little reason to indicate that pharmaceutical companies are as unethical and greedy as they may initially appear. Evidence from a recent conference of KOLs (“Key Opinion Leaders,” or influential doctors who negotiate with pharmaceutical companies regarding appropriate practice) confirms good faith that pharmaceutical representatives are doing their best to foster responsible communication with doctors. Whether the relationships between doctors and big pharmas are ultimately deleterious to public welfare remains to be seen, and time will tell if practices like MD habit databases are healthy business practices.

Take Care When Firing a Patient --Medical - Legal Matters--

Mon, 04 Feb 2008 00:00:00 -0500

While there are a number of reasons why a physician would be justified in terminating a physician-patient relationship, including a failure to pay bills, continual rude disruptive, or threatening behavior, patient dissatisfaction with care received, or a patient’s requirement of specialized services a physician cannot provide, special care should be taken in acting on this decision. Steven M. Harris, a partner at McDonald Hopkins, a firm concentrating on healthcare law, suggests that the physician should handle the termination like any other contractual relationship, by drafting a letter to the patient that specifically details why the relationship has been terminated. Additionally, it is prudent for the physician to consult an attorney, to avoid any possible legal issues in the termination process. In general, Harris advises the physician to: -Clearly communicate his or her decision, in as compassionate and supportive a manner as possible. -Offer assistance and provide the patient a reasonable timeframe in which to select another physician. -If medical care is needed during the patient’s search for a new physician, care should be continued by the original physician in the interim. -Notify the patient’s other physicians of his or her change in care provider. -Carefully document all related proceedings, including detailed records of discussions with the patient. Above all, the physician must be sure to always act in the best interest of the patient.

Hospital Emergency On-Call Coverage: Is There a Doctor in the House? --Medical Specialty Focus--

Thu, 01 Nov 2007 00:00:00 -0400

Community hospitals are finding it difficult to obtain on-call specialist physicians for 24-hour patient care, as a recent study notes that 73% of emergency departments in the U.S. report insufficient on-call coverage. Factors contributing to the reluctance of physicians to provide on-call services include decreased dependence on hospital admitting privileges, payment for urgent care treatment, and increased medical liability. Although hospitals have adapted strategies to secure on-call coverage, many continue to toil with insufficient coverage that threatens patient care and may increase healthcare costs overall. In the past, doctors agreed to provide on-call care in exchange for hospital admittance privileges. More recently, physicians are moving away from practice in hospital settings or shifting to specialty hospitals that don’t have emergency departments. Payment for medical care also proves to be a limiting factor, as physicians note that the payment they receive for on-call care is often inadequate, and the opportunity cost of leaving their private practice to attend the hospital is great. Furthermore, cases seen in the emergency department are often large and more challenging, which translates into a greater risk for those physicians who provide care, to say nothing of the quality of life issues involved with being on-call. To combat this deficit, hospitals are engaging in numerous strategies, including weekly or daily payment for on-call coverage, payment per-patient-seen while on-call, and more direct employment of specialty physicians by hospitals.

Outcomes of Care by Hospitalists, General Internists, and Family Physicians --Medical Specialty Focus--

Thu, 20 Dec 2007 00:00:00 -0500

This 2007 study compares the efficiency of the hospitalist model in patient care and health outcomes to healthcare provided by general internists and family physicians. The study found that after controlling for numerous patient, hospital, and physician-related factors, patients treated by hospitalists had a shorter length of stay and lower healthcare costs at the time of visit while exhibiting similar death rates and readmission rates to those patients treated by the other groups. Patients included in this retrospective cohort study were diagnosed with one of seven common illnesses (pneumonia, acute exacerbation of chronic obstructive pulmonary disease, ischemic stroke, chest pain, acute myocardial infarction, heart failure or urinary tract infection). Primary analyses showed that the majority of patients (43%) in the study were cared for by general internists, 32% received care from hospitalists, and the remaining 25% received care from family practitioners. The results of the multivariable analyses, after controlling for factors including the patient’s principal diagnosis, patient demographic characteristics, hospital characteristics, physician case volume and clustering of patients with physicians and of physicians with hospitals, show that patients cared for by hospitalists had a 0.4-day shorter length of stay (p<0.001) and costs that were $268 lower (p=0.02) than those patients treated by internists and family physicians.

The Palliative Care Initiative --Medical Specialty Focus--

Mon, 01 Oct 2007 00:00:00 -0400

With over 90 million people living in the US with chronic illness, many Americans will need some form of palliative care in the near future, but increasing healthcare costs translate into a huge burden for those requiring this form of care. Statistics show that approximately 75% of the nation’s healthcare spending goes to care for those with chronic illness. While many of those receiving palliative care are older and receive some coverage under Medicare, many out of pocket costs weigh significantly on individuals and families of chronic disease patients. For the incredible costs that patients receiving palliative care incur, the improvements in their health and overall quality of life are not always guaranteed. A new model of palliative care has now become necessary to aid in cost control and to solidify the promise of comfort and care with chronic disease. There has never been a better time to strengthen the use of palliative care within hospitals. Use of this care within hospitals has been shown to decrease costs by $6,580 per patient. It can also be performed by a multidisciplinary team that can work together to improve patient health, overall quality of life, control of symptoms, and direct management of pain.

Major Trends Affecting Hospital Payment --Payer & Reimbursement Issues--

Tue, 01 Jan 2008 00:00:00 -0500

As healthcare spending continues to increase, hospitals need to act more efficiently in key areas in order to maintain sustainable profit margins. Payment policing efforts will be very important, as hospitals are currently seeing 8 to 14 percent of revenues go uncollected. Hospitals should install monitoring systems to find out how and why underpayments are occurring and increase communication with payers like Medicaid, Medicare, or PPOs. Additionally, hospitals should analyze contract performance through modeling systems that predict how profitable each contract will ultimately be. Payers are increasing pressure to shift volume and cost risk to hospitals. To prevent hospitals from having to accept lower payments, hospitals should understand their preferred payment methods as well as what sorts of risks are acceptable to assume. By shifting risk back to providers as much as possible, variability of cost and volume will stabilize and hospitals will receive higher payments. As patients begin gaining more leverage through consumer-driven health plans, hospitals should establish benchmarks to ensure that their level of service is as attractive as possible for patients shopping for medical services in an open market. As health plans are consolidated in the name of efficiency, hospitals should strive to make sure that these efficiencies are not reached at the hospital's expense. Healthcare executives should strive to provide the highest level of care possible while remaining cautious about accepting too many financial concessions in negotiations with payers.

How to Collect From Patients Without Scaring them Away --Payer & Reimbursement Issues--

Fri, 15 Feb 2008 00:00:00 -0500

Realizing that missed payments can be a major source of discomfort to physicians’ offices, Medical Economics makes recommendations for dealing with irresponsible patients. Rather than treating all patients as freeloaders, doctors should assume that everyone wishes to pay their bills in good faith. Oftentimes patients do not realize that they are obligated to pay for every visit, or that certain procedures are not covered by their insurance. Educational tactics that gently remind patients of their obligation to pay for services can be very helpful as they do not antagonize passive individuals. When involving third-party collection agencies or reporting patients to a credit bureau, doctors should be certain that all other means of asking for payment have been utilized. Using an overly abusive collection agency that threatens patients can generate much unneeded negative publicity, and ruining a patient's credit by involving a credit bureau can have a ripple effect among the local community. In rural areas, doctors will find that losing long-term customers from word-of-mouth smear campaigns is much more financially troublesome than losing a payment or two from individual patients. Physicians must be firm in requiring timely payment, so as not to seem a pushover, but treating all patients with respect in regards to financial issues will ensure better long-term success at a private practice.

It’s Everywhere --Payer & Reimbursement Issues--

Mon, 24 Dec 2007 00:00:00 -0500

A recent survey conducted by the Leapfrog Group and Med-Vantage has shown that Pay-for-Performance (P4P) is widely utilized among hospitals and physician groups nationwide, and the programs are also increasing in number to include a broader base of physician specialties. Yet while its practice is becoming increasingly apparent, the overall effectiveness of P4P is much more difficult to measure. In an attempt to evaluate P4P practice, Med-Vantage surveyed 75 P4P sponsors including government agencies, health plans, and purchaser coalitions. Seventy-five percent of survey respondents reported that P4P helped to improve health care quality - including clinical health outcomes and overall patient satisfaction – and helped to decrease medical errors. Almost one third of respondents reported that cost performance improved upon initiation of P4P. The majority of respondents to the survey were physician P4P groups, which outnumbered hospital-based programs 4 to 1. Almost half of respondents said that their P4P programs were between one and two years old.

Simulated Data Study May Boost Hospitals’ Bottom Line --Payer & Reimbursement Issues--

Fri, 04 Jan 2008 00:00:00 -0500

The Methodist Le Bonheur Healthcare Research Center in conjunction with the University of Memphis Center for Healthcare Technology has recently developed an innovative approach to finding ways to boost nurse capacity and efficiency. Data farming is a technological way of examining what nurses do in one day in order to determine the best way to utilize them as resources within the hospital setting. First developed by the Marine Warfighting Laboratory for use in improving the understanding of combat situations, data farming uses computer simulations to analyze nurse workflow to find ways to increase nursing time at a patient’s bedside. Not to be confused with data mining, which uses de-identified real-patient data to study patterns in marketing, data farming essentially creates data to generate scenarios within a group of imaginary patients. Data farming can also find ways to improve physical environments in nursing areas. By developing ways to group nurses together and requiring them to do less walking between patients, nurses can perform better and more efficiently overall. Preliminary data from this study has shown the potential of data farming to decrease patient hospital stays, which can reduce healthcare costs for the hospital’s bottom line. Decreased patient stays may help improve nursing work capacity which, overall, may also aid in the retention of nursing staff and a reduction in nurse-to-patient ratios.

Aetna to Stop Paying for Anesthesiologists During Colonoscopies --Payer & Reimbursement Issues--

Mon, 04 Feb 2008 00:00:00 -0500

At a meeting in January between Aetna insurance representatives and one of Atlanta’s largest gastroenterology groups, fifty doctors gave out letters of resignation to the company and threatened to pull out of the insurer’s network in protest of a change in the company’s policy regarding anesthetizing patients during colonoscopy procedures. Beginning in April, the company is set to end its coverage of anesthetization of patients during the invasive procedure. Physicians of the Atlanta-based gastroenterology group are asking Aetna to rethink their decision since it will most likely discourage patients from undergoing the important cancer-screening procedure. Aetna is following suit in withdrawing coverage of the colonoscopy procedure after Humana and Wellpoint made similar change in their coverage within the past two years.

Study Supports Periodic Re-Certification For Doctors --Credentialing, Licensure, Quality Management--

Mon, 21 Jan 2008 00:00:00 -0500

In 2006, specialty medical boards began requiring periodic re-certification for physicians, though scientific justification for the decision was at the time lacking. A new study led by Dr. Alexander Turchin of Brigham and Women’s Hospital in Boston found a positive correlation between recent physician re-certification and proper medical treatment for hypertension patients. The study’s results, to be published in the February issue of Circulation, supports current mandatory re-certification practices, according to Turchin and his colleagues. For patients admitted to hospitals for hypertension, increased intensity of care is indicative of higher quality care. Looking at 54,000 medical visits from 2000 to 2005 where patients showed signs of high blood pressure, Turchin compared changes in treatment intensity with the most recent time doctors were re-certified. The highest frequency of treatment intensification occurred where physicians were certified within one year of the hospital visit. For every decade since the most recent board certification, treatment intensity was diminished by roughly 21 percent, with the worst care given by the six physicians who were last certified over thirty years ago. The study gives credibility to specialty boards’ decision to require re-certification, and Turchin hopes the research will be used to increase educational efforts to “help improve quality of care delivered by physicians.”

Microsoft, Mayo Clinics join to empower patients, protect privacy --Credentialing, Licensure, Quality Management--

Fri, 25 Jan 2008 00:00:00 -0500

Microsoft and Rochester, Minnesota's Mayo Clinic recently announced a partnership that will focus on increasing patient-to-physician dialogue for individuals using the Mayo Clinic Health Solutions. The partnership will focus on providing new technology that enables patients to have more control over decisions affecting their health. Using Microsoft's HealthVault program, the partnership will build "solutions that are dynamic, secure and focused on the needs of the user, in order to effectively improve health and well-being," according to Peter Neupert, corporate vice president of Microsoft Health Solutions Group. Protecting patients' personal information has been a major focus of the program, and a spokesperson for the Coalition for Patient Privacy has stated that the HealthVault technology is the first system to pass the coalition’s rigorous privacy standards. Further details of this project are expected to be announced in the near future.

Engage Employees to Improve Staff and Patient Satisfaction --Credentialing, Licensure, Quality Management--

Tue, 01 Jan 2008 00:00:00 -0500

In hospitals, there is a well demonstrated correlation between patient satisfaction and employee satisfaction. Creating a hospital that provides the highest level of service for patients also means that employees should be given the best possible environment in which to work. According to a study by Press Ganey, the biggest cause for employee dissatisfaction is lack of participation in decision-making processes involving hospital organization or improving customer service. Strategic management initiatives that involve staff members in decision-making will benefit the hospital as a whole and in turn increase patient satisfaction levels. Exemplifying the idea of employee participation, at King's Daughters Medical Center (KDMC) in Ashland, Kentucky, the hospital management created a program to generate ideas for improving hospital operations. All employees are encouraged to submit proposals for improving customer service. KDMC team leaders vote on which initiatives to implement, and winners are given an unbudgeted capital item. Other management techniques include sponsoring a Customer Satisfaction Innovations Fair where employees are shown new opportunities for improving customer service. Involving employees in the management of a hospital can be a useful way of improving customer service all around. Hospital executives should continue to monitor patient satisfaction levels, making this information available to all employees. Further, rewarding employees who show a unique commitment to customer service will ensure that staff and management are working together towards an overall improvement of hospital operations.

Mapping Opens Hospitals’ Eyes to Patient Experience --Credentialing, Licensure, Quality Management--

Fri, 01 Feb 2008 00:00:00 -0500

A growing number of hospitals are beginning to employ “experience mapping” techniques to gain better insight into their patients’ expectations and experiences. Such processes, which combine in-depth patient interviews with general research on patient needs, are proving useful when undertaking major planning initiatives such as designing a new facility, selecting a new information technology strategy, or embarking on a rebranding campaign. Hospitals utilizing experience mapping techniques typically start by establishing a team of internal stakeholders responsible for delivering care in a specific project area. The team works with researchers to draft an “experience map” to serve as a guide for patient interviews. They next employ a variety of interview methods, including one-on-one settings, small groups, or patient intercept techniques. In small group or one-on-one interviews, patients are asked to recall their first experience with the hospital and then compare it to later experiences. When conducting a patient intercept, researchers follow patients through their entire hospital visit, from admittance to discharge. As a final step, team members and other hospital staff examine interview transcripts and research and try to devise ways to translate what they have learned into practice. Results from such projects have ranged from more patient-friendly online services to ads incorporating physician and staff photos to humanize care as part of a rebranding initiative.

Healthcare Providers Will Broaden Adoption of Clinical Technology in 2008 --Healthcare Technology--

Wed, 23 Jan 2008 00:00:00 -0500

According to an annual study published by the Gallantry Group, 2008 should see major increases in available clinical technology at healthcare facilities of all sizes. Nearly half of healthcare providers will spend upwards of 40 percent of their existing technology budgets to increase current offerings, and by the end of 2008, more than 80 percent of healthcare facilities should have invested in the following technologies: -Digital medical imaging -Medication management/e-prescribing -RIFD patient identification/drug distribution -EMR/EHR -Computerized physician order entry -Mobile applications (e.g. charge capture, rounding, prescriptions) -Patient documentation -Patient care planning solutions The report surveyed facilities of all sizes, from 150 beds to over 1,000 beds, including both public and private hospitals.