VeinInnovations

Wearied by Warnings

Can you have email without a spam filter? Personal and important missives from friends, family, and co-workers would be lost in a sea of bilge junk emails. Eventually, most of us would miss something that mattered.

I’ve written before about distracted doctoring caused by the use of smartphones in medicine and text messages. Medical professionals are faced with the opposite problem when dealing with EHR alerts.

Whenever an order is typed into an EHR or e-prescribing system, there’s a pop-up. There are so many alerts, doctors and nurses are ignoring them. Much like the spam we all dread, warning alerts are being filtered as medical professionals close the box before reading them. Don’t think that they’re being nonchalant: the majority of these alerts aren’t life saving.

Some alerts are critical, but because of fatigue, they sometimes aren’t read. Solutions are already in the works. Advances in technology make customization easier than ever before so nuisance alerts are reduced. As we work to perfect health IT systems, we all expect some bumps in the road that will hopefully lead to smooth sailing.

http://saportareport.com/leadership/healthcarepractice/2012/05/01/wearied-by-warnings/  

Keep to the Code

Thanks to years of fictional medical dramas, just about any American can answer the question, “What is a code blue?” But how many Americans could tell you what an ICD-9 code is?

Anyone who works as a medical coder could: ICD-9 is the International Classification of Diseases, ninth revision. In order for a medical practice to stay open and get paid, they’ve got to have at least one (probably more) medical coder on staff full time. Medical coding is a daily headache, and it’s also the fastest growing job in America. From 2010 to 2020, medical coding employment is expected to increase by 21 percent.

It’s easy to get overwhelmed by the world of coding; the sheer number of acronyms for coding systems could swallow you whole. No matter how you feel about ICD-9, ICD-10, and coding regulations, they’re here to stay. I’ve written before about the importance of business when running a practice. If your practice doesn’t code correctly, you’ll see claims rejected over and over until you get it right. Without smart, detail-oriented coders, you’re not going to get paid. Take your time and hire a great coder. Your headache will shrink exponentially.

http://saportareport.com/leadership/healthcarepractice/2012/04/24/keep-to-the-code/

Medical Waste Solutions

April 22 is the 42^nd Earth Day- what started as just American activism has spread across the globe. The Earth Day Network (http://www.earthday.org/) estimates, perhaps a tad optimistically, that this year one billion people will participate in education and activism. For most Americans, Earth Day makes us pause to consider our carbon footprint. Our first thoughts are to turn off the lights, replace old appliances with more efficient ones, and start recycling! What can a medical practice do to pitch in?

Medicine heals, but it also creates a lot of waste. The last estimate of medical waste, from the 1990s, was two million tons a year. This is an avoidably high number, and there are groups working to reduce the amount of trash. Practice Greenhealth is a nonprofit group that works with hospitals to institute sustainable health care policies. Children’s Healthcare of Atlanta at Hughes Spalding is a member.

More hospitals are joining in cutting waste; we can thank the recession, in part, for some of the motivation. Recycled medical supplies are much cheaper (and just as safe). Reusable gowns and linens have replaced disposable ones, and unnecessary tools have been removed from packaged surgical kits. At my own practice, we replaced paper shorts for reusable cotton ones a few years ago. It saves money and reduces our footprint. That hospitals are saving lives, and are now joining in to save the planet, is something we can all celebrate on Earth Day.

http://saportareport.com/leadership/healthcarepractice/2012/04/12/solutions-to-reduce-medical-waste/

Business and Medicine Are Equally Important

What factors contribute to the success of a practice? Our first thought is usually the team of medical professionals in the office. As a founder, you take your time assembling a team of experienced, trustworthy medical professionals. It’s important to be surrounded by practitioners you can rely on. But your practice won’t make it unless you spend an equal amount of time and effort on hiring the best staff to run your business.

In order for your practice to run smoothly, you need a great business staff. A medical practice administrator wears a number of hats and makes sure your practice runs smoothly so you can focus on your patients. So take your time, and make sure you hire the right person for your practice. Here are a few tips for making sure you find the administrator that best helps your practice.

· They have three to five years of healthcare experience.

· Their skills mesh with your needs. If you’re struggling with the transition to EHRs, hire someone with EHR experience. If you need help with billing, hire someone with proven skills in that area.

· Make sure whomever you hire is familiar with, and comfortable using, social media. Social media’s role is increasing, even for health care practices, and this skill is a must have.

· Take your time. The administrator you hire should have great people and communication skills. And remember that they really need to click with your staff!

http://saportareport.com/leadership/healthcarepractice/2012/04/03/business-and-medicine-are-equally-important/

The Internet and the Doctor-Patient Relationship

Not too long ago, patients relied almost exclusively on doctors and nurses for medical information. Since the advent of the Internet, individuals have access to a slew of information about their health. Most patients in the waiting room have done at least a little research about what’s ailing them. How should we handle the changing dynamic in the doctor-patient relationship?

My feelings are mixed regarding these sites. As long as they are regarded as a useful adjunct for information, but not by any means the final word, they offer easily accessible information to interested readers. When patients seek to self-diagnose and arrive certain about what’s wrong, doctors have some extra work to do. Health care professionals have to un-teach their patients so they can treat them properly.

When making a diagnosis, it might be a good idea to warn patients away from health sites. A symptom checker provides a plethora of possible maladies. A sore throat can return results as benign as a cold to something as harrowing as scarlet fever! Patients might cause themselves unnecessary anxiety they could otherwise avoid.

Online sites can be a good thing if a patient is seeking to educate themselves about their condition and uses a reputable source. Doctors refer patients with new diagnoses to books, brochures, and support groups. Most of these resources have an easy-to-access home on the web, and we shouldn’t eschew good information on the Internet.

As health care professionals, we need to continue to educate our patients. While online resources can be helpful, we must make sure our patients know that they are never a substitute for the expert and eyes-on opinion of an actual provider.

(Source: saportareport.com)

Progress and Practicality

Driving in the streets of Atlanta is stressful; besides dealing with the usual heavy traffic, we’ve all had close calls with distracted drivers. In July 2010, the city outlawed texting while driving. When I Google searched to find the actual law, I found a litany of personal injury attorney websites instead. We can all agree that texting and driving is unsafe. So would it surprise you to learn that quite a few medical professionals are texting or talking on their phones during procedures?

Medicine and technology are inextricably linked, and advances in technology save lives. A doctor with an iPad holding your medical information in an emergency could make all the difference in a crisis. Mobile health (mHealth) is here to stay. The pitfall medical professionals must avoid is distracted doctoring, an unfortunate byproduct of our technological progress.

How do we put an end to distracted doctoring? It starts with separating work functions and social functions on mobile devices. One option is to keep a smartphone just for work. Don’t store any personal numbers on your smartphone, and don’t give the number to friends and family. And make sure the only apps you download are for work, not play. Remember that you’re treating the patient- that’s where your focus should be. Shelve the tech in the exam room unless it’s absolutely necessary; and if you do have to use it, explain why and what you’re doing to the patient.

http://www.nytimes.com/2011/12/15/health/as-doctors-use-more-devices-potential-for-distraction-grows.html?_r=2&scp=4&sq=medical%20devices&st=cse

My Phone, My Self: Health on an iPhone

An important aspect of diabetes care is monitoring how well you control your blood sugar, and the best way to do that is by recording it each and every time you test it. Let’s be honest: even the best patients are going to slip on this. Carrying pen and paper everywhere? Not likely. But then came the smartphone. Most people keep their friends close, their enemies closer, and their smartphones closest. There are thousands of medical apps available for smartphones, from the possibly helpful (a white noise app to help you sleep) to the pretty good (an app that helps you determine how healthy any packaged food is). The FDA approved one of the most innovative smartphone technologies for health last year. iBGstar is a blood glucose meter that connects directly to your iPhone. Information is stored instantly, arranged so you can track progress, and can easily be emailed to your doctor. The program also gives users space to record important factors like what they ate or if they’d been exercising. The FDA has been notoriously slow to approve medical technology on smartphones, but I’m sure that the iBGstar is just the first of many similar health devices to come. And if they make it easier for patients to keep track of their health, and take better care of their selves, it’s a good thing. 

http://saportareport.com/leadership/healthcarepractice/2012/03/19/my-phone-my-self-health-on-an-iphone/

Dealing with Malpractice

Utter the word “malpractice” around anyone in the medical profession, and an ominous feeling settles over the room. Malpractice is an unfortunate fact of life in medicine today. It is estimated that by the age of 65, 75% of physicians in low-risk specialties will face a malpractice claim. For those in high-risk specialties, such as neurosurgery, 99% of physicians will face a malpractice suit by age 65.

The large majority of claims do not result in any payment to the patient and the doctor is vindicated. Still, direct and indirect costs of malpractice suits add up to about $55 billion yearly. Malpractice is one of the foremost causes of stress for doctors (some claim it’s right up there with life-and-death circumstances). So make sure you’ve got good malpractice insurance!

When you sign before checking all the particulars of your malpractice insurance policy, it can come back to haunt you. This story in Renal and Urology News illustrates the unfortunate point. Faced with a malpractice suit, a doctor met with his lawyer and prepared for the trial, certain he would be vindicated. His insurance company decided they’d rather settle. The doctor’s desire to fight the suit was ignored, and the case was settled without his consent.

A “consent to settle” clause means that your carrier will have to first obtain written permission from you in order to settle the claim. Carefully go over your malpractice insurance contract, checking all of the fine print. What does your insurance cover? What does it control? In a malpractice suit, your reputation is on the line. Don’t let your insurance company make a decision that’s easy for them over something that is beneficial for you.

http://saportareport.com/leadership/healthcarepractice/2012/03/12/dealing_with_malpractice/

Responding to Negative Reviews Online

I wrote previously about the importance of “service with a smile” and the growing influence of online review sites. One such site, RateMDs.com, has become the source of ire for many doctors in North America.

 RateMDs was founded in part by Joanne Wong. She was given blood tests and prescribed medicine for a virus her doctor refused to identify for her. Though she asked repeatedly for the simple information, the doctor (for reasons no one can fathom) refused to tell her. She only learned that she had hepatitis A after she obtained her medical records.

 Many patients do not confront their doctors when they feel they’ve been treated poorly. They tell friends, family… and increasingly, share their feelings on the Internet. These ratings can he helpful or incredibly harmful, even libelous. RateMDs reviews are anonymous. Doctors citing damage to their reputations and objecting to libelous material have sued the site, but not with great success.

 Medical Justice, a group founded Dr. Jeffrey Segal to fight frivolous malpractice lawsuits, created a contract to combat negative patient reviews. In the contract, doctors promised not to break federal patient privacy protections in exchange for patient’s agreeing not to post public comments about them. Doctor-patient confidentiality is not a bargaining tool. The form has been taken down after a case in New York.

My advice is to monitor your ratings and stay up to date about the legal action others have taken to see what’s working and what isn’t. As in medicine, the best cure is prevention: Treat every patient with care and be vigilant about privacy concerns and listen to and ask follow-up questions about the patients’ concerns.

Link to the SaportaReport:

http://saportareport.com/leadership/healthcarepractice/2012/03/06/responding-to-negative-reviews-online/

Healthy Financial Practices

I’ve written earlier about how a health care practice should respond to and use new technology. This post deals with nuts-and-bolts accounting, something as old as Hippocrates himself.

How much is your monthly A/R (accounts receivable)? Quick economics refresher: accounts receivable is money owed by patients, not yet paid. A/R is recorded as an asset on your balance sheet. If your practice’s A/R exceeds 1.5 times your monthly charges, it’s time to take a closer look at how your billing company is operating.

First, check your 0-30 days A/R; this is your current A/R. It’s also where you’d like the majority of your claims to be. Next, take a look at your 30-60 days A/R and pay attention to the payer mix in this category. Remember that Medicare claims are supposed to be paid within 14 days; if there are Medicare claims 30-60 days old, it’s time to give your billing company a call. A/R more than 60 days old should only consist of worker’s compensation, liens you take, or some private insurance funded by specific states.

Make sure your billing company has an organized system for dealing with unpaid claims after 30 days. Another easy fix if you find problems with your A/R is double-checking to make sure you’re sending clean information to your billing company. A misspelled name or inaccurate policy number can cause unnecessary headaches for you and your staff.

The better your practice is about turning accounts receivable into cash on hand, the more you can invest in your business to continue growing it.

(Source: saportareport.com)