Believe it or not, there are some physicians out there who only want to practice medicine, the noble profession to which they've dedicated their entire lives.
For some reason, claims coding updates, haggling with insurance companies, monitoring the new walk-in clinic across the street, recruiting new partners to the practice, and developing relationships with referring physicians don't interest them.
Depending upon who's talking, these medicine-only physicians represent either a dying breed or a growing trend.
David R. Neiblum, MD, says these single-hat physicians are disappearing. "We're probably seeing it less so than in the past, where people used to go into practice and not worry about anything except seeing patients and doing clinical activities," says Neiblum, the managing partner at West Chester Gastrointestinal Group, an eight-physician practice in West Chester, PA.
"Now, if you are an owner or a partner in a practice, the business part of it becomes large depending upon your role in it," he says. "So much has changed in healthcare with reimbursement issues and having to worry about increased costs and decreased reimbursement. There is much more of a focus on what we are allowed to do, how to code properly, how to stay in compliance with Medicare regulations, and so on. There is so much more bureaucracy and governmental intrusion and rules that we have to be cognizant about, not just practicing and winging it. You see a patient and you have to know 'are you coding a three-level office visit or a four, and if you code a four can you prove you did that much work?' "
Kenneth T. Hertz, a senior consultant with Alexandria, LA–based MGMA Health Care Consulting Group, is in the other camp, claiming that younger doctors are more inclined to shirk their business duties.
"One of the things we are finding is that a lot of the young docs coming out of school want to go into practice and do one thing: practice," he says. "They don't want to deal with the business side. They don't want to deal with governance issues. They don't want to deal with any of those issues. So, what is happening in some of the practices we are working with, the senior docs are asking ‘what can we do to get the younger docs to get interested in the business side of the practice, the things that need to be done to keep the practice going?'"
To some extent, Hertz says the negligence starts in medical schools. "The business side is something that is simply not talked about in medical school," he says. "In medical school, you 'learn how to be a doctor.' The issues related to running a practice, to how do you code and document properly, to how do you deal with personnel issues, are not talked about."
Because physicians make money when they're practicing their highly skilled profession, it's understandable if they don't want to waste time on less-profitable distractions. But, Hertz says, physicians in private practice have to accept that they are businessmen as well as healing professionals, and that both the clinical and business sides of the practice come with important responsibilities.
"There is the notion of the more time you spend practicing, the more money you make, sure," he says. "But as a business owner, you have certain responsibilities. In that sense, running and owning a medical practice if you are in private practice is really no different than owning the UPS store."
Understand management vs. governance
Hertz says it's also important to make a distinction between the physicians' roles in the management and the governance of the practice.
"Running the practice is management. Physicians don't run the practice. They provide the governance for the practice," he says. "It is their responsibility to set the vision, set the direction, and set the policies. But they hire people to manage the practice."
Hertz says it's critical to spell out the business- and governance-side obligations to new physicians before they're hired.
"In the interview process, when a practice goes to recruit new docs, it is where they have conversations with them, and they discuss what is going to be involved in being part of the business," Hertz says. "'Dr. Smith, you are going to be expected to serve on the board and attend meetings and help market your practice.' If the candidate says 'I'm not interested in that,' you can decide to hire the doc and run into upset down the road or you make a decision that maybe this doc doesn't mesh with the practice."
But in this age of physician shortages, perhaps your practice can't be that choosy. So, be flexible, but also be clear.
"If we find Dr. Jones is absolutely perfect in every way except that he says 'I just want to be an employed doc, I don't want to be an owner, I don't want to do this, that, and the other thing,' it is incumbent on us to be creative and find a way to make it work if we think that Dr. Jones will add that much to the practice," Hertz says.
"Laying out expectations is appropriate. A lot of practices get into trouble when they don't. But by the same token, the idea that it's business as usual is not what today is," he says. "Today it's 'how can we approach it differently? What can we do to make the situation work for us and the candidate? Now is the time we have to be more creative in how we deal with these issues.'"
Consider compensating business responsibilities
Neiblum says the up-front discussions about business responsibilities during the interview process have helped West Chester Gastrointestinal Group avoid friction down the road. New doctors need to know that it's not all going to be Marcus Welby.
"Talk about the business end and how much they are expected to be involved," he says. "Certainly if they are not going to be actively involved, they still have to know about it and keep things in mind and know how to code properly and how to be in compliance with regulations. You can't escape it entirely. Even if you are not going to be a big decision-maker, you have to be aware of them."
Neiblum says West Chester Gastrointestinal Group compensates him for taking extra time to address business issues beyond his normal practice schedule.
"We have a good staff who do most of the things, and that is 90% of the battle, and I keep an eye on things globally, doing some things on my own but often delegating," he says.
He warns, however, that sometimes it's possible for practice partners to be too involved in business operations.
"We have a good structure, but maybe a little too much of the too-many-cooks-spoil-the-brew mentality," he says. "On some things, it's best where I would just make a decision and let's move on. Sometimes we sit down and say this is what we want to do and all of a sudden you start getting dissenting opinions and it becomes a big issue when before it wasn't. But besides that, the structure is pretty good."
For most of us, watching 2009 recede in the rearview mirror is a pleasant sight. Good riddance to a lousy year and a lousy decade!
But even within the worst economic climate since the Great Depression, 2009 was not such a bad year for job growth in the healthcare sector—which includes everything from hospitals to outpatient surgery centers to podiatrists' offices—when compared with the overall economy.
Yes, healthcare job growth was slower than in years past. Bureau of Labor Statistics preliminary data show the healthcare sector created 267,000 new jobs in 2009, including 22,000 payroll additions in December. That's a considerable drop from 2008, for example, when healthcare created 363,600 new jobs.
Before you grouse, let's get some perspective. That we are even talking about "job growth" in this economy should be a cause for celebration. Healthcare has created 631,000 jobs since the recession began in December 2007. In that time, the number of jobless people in the nation has risen from 7.7 million to 15.3 million, BLS figures show.
"One thing we've learned is that healthcare was not completely recession-proof over the last year and a half as we've seen a number of large-scale layoffs across the board," says David Cherner, managing partner of Health Workforce Solutions, LLC, a San Francisco-based research firm. "But, certainly, it is much stronger than any other segment of the economy."
The ambulatory services sector, for example, has shown itself to be remarkably resilient and consistent, having created 179,000 new jobs in 2009, 182,400 jobs in 2008, and 180,600 jobs in 2007.
Cherner says he was surprised to see that job growth at the nation's hospitals was essentially flat in December, with only 1,400 new jobs reported. That—at least temporarily—puts a halt to an encouraging uptick in hospital job growth over the last few months of 2009. The hospital sector added 37,600 jobs in 2009, the lowest level of growth in the decade. Hospitals created 137,100 jobs in 2008, and 105,700 jobs in 2007, BLS data show.
"What I found interesting was the increase was not larger, based upon some notable hiring announcements we've seen over the last few months in a number of large markets," Cherner says. "That tells me that the bulk of these jobs have yet to be filled and will be filled over the course of 2010."
"After several quarters of delayed expansions and in some cases layoffs, even of patient care staff, the last two quarters we saw slight improvement across the board, and in the last quarter we have seen some healthy improvement across many areas," he says.
Cherner says many of the cutbacks and project delays during 2009 were a response to the economic unease about deteriorating financial conditions.
"But as a result of the belt tightening, we are also seeing many institutions reporting better-than-expected results over the last couple of quarters," he says. "Anecdotally, I've heard from a number of hospitals that they may have overreacted in terms of staff reductions and they are now trying to put stuff back on track."
Cherner's take on all of this strikes me as a fair assessment of the prospects for hospital job growth in 2010. It only makes sense that hospitals would cut back on labor costs in the face of tanking investment portfolios, adverse patient mixes, and other attacks on the bottom line.
But, it also appears that many hospitals have taken the last few months to assess their financial situations, as many investment markets have rebounded, and reassess their strategic visions.
All of this is occurring as Congress cobbles together reforms that could make health insurance available to another 30 million people, and as our nation's population—now at 308 million—gets older, fatter, and sicker.
Predictions are just that. But there is one thing you can bank on in healthcare, even when everything else is in flux. The demand will always be there.
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Lawson Software announced this week that it will acquire Healthvision Solutions, Inc., through the acquisition of privately held Quovadx Holdings, Inc., its parent holding company. The all-cash transaction of $160 million is subject to regulatory approvals and expected to close this month.
Healthvision is a Dallas-based company whose Cloverleaf integration technology connects software applications and technologies to facilitate data flow at large healthcare organizations.
Lawson said in a media release that the Healthvision acquisition allows it to connect multiple source systems and provide healthcare providers with quick access to clinical, financial, and operational information reliably and securely, regardless of the source system. Lawson said it can now help hospitals and healthcare organizations protect their existing technology investments, while adapting to future compliance and interoperability requirements driven by healthcare IT reform.
"Most healthcare organizations have added or acquired multiple IT systems throughout their lives and want to get the most out of these assets. Taking on this integration task themselves requires building, monitoring, and maintaining their own interfaces. That's expensive, time-consuming, and difficult and results in large organizations maintaining thousands of interfaces," said Jim Catalino, senior vice president and general manager of Lawson Healthcare.
"Smaller healthcare organizations usually don't have the money or IT resources to even do this task so their systems can't talk to one another. Big or small, these IT costs and disparate systems add to the big issues healthcare faces in terms of efficiency, affordability, and patient care. Healthvision eliminates the need for homegrown interfaces and the cost of those interfaces and allows healthcare CIOs to allocate IT resources to more strategic needs," said Catalino.
Healthvision has 800 customers, including 200 joint customers with Lawson, and its products are used in more than 3,000 healthcare facilities around the world. Healthvision product lines also include a Health Information Exchange platform that links an entire healthcare network consisting of hospitals, clinics, laboratories, pharmacies, and other stakeholders like payers, partners, and vendors, according to the company.
Based in St. Paul, MN, Lawson provides software and services to 4,500 customers in equipment service management and rental, fashion, food & beverage, healthcare, manufacturing & distribution, public sector, service industries, and strategic human capital management across 40 countries.
Primary care physicians could increase Americans' willingness to become organ donors by educating their patients on the process during routine office visits and discussions about end-of-life care, according to a study in the January issue of the Journal of the National Medical Association.
"With more than 100,000 Americans waiting for organ transplants, it is crucial that we find new ways to increase donation. New efforts should focus on improving communication on the subject between healthcare providers and their patients," said J. Daryl Thornton, MD, lead author of the study.
Thornton conducted the research as a scholar with the Harold Amos Medical Faculty Development Program, a national program of the Robert Wood Johnson Foundation. Thornton is medical director of the Medical ICU at MetroHealth Medical Center in Cleveland and an assistant professor at Case Western Reserve University. He is also a researcher at the Center for Reducing Health Disparities at MetroHealth and CWRU.
Most often, the decision about organ donation is made by individuals coping with the death of a family member. Obtaining consent for organ donation under these circumstances is complicated, sensitive, and often unsuccessful. Most individuals who are organ donors make the decision during a visit to their local departments of motor vehicles, where workers are often not fully trained to address questions about the topic, the study found.
Shifting the location for requesting consent to a routine patient care setting may have an important impact on the number of organ donors, according to the study. About 65% of physicians surveyed agreed that organ donation discussions were within the scope of their medical practice, but only 4% reported having discussed the subject with their patients.
This is in spite of the fact that 30% of physicians reported talking about end-of-life care with their patients. The authors believe the study is the first to report on the paucity of organ donation discussions among primary care physicians and their patients.
According to physicians, the reasons for the low number of organ donation discussions include: the lack of formal training in organ donation, with only 17% of physicians receiving such training; and the lack of staff to address organ donation issues with patients, as reported by 64% of physicians. A small percentage of doctors reported having donor information available in their medical offices (11%), with even fewer having donor cards available (5%).
Primary care physicians, who had received organ donation education or who regularly discussed end-of-life issues with their patients, were more likely to talk about organ donation issues, the study found.
For this nationally representative study, 831 family and internal medicine physicians were surveyed. Hispanic and African-American primary care physicians were oversampled to determine how frequently they discussed donation with their patients and what factors encouraged or inhibited such discussions.
Race and ethnicity of primary care physicians may play an important role in improving organ donation, particularly among minorities. African-American and Hispanic physicians are likely to care for patients of similar race and ethnicities, according to the study.
As of Jan. 6, there were 105,307 people waiting for organ transplants, according to the United Network for Organ Sharing. People of color are disproportionately in need of donated organs, making up more than 50% of those waiting for a donation. African Americans, who comprise only 15% of the population, represent more than 25% of those on organ donation lists, and are more likely to die while waiting for an organ transplant.
"Increasing organ donation among people of all ethnicities should be a national healthcare priority. By increasing the number of organ donors, we can extend both the length and quality of life for those who need transplants," Thornton said.
The healthcare sector created 267,000 new jobs in 2009, including 22,000 payroll additions in December, new Bureau of Labor Statistics preliminary data released this morning show.
The overall economy shed 85,000 jobs in December as the nation's unemployment rate remained unchanged at 10%, according to BLS preliminary data.
Of the 22,000 new jobs in the healthcare sector in December, the biggest job growth came from physicians' offices, with 9,000 payroll additions, and home health services, with 8,000 payroll additions. Physician offices added 55,000 jobs in 2009.
The healthcare sector—which includes everything from hospitals to outpatient surgery centers to podiatrists' offices—has added 631,000 jobs since the recession began in December 2007. In that same time frame, the number of jobless people in the nation has risen from 7.7 million to 15.3 million, BLS figures showed.
Other healthcare highlights include:
Ambulatory healthcare services continue to push job expansion in this sector, with 179,000 jobs added in 2009, and 23,000 in December alone.
Outpatient care centers increased jobs by 13,000 in 2009.
Home healthcare services increased 74,000 jobs in 2009, with 8,000 added in December.
The BLS information is considered preliminary and may be revised.
The National Association of Insurance Commissioners told Congress this week it supports health insurance exchanges but wants them to be established and administered at the state level.
In a letter this week to House Speaker Nancy Pelosi, D-CA, and Senate Majority Leader Harry Reid, D-NV, NAIC said it backs the goals of healthcare reform to curb rising costs and improve quality of care. The association offered a qualified endorsement of provisions in the House and Senate bills that would:
Extend guaranteed issue protections to the non-group health insurance market
Eliminate pre-existing condition exclusions and annual and lifetime limits
End the practice of rating policies based upon gender and health
"The NAIC supports these measures, if they are paired with an effective individual mandate to mitigate the risk of adverse selection," said NAIC President and West Virginia Insurance Commissioner Jane L. Cline in the letter. "We also support the creation of state-based health insurance exchanges to streamline the process of purchasing coverage and make meaningful comparisons of health insurance plans much easier."
However, NAIC said consumers will benefit most from reform that ensures continued consumer protection and oversight of health insurance policies at the state level. NAIC wants Congress to:
Oppose the creation of a new federal Health Choices Commissioner and Health Choices Administration. Instead, regulators recommend health insurance exchanges be established and administered at the state level.
Ensure that all group policies be subject to the bill's reforms at the end of a five-year grace period and ensure that any risk adjustment be applied to both grandfathered and newly-issued policies.
Impose stronger penalties under the individual mandate provisions.
Avoid provisions that could separate the regulation of premiums from the regulation of solvency.
Allow the federal government to quickly shut down fraudulent multiple employer welfare arrangements that falsely claim to be exempt from state regulation.
Ensure that the effective dates of provisions in the new law are coordinated with implementation of the individual mandate and subsidies in order to mitigate the risk of adverse selection.
Insist that nationally-sold plans be subject to all statutes and regulations that apply to other plans being sold to the same population and that they remain subject to the oversight of state insurance regulators.
The NAIC also urged Congress to address healthcare costs, warning that unless spending is brought under control, all of these reforms will shift the financial burden from one group to another without reducing overall cost.
HHS today released its first National Health Security Strategy to protect public health during large-scale emergencies, such as natural disasters, bioterrorism strikes, and pandemics. The strategy sets priorities for government and non-government activities over the next four years.
"As we've learned in the response to the 2009 H1N1 pandemic, responsibility for improving our nation's ability to address existing and emerging health threats must be broadly shared by everyone—governments, communities, families, and individuals," HHS Secretary Kathleen Sebelius said in a media release. "The National Health Security Strategy is a call to action for each of us so that every community becomes fully prepared and ready to recover quickly after an emergency."
The strategy provides a framework for actions that will build community resilience, strengthen, and sustain health emergency response systems, as well as fill current gaps, she said.
"Events which threaten the health of the people of this nation could very easily compromise our national security. Whether it's a pandemic or a premeditated chemical attack, our public health system must be prepared to respond to protect the interests of the American people," Sebelius said. "In order to be prepared to both respond to an incident and to recover, we need a strong national health system with individuals and families ready to handle the health effects of a disaster."
The National Health Security Strategy and an interim implementation guide outline 10 objectives:
Foster informed, empowered individuals and communities
Develop and maintain the workforce needed for national health security
Ensure that situational awareness so responders are aware of changes in an emergency situation
Foster integrated, healthcare delivery systems that can respond to a disaster of any size
Ensure timely and effective communications
Promote an effective countermeasures enterprise, which is a process to develop, buy, and distribute medical countermeasures
Ensure prevention or mitigation of environmental and other emerging threats to health
Incorporate post-incident health recovery into planning and response
Work with cross-border and global partners to enhance national, continental, and global health security
Ensure that all systems that support national health security are based upon the best available science, evaluation, and quality improvement methods
The National Health Security Strategy also highlights specific actions that the nation—including individuals, communities, non-government organizations, and government agencies—should take to address public health threats.
Priorities for the federal government include improving the system for developing and delivering countermeasures—medications, vaccines, supplies, and equipment for health emergencies; coordinating across government and with communities to identify and prioritize the capabilities, research, and investments needed to achieve national health security; and evaluating the impact of these investments.
Federal, state, local, tribal, and territorial government agencies, as well as medical, public health, and community-based organizations collaborated to develop the strategy and interim implementation guide. HHS also solicited direct input from non-federal participants during six regional workshops, and worked with the Institute of Medicine to engage the medical community.
The Pandemic and All Hazards Preparedness Act directed HHS to develop the National Health Security Strategy with an accompanying implementation plan by 2009 and to revise the documents every four years. HHS said it will update the implementation plan every two years to reflect advances in public health and medicine.
Many of the Washington, DC, interest groups that are seeking to shape final healthcare legislation in the coming weeks operate with opaque financing, often receiving hidden support from insurers, drugmakers, or unions, the Washington Post reports. The groups, some newly formed and others reappearing with different sponsors, have spent months staging protests, organizing letter-writing campaigns and contributing to a record $200 million advertising blitz on healthcare reform, the Post reports.
The American College of Radiology today downplayed concerns that full body scanners at security checkpoints in U.S. airports would pose a health risk.
In the wake of a thwarted Christmas Day bombing attempt on Northwest Airlines Flight 253 in the skies over Detroit, the Transportation Security Administration has announced that it is ramping up the deployment and use of the scanners, which produce anatomically accurate images of the body and can detect objects and substances concealed by clothing.
TSA has deployed two types of scanning systems: Millimeter wave technology uses low-level radio waves in the millimeter wave spectrum. Two rotating antennae cover the passenger from head to toe with low-level RF energy. Backscatter technology uses extremely weak X-rays delivering less than 10 microRem of radiation per scan—the radiation equivalent one receives inside an aircraft flying for two minutes at 30,000 feet.
"The ACR is not aware of any evidence that either of the scanning technologies that the TSA is considering would present significant biological effects for passengers screened," ACR said in a media release.
"An airline passenger flying cross-country is exposed to more radiation from the flight than from screening by one of these devices," ACR said. "The National Council on Radiation Protection and Measurement has reported that a traveler would need to experience 2,500 backscatter scans per year to reach what they classify as a negligible individual dose. The American College of Radiology agrees with this conclusion."
AdvancedMD Software, Inc., a software-as-a-service medical practice and revenue cycle management provider, announced today that it has acquired PracticeOne, a private, CCHIT-certified, electronic health records software provider for physician practices. Financial terms of the deal were not disclosed.
AdvancedMD, based in Salt Lake City, said the acquisition of PracticeOne will allow it to expand its product line to include a SaaS-based electronic health records, integrating the clinical and financial functions of a practice to boost profitability, productivity, and improved claims processing, and patient safety and satisfaction.
The new product line also includes a patient portal, and mobile access to provide secure access to patient information and medical decisions via smartphones.
PracticeOne has headquartered in Richland, WA and Canoga Park, CA.