New research suggests that physician practices that use EHRs have fewer paid malpractice claims. The study, Electronic Health Records and Malpractice Claims in Office Practice, examined 10 years of data on paid malpractice settlements across Massachusetts. Study results show that of the 1,140 physicians who responded, 33.2% use EHRs in their practices. Of these respondents, 6.1% had a record of paid malpractice claims compared with 10.8% of physicians who did not use an EHR.
With patients already facing out-of-pocket healthcare expenses ranging from $20 copays with traditional insurance to $3,000 deductibles with some consumer-directed plans—assuming they're insured at all—a fragile economy will make it even more difficult to get patients in the door.
As a result, "we will see many boutique practices and medi-spas folding or redesigning their business models," predicts Judy Capko, a California-based consultant and president of Capko & Company in Thousand Oaks, CA.
However, this does not mean the disappearance of the small medical group is imminent or even likely, experts say. Survival "is about being systemized, about giving care, and about using technology. A small group can be systemized using an electronic medical record just as well as a big practice," says Bruce Bagley, MD, the American Academy of Family Physicians' medical director for quality improvement.
"Technology will be the holy grail for financial survival of medical practices nationwide," Capko says. Although the tandem messages to invest in technology and control expenses may seem contradictory, they go hand in hand.
"EMRs are going to become the standard in order to practice good medicine—period," Bagley says. "It serves as the foundation for doing some of the information management that allows us to give better care."
So as patients and payers are increasingly seeking proof of quality healthcare, the technology required to capture quality and performance data will be a must.
In a similar vein, practices, particularly primary care, "are going to need to get on the office redesign bandwagon" to promote the primary care office as the medical home, Bagley says. To make the medical home concept work, enhance efficiency, and decrease repetition, specialty offices will also have to consider revamping their practices to support the team approach to care, better electronic access for patients, and better support for patient self-management, he says.
This article was adapted from one that originally appeared in the January 2009 edition ofThe Doctor's Office, a HealthLeaders Media publication.
Physicians have a hard time communicating effectively with patients in general—whether because of confusion over medical jargon, not enough time to spend with a patient, or just poor communication skills. Add in a language barrier and miscommunication problems can become much more problematic, even dangerous.
But that's an obstacle many physicians increasingly face as a nation historically known for its diversity continues to accept immigrants from around the world. The number of Americans with limited English proficiency grew by 53% in the 1990s to more than 22 million, according to the last U.S. Census.
For physicians, that means having to practice around language and cultural barriers that can lead to decreased access to preventive services, poor understanding of instructions for medications, longer hospital stays and an increased risk of medical errors, and misdiagnoses.
Yet many physicians, particularly residents, don't use readily available interpreters, according to a recent study by the Yale School of Public Health. Instead they rely on their own foreign language skills or a patient's friend or family member.
Is that enough? Not according to legislators in California, who this week enacted a law requiring patients with limited English proficiency to have access to an interpreter. The state is understandably at the forefront of the issue considering nearly one in five residents have limited English proficiency.
The concern, as with almost any effort to improve healthcare, is the cost, which is estimated to be about $25 million.
Where the California law differs from other guidelines about interpreters, including those handed down from the Department of Health and Human Services, is the cost doesn't fall solely on physicians. HMOs are primarily footing the bill and responsible for coordinating interpreter services.
That's a better formula for effectively improving the use of interpreters.
Physicians are responsible for preventing communication breakdowns with patients, and cultural and language barriers need more attention from practicing physicians and medical schools. But it is ultimately a public health issue, and unfunded mandates that place the entire cost burden on physician practices are not only unfair, they aren't very effective.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.
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Former Sen. Tom Daschle will be the first of President-elect Barack Obama's Cabinet choices to undergo a hearing. Daschle, Obama's pick as the next health and human services secretary, is to appear before the Senate Health, Education, Labor and Pensions Committee. Lawmakers will most likely question him about one of the most contentious aspects of President-elect Barack Obama's domestic agenda: his call for a new public health insurance plan to compete with private insurers. Daschle supports the concept of "a government-run insurance program modeled after Medicare." It would, he says, give consumers, especially the uninsured, an alternative to commercial insurance.
With consumers pressed for time and money, Michigan hospitals are adding services for patients to keep them coming back. The basic, consumer-friendly services are growing as health system officials look for ways to help people in a difficult economy. The services include door-to-door shuttles, increased hours, discounts on care, and even gas cards for poor patients and their families.
Milwaukee-based Aurora Health Care has acquired a 43-person physicians group in northern Illinois. Northern Lake Medical Ltd. primary care clinics serve the Illinois communities of Gurnee, Lindenhurst and Fox Lake. Nick Turkal, MD, Aurora's president and CEO, said the affiliation makes sense because a growing number of Illinois residents seek healthcare services in Wisconsin.