Approximately 80% of medical records contain inaccurate information, posing serious health risks for patients. Many physician practices and health systems simply do not update medical records on a regular basis, thus leaving them incomplete. To ensure the safety of patients and eliminate potential liabilities for practices and hospitals, medical records cannot be overlooked.
Communication is key in ensuring that medical records are as accurate and up to date as possible. More organized recordkeeping is crucial in the fight for accuracy.
Physicians should be checking with patients at each office visit about health conditions that may have changed, changes in disease or disorder symptoms, and other physicians patients might be seeing, says Paula Griswold, executive director of the Massachusetts Coalition for the Prevention of Medical Errors.
"This is a good opportunity to open the lines of communication," she adds. Although the responsibility to keep records up to date lies primarily with healthcare providers, Griswold says patients should be held equally accountable.
"Practices should think about asking patients when they come in, while they're in the waiting area, if there have been any changes since their last visit," Griswold says, noting that there is not always ample time to discuss such matters during the actual visit with the doctor.
Physicians can use the appointment reminder call to ask patients to be ready to share any health-related changes with the doctor, such as new medications they are taking. Creating a medication form for patients to fill out can also help ensure that the information in the records is accurate and up to date.
Griswold says healthcare providers should additionally urge patients to carry with them a list of prescribed and over-the-counter medications they're taking and what disorders and symptoms each drug is treating. She does this for her father, making sure to update the list when anything changes.
Taking the time to check on changes, ask about concerns, and talk about how the patient is generally feeling is a good idea too. "People tend to be concerned with breaches to privacy and identity theft," Griswold says. "But you can have breaches to a patient's safety too with inaccurate records."
This article was adapted from one that originally ran in the October 2008 issue ofThe Doctor's Office, a HealthLeaders Media publication.
Physicians might soon find out that healthcare is not completely immune to tough economic times. It's often said that Healthcare is the most recession-proof industry—people get sick regardless of what's going on in the economy and can rely on publicly-funded safety net programs if worse comes to worst, after all.
But as the Congressional debate over bailing out Wall Street draws the news world's focus toward the financial sector, a couple of recent news items suggest physicians are already feeling the effects of a sluggish economy.
The first comes from the Wall Street Journal, which points to evidence that Americans are cutting back on healthcare spending as the credit crunch threatens to throw the economy into a major slump.
For instance, the number of prescriptions filled per year in the United States has declined for the first time in a decade. Physician office visits have also dropped since 2006, and 22% of consumers in a recent survey said economy-related woes were causing them to go to the doctor less often.
This is good news for a work force that is overworked and hit by shortages, right? Well, maybe not if you rely heavily on hip and knee replacements, mammograms, and other preventive or elective procedures. Knee replacements per 1,000 people fell 18.6% between March 2007 and 2008, pap smears fell 6%, and dispensed prescriptions for antidepressants dropped 29%, according to a survey conducted for the WSJ by research firm D2Hawkeye.
Many of these elective procedures are extremely profitable, and doctors may start to really lose revenue if the economy turns for the worse. Ultimately, the consumer cutbacks will increase strain on the system, as patients who forgo testing and preventive care end up clogging hospital emergency rooms with more serious conditions.
But what about that publicly-funded safety net? It's going to take a hit as well. A new report suggests many states may begin cutting Medicaid payments to physicians as early as next year in order to reign in rising costs. According to the authors of the Kaiser Family Foundation Survey, Medicaid enrollment rates are climbing—by 2.1% in 2008—in part because of patients losing their jobs and employer-based coverage.
Every 1% increase in the national unemployment rate translates to one million more enrollees in Medicaid and the State Children's Health Insurance Program (SCHIP) and $1.4 billion in state Medicaid costs, according to the study's authors.
And without additional tax revenue, states may have no choice but to cut reimbursement. At the federal level, prospects of Medicare or Medicaid increases become slimmer as Congress considers spending $700 billion of taxpayer money to fix the current financial mess.
It's a good thing that legislators already voted in July to eliminate this year's 10% reduction in Medicare physician payments, because if it was coming up for a vote now or later in the year, I'm not so sure it would pass.
I'm not trying to be alarmist. Many of these problems—the stagnant reimbursement and rising costs—are not new to the industry. But a bad economy could exacerbate the financial problems physicians have been facing for years and delay much-needed reform.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.
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Hartford, CT-based St. Francis Hospital and Medical Center confirmed that it will eliminate 50 positions, mostly employees who don't deal directly with patients. The job cuts come as the St. Francis takes steps to "stabilize" its expenses and prepares for the upcoming fiscal year, hospital representatives said. "This will not impact the level of care our healthcare workers provide to patients every day," the hospital said in a statement.
Executive physicals are marketed as the ultimate medical checkups for consumers. In these one- or two-day sessions, executives undergo a battery of high- and low-tech medical tests and comprehensive evaluations by physicians. But Brian Rank, MD, medical director of HealthPartners Medical Group and Clinics of Minnesota, argues they do not live up to their promise in an article published in the New England Journal of Medicine. Rank says the physicals are often just expensive, unnecessary tests.
Two Massachusetts labor groups say they have launched a website to monitor treatment of patients and employees at Beth Israel Deaconess Medical Center. The two groups said the Boston hospital overcharges patients and pushes caregivers to work long hours. The website will also allow viewers to post their experiences at Beth Israel Deaconess, the groups said.
CEOs and other leaders at America's rural and community hospitals frequently complain to us that they have a hard time getting so-called rent-a-nurses or "travelers" to buy into their hospital's mission and methodology. And buying in to a hospital mission is particularly important with today's increased emphasis on teamwork and communication, standardized treatment plans using evidence-based medicine, quality outcomes, and the proper documentation of every move.
It's not that travelers are incompetent, reckless, or indifferent. But in many hospitals, they are seen as "outsiders" and "others," migrant workers who come in for a 13-week tour of duty and move on. And, let's be honest, there may be a little bit of generational tension out there. There is a perception among some hospitals leaders that travelers—particularly the younger nurses—aren't as committed to the mission of the hospital and are much more concerned with issues like pay and scheduling. That may be why they gravitate towards traveling in the first place.
Until recently, travelers were given the "outsider" status at Glendive Medical Center, a health system on the high plains of Eastern Montana that includes a 25-bed, acute-care hospital with 24/7 emergency care, a 75-bed, extended-care facility, an after-hours clinic, an assisted living facility, and a veterans' home. Like hospitals everywhere—and especially rural hospitals—GMC has had a hard time recruiting and retaining healthcare workers, particularly nurses. So they rely heavily on nurse travelers and other temporary, contract workers.
Scott A. Duke, CEO at GMC, says his hospital had an "A Ha!" moment about a year ago when, in the midst of what he called a planned "cultural transformation," they realized that travelers were a big part of the health system's operations but weren't part of the call for staff inclusion and connectivity. In Duke's view, nobody had really thought about enhancing that relationship before. "I've been to hospitals where the attitude is 'These people are travelers. They're not on our staff. We're not going to treat them bad, but we aren't going to treat them like our staff,'" he says.
Armed with this newfound realization, GMC made an effort to improve its relationships with travelers. It didn't involve any grand strategies or formal declarations. GMC had always provided orientation for travelers, but the emphasis and the approach now stresses inclusion. There was a systemic attitudinal change that made sure the travelers knew they were part of the system, that their role in the success of the health system was critical, and that their input and feedback was sought and valued. "We make them part of the family," Duke says.
A few travelers appreciated the inclusiveness so much that they joined the staff permanently, Duke says. Most, however, prefer to remain orphans. "They don't want to be a part of the organization or get to know staff in the same manner. It's part of who they are and how they want to work in their professional life. That's OK. As long as they are doing their job and providing professional high-quality care, they are filling a very necessary void."
At the end of their 13-week contract at GMC, Duke says, many travelers have expressed gratitude. "Several have said this is the best place they've ever worked at," he says. "They still want to be travelers but they want to be travelers at our hospitals." Duke says he can't say if the emphasis on inclusiveness is cost-effective. Traveling nurses are expensive and it's always preferable to have permanent staff. But if they feel good about the way they're treated, maybe more of them will join the staff. Or if they return for another contract, there are training and orientation costs that can be avoided.
Duke admits GMC doesn't have the data to suggest that their inclusive approach will save money. "We just feel this is more of a feel good approach, that if we are going to use travelers, this is the way to go," he says.
John Commins is the human resources and community and rural hospitals editor withHealthLeadersMedia. He can be reached at jcommins@healthleadersmedia.com
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