A study by Northwestern University doctors shows that more than three-quarters of emergency room patients leave the hospital without completely understanding their discharge instructions. Kirsten Engel, MD, talks about why this misunderstanding occurs and what clinicians can do to make sure that patients take proper care of themselves after their hospital stay.
A recent study found that surviving cancer can depend on location and even race. Researchers say that the country you live in, and in the United States, whether you're black or white, determines a person's odds for beating the disease. Among reasons cited for the findings were economic differences and access to healthcare.
While trolling the Facebook pages of the school's medical students,
University of Florida researchers found shots of future doctors grabbing their breasts and crotches or posing with a dead animal. They also found many photos of students drinking heavily.
The study also found that almost half of medical students had Facebook pages, but only 37% of those students limited viewership to friends.
This New York Times op-ed offers an analysis of the flaws in our current fee-for-service reimbursement system by contrasting the profitability of a CT scan to a standard patient visit. "The best way for a doctor to make money in his practice is not to spend time with patients but to use equipment as much as possible," says Peter B. Bach, MD, a doctor at Memorial Sloan-Kettering Cancer Center. "That means moving the maximum number of patients through the practice, and spending the minimum amount of time with each one."
A new survey by Press Ganey finds that physicians practicing in rural areas tend to be more satisfied overall than their urban counterparts. The survey also found that surgeons and critical care specialists are the least satisfied medical staff, while pathologists and rehabilitation specialists are most satisfied.
As an increasing share of healthcare costs has been shifted by employers to their employees, copays and deductibles have gone up substantially. This increase has left providers with a significant amount of outstanding self-pay revenue to collect.
One effective method of capturing outstanding self-pay balances is to designate one of the billing staff members to provide financial counseling to patients. This person would meet with patients who have outstanding bills and establish a payment plan that would fit into their budget.
For example, if an uninsured patient has an office visit but cannot pay the entire charge for the day, the patient might ask to pay a portion before he or she leaves the office and then pay additional installments by mail for the remainder of the bill.
Practices such as surgery or OB/GYN, in which self-pay balances tend to be high after the insurance company has paid its portion of the bill, may also reap the benefits of having a financial counselor.
For example, if a patient is scheduled for a major surgery, the financial counselor may call the patient’s third-party payer to determine the patient’s responsibility after the insurance has paid its portion of the service.
If the patient is responsible for 30% of the allowable, he or she should be aware of the amount that will be owed after the insurance company has paid its share. Once the insurance company sends the payment with the EOB, the financial counselor will want to set up a payment plan with the patient.
This article was adapted from one that originally ran in The Doctor's Office, a HealthLeaders Media publication.
When I talk to physicians in private practice about their struggles these days, I rarely hear business terms like market share, growth, or profit. Instead they talk about basic survival, as if they are up against the elements and concerned first and foremost about weathering the storm.
It may be a bit of hyperbole, but it is a fitting analogy. Richard A. Schoor, MD, FACS, an independent urologist from Long Island, compares a solo practitioner to an eco-survival specialist left in the wilderness. "Without the proper skills, knowledge, and a bit of luck, you can die out here."
I've spent enough time in the woods to know that your chances of survival increase when you aren't alone. A lot of physicians and industry experts I've spoken with recently have pointed out a trend of physician practice consolidation—medical groups are merging or bringing in new doctors because keeping a practice alive is a little easier when you have help.
Lagging behind when it comes to technology? Larger medical groups are able to achieve certain economies of scale to make electronic medical record systems and other IT more affordable.
Tired of lousy reimbursement rates? Bigger groups of physicians tend to have more leverage when negotiating contracts with private payers and are better able to point to market share, community advocates, or utilization/quality data to justify higher rates.
The benefits go on: More opportunities for ancillary revenue, additional referral sources, cost mitigation, and practice management expertise.
Achieving this strength in numbers doesn't necessarily require more physicians. Joint ventures, gainsharing, and other forms of partnerships and alignments with hospitals allow physicians to overcome the limitations of a small practice without drastically changing the practice structure. Regardless of the method, the point is to get the physician—or small group of physicians—a little help.
Knowing these benefits, however, some physicians still prefer solo or small practice—they value autonomy, control over financial decisions, or the more personal patient relationships. Should these physicians just give up on their dreams as the industry pushes doctors into bigger groups?
Not necessarily, but they need to recognize that they are willingly walking into the wilderness and must develop appropriate skills. Solo doctors have to do more with less. They must budget meticulously and cut costs whenever possible. That means paying attention to little things like turning off lights and saving paper. The line between personal and business finances often becomes blurred, and the solo practitioner must be careful with both.
But most important: Don't expect to be rescued.
Healthcare reform or government assistance of some sort would be nice, but don't count on it, Schoor cautions. We often assume that those in charge can't let physicians go under, but as we saw with the recent Medicare payment debacle, that's a dangerous gamble to make.
If you decide to venture into the wilderness alone, be prepared for a long trip.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.Note: You can sign up to receive HealthLeaders Media PhysicianLeaders, a free weekly e-newsletter that features the top physician business headlines of the week from leading news sources.
When's the last time you saw a surgeon jump up and down?
E. Patchen "Patch" Dellinger, vice-chair of surgery at the University of Washington Medical Center, says he did just that when the World Health Organization offered his hospital the chance to pilot a surgical safety checklist that was announced to the public last month.
"I work at a marvelous academic medical center. But it's a pretty big place, and has a way of making changes slowly," says Dellinger. Using the WHO surgical checklist, he says, was an opportunity for the medical center to weave certain safety precautions into its culture—a bit sooner than it might have otherwise. "When they asked for pilot sites, I thought, this is my chance."
Like the checklist studied late last year by Johns Hopkins researcher Peter Pronovost, MD, the WHO checklist isn't complicated. Each item is a simple task that, when completed, can improve the safety of a patient during surgery, reduce the chance of infection, and increase communication among the surgical team members while in the OR. A quick introduction of everyone in the operating room—including the patient—is just one item that must be checked off before surgery begins.
During the pilot period, Dellinger, who was on one of four working groups that helped create the list, made sure that the checklist was posted next to the operating table during every general surgery. A research coordinator kept track of the tasks and timed how long it took the team to get through the items on the list.
Dellinger's excitement for the WHO checklist spread throughout the hospital after it was shown that during the first 500 pilot surgeries, UW's error rate had been cut in half. It didn't take much to convince hospital leadership to take the program beyond general surgery. By October 1, use of the checklist will be mandated for every surgery performed at UW.
Of course, convincing not only executives, but members of the surgical teams, that the checklist was a good idea wasn't as easy as it sounds. At first, Dellinger did meet some resistance from those who feared the checklist would add to their workload. "Some said it was a good idea provided they didn't have to do anything more than they were already doing," he says. And with tight OR schedules, others feared that the checklist would add unnecessary time in to the procedure.
"I had our research coordinator time the checklist dozens of times," Dellinger says. "The average time it took was one minute, fifty seconds. The longest was three minutes, fifty seconds—and that was a very complicated case."
The bottom line, he says, is that checklists make sense, and they've been proven to work, and not just during the WHO pilot project. He points to the success of the lists at Johns Hopkins and other healthcare organizations that have similar policies in place.
"As they've found in aviation, as medicine gets more complex, the potential for errors increases dramatically," says Dellinger. "We can prevent errors by making sure that we have a systematic process in place to check for errors."
Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
Note: You can sign up to receive HealthLeaders Media QualityLeaders, a free weekly e-newsletter that reports on the top quality issues facing healthcare leaders.
Thousands of medical providers who care for low-income Californians are scrambling to find funds after lawmakers failed to pass a budget, forcing the state to halt payments to them. State officials put the healthcare facilities on notice that payments from the Medi-Cal insurance program for the poor will be frozen until a budget is approved. Although most of the facilities have no immediate plans to turn away patients, the providers warn that a budget stalemate will affect care. In the meantime, they are turning to banks, foundations, and their own reserves for emergency cash to pay the bills.
Some of the largest health insurers in Massachusetts say they will cover visits to the retail health clinics expected to open in CVS and Walgreens drugstores later this year. Harvard Pilgrim Health Care and Tufts Health Plan have signed contracts with CVS Caremark, which operates more than 6,000 pharmacies nationwide. The chain plans to open as many as 28 MinuteClinics in its Massachusetts stores this year and 100 statewide within five years. CVS also is negotiating coverage for clinic services with Blue Cross and Blue Shield of Massachusetts. Together, the insurers have nearly 5 million members.
