Consumer Reports launched an online tool that lets users compare hospitals on their treatment of patients with life-threatening chronic illness, based on the Dartmouth Atlas of Health Care 2008. The New York Times reports that the data show the city's private teaching hospitals were among the most aggressive in the nation, ranking in the 94th percentile as a group, while the public hospitals landed in the 69th percentile.
Research published by the Mayo Clinic found that 86 percent of patients said they knew they had been given a new drug, but only 64 percent could state its name or purpose. Only 11 percent reported that they had been told of potential adverse effects. The study also found that there was no difference between patients with more formal education and those with less schooling. Researchers say the findings suggest that poor communication by physicians might be to blame, and not low levels of health literacy.
Tampa (FL) General Hospital is conducting an internal investigation after staff members mistakenly started performing a cardiac catheterization on the wrong patient. The man was not harmed, but staff members failed to follow proper hospital policies to identify the patient before the procedure, said hospital representatives. Those who made the mistake "will be subject to the appropriate disciplinary actions," the hospital said in a statement. In announcing the error, Tampa General joined an increasing number of hospitals who choose to apologize for mistakes rather than deny them.
A new report says the New Orleans region might be able to support an even larger teaching hospital than the 484-bed facility suggested by a state consultant, and that a $1.2 billion cost estimate for the proposed hospital might be low. The ultimate success of the venture, however, will largely depend on the ability of Louisiana State University to transform from a charity operation that serves mainly the indigent into an academic medical center focused on high-end specialty care. The report, commissioned by the Downtown Development District, said it remains an open question whether LSU can make that transition.
In response to continued efforts to move Franklin County, NC's only hospital out of Louisburg, town officials have filed a lawsuit against one of the partners in the project, Rex Healthcare. The suit seeks copies of a confidential agreement officials say the hospital struck with WakeMed not to oppose each other's expansion plans. The lawsuit names Rex and its nonprofit parent, UNC Healthcare, and asks a judge to declare a public record any confidential agreement Rex entered into with WakeMed or any other hospital to remain silent during the state's review process for new hospital projects.
The North Carolina Medical Board wants to post doctors' malpractice information on its Web site, but the state's private physicians association says the information could be misleading. The medical board proposes to disclose malpractice payments going back seven years as part of a broader effort to strengthen its protection of patients. The board had been criticized in the past for failing to protect people from troubled doctors. The North Carolina Medical Society, a private association that represents about 11,000 of the state's doctors, says the medical board should disclose only payments going forward. The Society argues that it's not fair to disclose past settlements that doctors might not have agreed to if they had known they would become public.
It wasn't long ago that many physicians considered "marketing" a dirty word. Most doctors choose the field of medicine because of an interest in patient care, so it's not surprising that some would find the concept of selling or pushing their services to be in conflict with the Hippocratic oath.
But times have changed. It's not as easy for a physician to build a successful practice by relying on word-of-mouth and a loyal community of patients. With reimbursement constantly being cut and costs rising, the margin for error in managing practice finances is much smaller. Physicians have been forced to start treating their practices more like a business—it's tough to provide quality patient care if your practice is bankrupt—and most successful businesses rely on some form of marketing.
That doesn't mean physicians should push treatments on patients or star in their own infomercials. It just means physicians should view their practices through a marketing lens and strategically consider their practice image and ways to attract and retain patients.
Take the debate over the costs and benefits of EMRs, for example. The argument has become pretty predictable: Proponents argue that EMRs lower healthcare costs and reduce medical errors, and reluctant physicians claim the systems are too expensive and can be a burden on smaller practices. But why don't more physicians consider the marketing benefits of EMRs when weighing the pros and cons? Surveys have shown that patients prefer providers who use EMRs over those who don't 51% to 17%. There still may be valid reasons for holding off on an EMR purchase, but it's worth at least incorporating all of the benefits into the discussion.
An article I read earlier this week about the debate offered as an example an endocrinologist who can't afford an EMR system, so patients in his office carry index cards with them listing their brief medical history. I wonder how many patients have left the practice because of his antiquated record system? Given the choice, most patients will choose a competitor that doesn't rely on index cards.
At first, implementing an EMR may not seem like a marketing issue—we traditionally think of advertisements, direct mail, or public speaking when we think of marketing. But Patrick T. Buckley, who wrote Physician Entrepreneurs: Marketing Toolkit and is speaking on an upcoming audioconference about physician practice marketing, argues that marketing and operations are integrally wound together. Great group practices, he says, are able to provide a positive patient experience by combining the two approaches.
From that perspective, not only is EMR implementation a potential marketing issue, but so is almost every other decision about planning your practice's growth and understanding what's happening in your market. Julie Wright, CEO of Sound Family Medicine, and Buckley's co-presenter on the audioconference, for example, focused on marketing for referrals, and by developing a marketing plan to address the top 24 diagnoses in the practice, was able to increase visits per patient from 3 to 4.2, which generated $4 million in charges.
Part of the problem is many physicians harbor misconceptions about what marketing entails. Some physicians are already starting to come around to the necessity of practice marketing, and once more of them realize that it is not just a process, but a necessary way of looking at your practice, it will become a more integral part of practice operations.
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.
Medical practice styles are in a period of rapid evolution. A growing number of physicians is opting out of traditional medical settings and roles and electing to work part-time, in non-clinical positions, as hospitalists or surgicalists, or in boutique/concierge practices.
In some cases, physicians are motivated to seek these alternative practice settings for lifestyle reasons. In others, they are seeking ways to circumvent what they consider to be an increasingly onerous practice environment.
Take locum tenens, another alternative practice style that is becoming increasingly common, for example. Twenty years ago, locum tenens physicians were a relative anomaly at hospitals and medical groups, usually used to fill in for vacationing, ill, or otherwise temporarily absent doctors. Today, the use of locum tenens is largely driven by the physician shortage. Many hospitals, medical groups, and other facilities—77% according to Staff Care's latest survey—are using locum tenens physicians to maintain services while they seek hard-to-find permanent staff.
Measuring locums ROI
While locum tenens physicians are important to providing continuity of care they also have an impact on revenue. By treating patients who might otherwise not have been seen or who may have gone elsewhere, they can maintain revenue streams in the absence of permanent physicians.
Locum tenens physicians are paid on a per diem basis, and from the facility's perspective, daily rates must be balanced against revenues that physicians are likely to generate while working as locum tenens. The daily rate for a family practitioner, for example, is in the $750–$800 range. Rates are similar for general internists and run several hundred dollars per day higher for surgeons.
On average, a family physician generates approximately $1,433,000 a year on behalf of his or her affiliated hospital, according to Merritt, Hawkins & Associates' 2007 Survey of Physician Inpatient/Outpatient Revenue. This equates to approximately $4,000 per day.
Similarly, a general surgeon generates about $2 million a year on average for his or her affiliated hospital, based on the Merritt Hawkins survey. This equates to about $5,400 per day. In some situations, locum tenens physicians will be net revenue producers, in some cases they are a break-even proposition, and there are instances when they represent a net cost.
However, additional factors should be considered. By helping to alleviate physician burn-out, particularly in cases where deficits on the permanent staff are causing physicians to be overworked, locum tenens physicians can prevent the significant cost of physician turnover. Long-term, locum tenens physicians can help maintain patient satisfaction levels, which have a considerable impact on the reputation and market brand value of hospitals and medical groups.
Like other types of temporary clinical professionals, locum tenens physicians provide the most value when they are integrated into a facility's strategic staff plan. Planning in advance to use locum tenens physicians during peak usage times, to transition the practices of retiring physicians, and in other situations, is less stressful and often less costly than turning to them in emergencies. As a growing number of doctors embrace alternative practice styles, locum tenens physicians are one more piece of an increasingly varied mosaic.
Joseph Caldwell is president of Staff Care, a temporary physician staffing firm and a division of AMN Healthcare. He can be reached at joe.caldwell@staffcare.com.
Have you ever considered modeling your patient satisfaction goals after some of the best customer service providers in the country, such as the Walt Disney Company? In reviewing literature such as The Disney Way, written by Bill Capodagli and Lynn Jackson (1999, McGraw-Hill), it is apparent that practices can learn from the service excellence concepts practiced by the company and its Disney Institute, which offers seminars about Disney's brand of business management.
As explained by Capodagli and Jackson, many of Disney's techniques for boosting customer satisfaction can be applied to healthcare organizations. Founder Walt Disney believed that every employee is the company and that every customer is a "guest." In this way, Disney's pleasant environment permeates throughout the entire organization, regardless of an employee's title or duties.
Evidence of Disney's commitment to nurturing a cooperative corporate culture is reflected in its language. Employees don't have jobs; they play "roles" in a show. These theatrical references reflect Disney's culture and help new "cast members" understand and appreciate its culture. For example, although not everyone may know how to treat a customer, most people know how to treat a guest.
Disney's culture is grounded on three important concepts: its heritage, an understanding of its day-to-day operations, and its vision. Daily operation is the key to continuous improvement.
There is a perception that an employer has to pay higher salaries and have better benefits than competitors to obtain a high level of service. But these are not the only factors that motivate employees, as Disney has found. Nonmonetary benefits, such as employee outings, can also enhance the "cast" experience and make employees feel valued. Disney teaches its cast members to balance "quality cast experience, quality guest experience," and quality business practices, according to Capodagli and Jackson.
You might be thinking, "We are not a resort or a vacation spot." But that misses the point. The concept of treating the patient as a guest by trying to enhance his or her experience is critical to your success. Your efforts do not have to be fancy, fun, or exciting. But they should focus on identifying, meeting, and exceeding your patients' expectations. In healthcare, there can be movement toward a five-star service culture. It starts with acceptance by the leaders or personally by a healthcare professional.
It is not an easy process to either start or keep going, but it is an important one.
This story was adapted from one that first appeared in the March edition of The Doctor's Office, a publication by HealthLeaders Media.
Daniel and Colleen Fledderman decided in 2001 that the doctor who performed the fatal liposuction surgery on their daughter, an 18-year-old Penn State freshman, must be held accountable for her death. Exactly seven years later, a jury has awarded the Fleddermans $20.5 million in compensatory and punitive damages, finding that Richard Glunk, MD, and his nurse anesthetist were responsible for their daughter's death.
