Blue Cross and Blue Shield of Illinois, the state's largest insurer, has announced its business may not grow for the first time in 25 years. The top executive at the insurer said the recession and rising number of unemployed consumers will lead to losses in the number of health plan subscribers. Illinois Blue Cross, which grew its enrollment 2%, to 7.3 million plan members, last year from 2007, did not say how much it expected its membership to decline.
State regulators voted to accept a bid by a Massachusetts Catholic hospital chain and a secular health organization to provide health insurance to thousands of low-income residents. The Connector Authority board voted unanimously in favor of the joint venture proposed by Centene Corp., a St. Louis-based health organization, and Caritas Christi Health Care Network. The vote followed several closed-door sessions in which officials from Centene and Caritas assured regulators that women will have "ready access" to family planning and reproductive services, an issue that sparked concerns from abortion foes and reproductive rights activists.
Physician leaders are being forced to trim operating expenditures, but they must be careful not to cut the legs out from under the organization while doing so. +
Patient demand for intensive care services continues to rise—but ICUs cost a ton of money. Here's how some providers are making intensive care worth their financial while. +
Kenneth Irons, MD, chief of regional and neighborhood clinics for Duluth Clinic, talks about his organization's policy that set guidelines for how physicians and employees relate to pharmaceutical representatives. +
A lack of consumer understanding has contributed to the glacial growth of consumer-driven plans. Can better information from health plans help CDHPs take hold? +
Methodist Hospital, a community hospital in Kentucky, continued to provide care during a crippling ice storm this winter because of dedicated employees, a solid emergency management plan, and the help of suppliers. +
Research continues to show that the clinical decision support systems intended to protect patients from medication errors prove in some ways to be more of a hindrance than a help to doctors, says this article published by the American Medical Association. The latest example is a study of the electronic prescribing records of nearly 2,900 community physicians and other prescribers: Nearly 230,000 times these doctors were warned about potential drug interactions, and 90% of the time they decided to proceed as if the alert had never appeared.
An Arkansas state court has ruled that Baptist Health, Arkansas' largest hospital system, acted improperly by inappropriately restricting hospital admitting privileges and interfering with the continuity of patient care. The ruling in Baptist v. Murphy permanently prohibits an economic credentialing policy adopted by Baptist Health in 2003, which would have allowed the hospital system to interfere in the patient-physician relationship by denying hospital-admitting privileges to medical staff members based on financial concerns.
A widely-known Massachusetts anesthesiologist, whose research has influenced how doctors treat surgery patients for pain, has been accused of fabricating results in at least 21 published papers, and in some cases even inventing patients. Colleagues say the case is one the largest ever of alleged medical research fraud. Scott Reuben, MD, works at Baystate Medical Center in Springfield, and has published dozens of articles on an important and emerging area of anesthesiology involving the use of more than one type of drug to relieve post-surgical pain and foster faster recovery.
The ever-increasing role of technology in healthcare will bring security and privacy challenges into the forefront for physician practices in 2009. Consider the following expert predictions.
Disaster recovery planning. Disaster recovery planning has always been a challenge, but it will pick up steam in 2009 because of the continued automation of healthcare records in the industry, says William M. Miaoulis, CISA, CISM, manager of HIPAA Security Services at Phoenix Health Systems in Montgomery, AL. To know whether your current disaster plan is up to par, Miaoulis says providers must first ask themselves these important questions:
If your computer systems went down, would you have access to medication history and lab results?
What would be the effect to your current patients?
Would the way you deliver care be affected?
Minimum necessary standard. The minimum necessary standard, a key protection of the HIPAA privacy rule, requires covered entities to make reasonable efforts to limit protected health information (PHI) to the minimum necessary.
The challenge is defining what is "reasonably necessary" and determining how you will manage these uses, disclosures, and requests.
The minimum standard doesn't apply when information is:
Requested by a provider for treatment
Authorized by the patient
Needed by the Department of Health and Human Services or the Office for Civil Rights for a complaint investigation or compliance review
Required by law
Required for HIPAA compliance
Security audits. The Office of Inspector General (OIG) released a report October 27, 2008, regarding how well CMS is enforcing the security rule.
Although the OIG's report did not specifically state whether the OIG has scheduled another performance review, it is highly likely it will revisit CMS' progress and activity in carrying out its HIPAA enforcement responsibilities, which should signal a red flag for organizations, says John Parmigiani, MS, BES, president of John C. Parmigiani & Associates, LLC, in Ellicott City, MD, and chair of the team that created the HIPAA security rule.
Organizations need to be aware that CMS and the OIG are continuing to audit for HIPAA security compliance. Health information technology initiatives, increased consumer awareness of data losses, and a new administration are additional drivers for increased compliance with healthcare privacy and security safeguards enforcement. Organizations may need to increase the money and internal resources they set aside for security compliance, says Parmigiani.
Medical identity theft. Healthcare organizations should also be aware of the Federal Trade Commission's Identity Theft Red Flags rule under the Fair and Accurate Credit Transactions Act of 2003 (FACTA), says Miaoulis, adding that the regulation requires many healthcare organizations to implement programs to prevent and detect identity theft by May 1.
To mitigate the risk of identity theft, Miaoulis says organizations should take the following steps:
1. Research the FACTA Identity Theft Red Flags rule.
2. Implement the HIPAA minimum necessary standards to include demographic information. "Specifically, organizations should inventory which systems maintain the Social Security numbers and patients' birth dates," Miaoulis says.
3. Determine who has access to information and whether access is appropriate. For roles that require the use of patients' Social Security numbers, determine whether limiting access to the last four or five digits of the number would be sufficient. Organizations could also consider limiting the use of patients' birth dates, Miaoulis says, noting that it may not compromise patient care to see someone was born in May 1970 versus May 15, 1970.
Editor's note: This article was adapted from one that originally appeared in the January issue ofBriefings on HIPAA, a publication from HCPro, Inc.
As expected, there was a lot of talk about the economic recession at the American Medical Group Association's annual conference in Las Vegas last week. I could barely walk between sessions without hearing someone ask, "Did you see how much the stock market dropped today?" And I heard from plenty of physicians and practice managers about budget strains and areas they have been forced to cut.
But attendees didn't travel to Caesar's Palace (a surreal place to be given the current economic climate) to talk about cutting budgets. They were there to learn where and how to invest the limited resources that remain in this challenging environment. Leaders are being forced to trim operating expenditures, but they must be careful not to cut the legs out from under the organization while doing so.
For me, the most important takeaway from the more than three days I spent at the conference was a phrase delivered by Tanya Chermak from Harvard Vanguard Medical Associates before the conference officially began.
"Leadership training and development can't be cut, even in hard economic times," she said during a presentation that was part of a day-long, pre-conference physician leadership workshop.
Some areas require more, not less, investment in a recession, and for many attendees and presenters in Las Vegas, physician leadership was one of those areas.
It isn't just enough to search for physicians with leadership potential or support existing leaders. Organizations are spending money to actively train physicians for leadership roles ranging from clinical department heads to vice presidents and CEOs.
They're teaching physicians to be better leaders the same way you teach almost any subject: In a classroom.
Harvard Vanguard was just one of several organizations experimenting with regular leadership classes designed to train physicians business and leadership skills. Chermak started Harvard Vanguard's leadership academy with 19 physicians in February of last year, and it has grown in popularity—the latest class has nearly 40 participants.
Physicians are nominated by department heads to add an element of prestige to the academy, and a mix of in-house experts and external consultants teach classes ranging from basic economics ("running a lemonade stand") to dealing with disruptive doctors and managing more complicated budgets.
Nancy J. Gagliano, MD, vice president for practice improvement for Massachusetts General Physicians Organization, has developed a similar program that provides a monthly, four-hour class for selected physicians over a two-year cycle. So far, the results have been overwhelmingly positive, she says. Each month, budding leaders come to class with stories about how a previous class has already helped them manage a problem within their department. After a class on how to talk to disruptive physicians, one participant was able to diffuse a situation with an older doctor in his department who had been clashing with nursing staff, for instance.
Johnathan Schwartz, MD, MBA, director of managed care for Henry Ford Medical Group talked about a "managed care college" that teaches physicians basic business concepts, including acronyms and the fundamental language used in budgets and other business transactions.
I could go on. There were a wide range of approaches to leadership development at the AMGA workshop, but the common thread was recognition that the transition from physician to physician leader isn't one that often happens without guidance.
As organizations undergo major changes, driven both by the markets and by federal healthcare reform, leadership in all forms is an increasingly valuable asset—which perhaps explains why the Commission on Accreditation of Healthcare Management Education is seeing substantial increases in applicants.
Medical groups and hospitals that continue to invest in developing physician leaders at all levels will see the rewards as delivering healthcare becomes even more complex.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.
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When the topic is the ongoing shortages of necessary personnel at hospitals, clinics, and physicians offices, the professionals that come immediately to mind are physicians and nurses. However, athletic trainers and other healthcare professionals are qualified to fill the role of physician extender.
Many clinics are now hiring physician extenders in their practices in order to save time and improve patient satisfaction, increase revenue, enhance physician productivity and efficiency, and educate patients about treatment plans.
Far from the athletic fields, athletic trainers and other physician extenders help improve productivity, patient outcomes, and satisfaction at clinics and hospitals nationwide. That's why they are so often employed in physician offices and specialty practices, including by specialists in orthopedics, osteopathy, family practice, pediatrics, and sports medicine.
In 2006, nearly 34% of athletic trainers worked in hospitals, clinics, and physician offices, according to National Athletic Trainers' Association. The Bureau of Labor Statistics expects athletic trainers' employment to grow 24% between 2006 and 2016—much faster than the average for other occupations.
Because athletic trainers tend to be less rushed than surgeons and other physicians, they have more time to spend with patients, providing them with post-injury or post-surgical rehab programs.
Athletic trainers' vital role in hospitals, clinics, and physician offices
In their growing role as physician extenders athletic trainers help physicians increase their productivity and efficiency. "Athletic trainers are a committed, essential component to physicians delivering the highest standard of team medical care to the patients of the Andrews Institute," says James Andrews, MD. "They know how to relate to the patient so his or her recovery is as quick as safely allowable, whether that person is a professional or youth athlete or just an average mom or dad."
According to NATA, a 1998 time-to-task study showed that athletic trainers working as physician extenders increased clinic production by 12 patients per day. The athletic trainer serves a vital role in the clinical setting by reducing re-injury rates through patient instruction, reducing recovery time from non-surgical injuries, and rehabilitating musculoskeletal injures.
"My patients experience excellent outcomes as a result of therapy provided by athletic trainers," said Thomas D. Kohl, MD, director of sports medicine at the Comprehensive Athletic Treatment Center in Pennsylvania. "My patients love working with them. Athletic trainers are a value-added service to my practice. I could not do without them."
Professional training leads to better healthcare coordination
Athletic trainers earn a bachelor's education and national certification that enables them to work closely with physicians and other medical professionals to develop better-coordinated, efficient, and responsive healthcare in a team environment. And their training equips them with the expertise needed to perform immediate and emergency injury management, injury assessment, and rehabilitation.
"I believe that athletic trainers provide a critical service as physician extenders in the doctor's office, and I work with them daily in that role," said John Xerogeanes, MD, at Emory Sports Medicine Center in Atlanta.
Athletic trainers' professional preparation is based on the development of specified educational competencies and clinical proficiencies. Through a combination of formal classroom and clinical instruction complemented by clinical experience, athletic trainers are prepared to provide healthcare within each of the following content areas:
Risk management and injury prevention
Pathology of injuries and illnesses
Orthopaedic clinical examination and diagnosis
Medical conditions and disabilities
Acute care of injury and illnesses
Therapeutic modalities
Conditioning, rehabilitative exercise and referral
Pharmacology
Psychosocial intervention and referral
Nutritional aspects of injury and illnesses
Healthcare administration
Until recently the relationship between physicians and athletic trainers has been on the sports playing field, where for years they have partnered in delivering healthcare to athletes. However, the increased need for providers during this shortage, means increased number of athletic trainers moving into the physician clinical setting, too.
Case Study: Emory Sports Medicine Center
In an effort to evaluate the benefit of employing certified athletic trainers, Emory Sports Medicine Center implemented a study to determine the financial and clinical effectiveness of using them as the primary clinical assistant in the orthopedic office.
"Athletic trainers help enhance a physician's communication with patients by serving as another source of expert information that patients can absorb," says Xerogeanes. "Athletic trainers are a key part of our sports medicine service delivery model."
By comparing the number of patient encounters and bill charges of two primary care physician practices—both before and during the introduction of a certified athletic trainer—it was shown that certified athletic trainers had a positive effect on patient throughput and revenue. Results showed that certified athletic trainers can increase a physician's productivity up to 23% and increase revenue by up to 42%.
"The use of certified athletic trainers has allowed us to better leverage our non-operative physicians, thus increasing productivity and professional billings," says Mark Miller, senior clinical administrator at Emory. "Over a six-month study period, we have seen improvements in provider productivity, as measured by encounters, on the order of 22%."
Athletic Trainers: Education, National Certification
Athletic trainers must have a minimum of a bachelor's degree (and seven in 10 have a master's degree or higher), and in most states, they must maintain certification through the Board of Certification, an organization independent of NATA. Certified athletic trainers differ from "personal trainers" who focus solely on fitness and conditioning and whose training does not require a college degree.
Before being certified, those hoping to become athletic trainers must complete an academic major or graduate-equivalent program that is accredited by the Commission on Accreditation of Athletic Training Education (CAATE).
Athletic training programs use a medical-based education model in both classroom and clinical settings that teaches students to provide comprehensive preventive services and care in six domains of clinical practice: prevention, clinical evaluation and diagnosis, immediate care, organization and administration, professional responsibility, and treatment, rehabilitation, and reconditioning.
Program graduates then take the Board of Certification (BOC) exam in order to be credentialed as a certified athletic trainer. The ATC credential is recognized and required by all but one state that regulate or license the practice of athletic trainers. They are licensed or recognized in 46 states.
Marjorie J. Albohm, MS, ATC, is president of the National Athletic Trainers' Association. To learn more about athletic trainers, contact the National Athletic Trainers' Association at 800-879-6282, or visit the NATA Career Center directly at www.NATA.org/careercenter.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
