Technology
Thanks to new federal initiatives and the increased use of smartphones and tablets, more physicians are communicating on the go By Marisa Torrieri
For most physicians, coordinating care with other doctors and staff can be a time-consuming, backand-forth, error-prone process. But for pediatrician Wendell Wheeler of South Park Pediatrics in Chicago, an EHR user of nine years who purchased his iPad and iPhone in January 2011, it’s as easy as making a few taps with his finger. Armed with his mobile gear, Wheeler can open patient charts at any time, anywhere, and do everything from advising patients on medications and sending prescriptions to pharmacies, to communicating with outside physicians about specific patients. “It’s a nice extension [to the EHR],” says Wheeler. “I’ve been using Amazing Charts for nine years. I went into private practice and I wanted something that would make it easier for me to keep up with my patients and [my iPad and iPhone] have done that.”
initiatives under the Patient Protection and Affordable Care Act — including the muchpublicized accountable care organization (ACO) initiative that rolled out in April — call for greater communica-
Technology helps physicians make quick decisions any time, anywhere. PLUGGED IN
Wheeler’s use of mobile technology to collaborate and communicate with his healthcare peers is representative of a shift in the way many physicians are practicing medicine. And it’s a shift that will only continue to expand. In addition to CMS’ meaningful use incentive for EHRs, new www.physicianspractice.com
tion between physicians. Additionally, a growing number of technology vendors are rolling out mobile versions of their EHRs that allow physicians to do everything from video chat with patients to send charts to hospitals utilizing different systems.
“If you think about healthcare IT, about a world where healthcare IT is being delivered in real time, you can see how mobile devices play a larger role, because physicians have a mobile device wherever they are,” says Albert Santalo, founder, president, and CEO of cloud EHR provider CareCloud. In the future, mobile collaboration between physicians is expected to deliver even more benefits, though it requires some considerations. Rise of the Mobile Physician
As with the general public, the use of electronic communications among physicians has picked up steam over the last several years. April 2012 | Physicians Practice |
9
Choosing
the Right
E-Prescribing
Application
Should you buy a standalone app or an EHR-integrated module? We review the pros and cons.
By Ken Terry
Terry Hashey, a family physician in Jacksonville, Fla., remembers how the e-prescribing application in his electronic health record helped him when a new patient presented at his office with an acute problem. She had just flown in from out of state to visit her daughter, and he knew nothing about her medical history. But by the time she’d filled out her registration form, he’d pulled up her complete prescription drug list by using the medication history feature of Surescripts, a company that connects his e-prescribing application online with pharmacies and pharmaceutical benefit management firms. A patient’s medication history, which shows which prescriptions were filled at area pharmacies as well, helps Hashey in a number of ways. He can use it to check on patient compliance, to see what prescriptions other physicians have written for his patients, and www.physicianspractice.com
to detect “shoppers” who are after controlled substances. And when he writes an electronic prescription, the medication history operates in the background to alert him to potential drug interactions. Hashey also likes his ability to do rapid refills and to obtain formulary information through his e-prescribing software. Overall, Hashey says, electronic prescribing is “the best part of the EHR for efficiency, work flow, and error prevention.” Al Juocys, who practices family medicine in Rochester, Mich., also loves his e-prescribing application, which is separate from his EHR. Juocys’s e-prescribing application can be used with a patient portal that allows patients to view their medications and request refills
online. The program also notifies patients when prescriptions are sent to pharmacies so that they can go pick them up. Neither of these features is available within his current EHR, Juocys points out. Also, he was reluctant to use the EHR’s e-prescribing module because his EHR vendor would have charged him a hefty fee for connecting with pharmacies through Surescripts. That link is included in his e-prescribing application’s cost. The downside of not using an eprescriber integrated with his EHR is that every time Juocys writes a new prescription or a refill, he has to re-enter the information into his EHR’s medication list. (He doesn’t consider that a bother, however.) If you’re considering getting into e-prescribing, a standalone application or one that’s part of a bundle January 2011 | Physicians Practice |
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Technology Arm your frontoffice staff with high-tech helpers that’ll keep them from getting frazzled By Marisa Torrieri
How did gynecologist Katherine Gregory manage to see 6,600 patients last year, despite being the lone physician in a practice with one nurse practitioner and a staff of four? Gregory gives a lot of the credit to the practice’s patient portal, a Web-based tool that helps streamline many tasks that other practices require staff to handle manually. That allows Gregory’s practice, San Francisco Gynecology, to work leaner. “The portal allows for electronic communication and completion of tasks that otherwise would have to be done on the phone,” says Gregory. “Like for example, appointments: Patients can request appointments at their convenience as opposed to just during our office hours. They can request prescripwww.physicianspractice.com
tions, they can ask questions at their convenience, and then we can answer them.” Patients love the portal because it provides them convenient access to the practice, and employees love it because it gets them off the phone. No matter how many patients per day your practice sees, chances are your front-office staff is always busy with something, whether it’s making patient appointments, handling check-in, or verifying insurance eligibility. Those staffers are both the customer-service arm of your practice — the pleasant bunch that is expected to smile warmly when greeting patients, even when paperwork is piled a foot high — and the collectors of vital information that you need to get paid. Indeed, the front-office staffer is “one of the most important posi-
tions within a physician’s office, and probably one of the least recognized as far as the importance,” says former practice manager Angie Midkiff, who is currently a business strategist for EHR vendor Cerner. Meanwhile, pushing more work toward the front desk is a growing trend among practices, says David Gracey, president of Network1Consulting, which works with Atlantabased medical practices. “We’re seeing a lot of change in that area,” says Gracey. “A lot of doctors are pushing to get more efficiency at the front desk.” Several technologies have emerged recently to help practices get by with fewer administrative staff while helping those that remain do their jobs more effectively. Let’s take a look at what’s out there. May 2012 | Physicians Practice |
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By Robert Redling
A Primer
www.physicianspractice.com
Patients say they want transparency and instant access to their healthcare information, yet most remain on the sidelines when it comes to using these tools. Maybe that’s no surprise when many physicians are still getting up to speed on EHRs. That may change — and soon. Stage 2 of the federal EHR meaningful use incentive programs requires that eligible providers make more healthcare information available electronically to more patients starting in 2014 — personal health records (PHRs) can help physicians reach that goal. Still, meaningful use is not the primary motivator for PHR adoption, say medical practices using the technology successfully. Instead, it is driven by patient expectations, adept integration of information systems, and demands for value from physicians, patients, and payers. So far, the PHR installations that seem to gain the quickest acceptance from patients share three elements: user-friendly technology, tie-in to a medical practice’s website, and the encouragement of physician advocates. Here’s more information on what’s driving the adoption of PHRs, what
value they bring to practices and patients, and key tips for implementing them and encouraging patients to use them.
Technology
How a PHR pleases patients, improves visits
PATIENT EXPECTATIONS
Although recent surveys indicate disinterest in PHRs among patients — about 10 percent of Americans used them in 2011, according to Deloitte Center for Health Solutions — Brock Morris, chief information officer at Redmond, Wash.-based Pediatric Associates, hears a different story from parents of the practice’s patients. That’s probably no surprise, he says. Many of the parents bringing their children to the 85-physician multisite practice also work for the city’s top private employer, Microsoft Corporation. “The parents of our patients tend to be a technicallyminded demographic,” Morris says. “We get asked all the time: ‘What new services and solutions can you provide us?’” PHRs, he adds, are a natural extension of his patients’ parents’ everyday experiences. “The parents are used to having information at their fingertips and being able to control it. They are frustrated when they want their child’s immunizations or a growth chart and are told they have to wait a few days. In almost every other environment today, people get information quickly and can manage it themselves.” As younger, more tech-savvy patients become more active users of medical practices, the drive toward PHR adoption will increase. Indeed, Morris notes that younger generations of patients, including the parents he hears from at Pediatric
October 2012 | Physicians Practice |
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Meaningful Use
Progress Report How CMS’ EHR incentive plan is working — and what the next steps are for your practice By Marisa Torrieri
When family physician Christopher Tashjian attested for Stage 1 of CMS’ “meaningful use” program bright and early on April 18, 2011, most other practices hadn’t even picked out an EHR. By April 2012, as few as one in five providers had attested, according to CMS’ count. www.physicianspractice.com
The purpose of the meaningful use program, and the stimulus dollars attached to it, was to digitize America’s healthcare-recordkeeping system — creating a data-based boon, say proponents, for providers and public health advocates alike. But the program got off to a slow start, and questions have emerged about the efficacy of the program and its administration by the government.
Is the incentive program working as it was intended? Let’s look at the details — past, present, and future — to find out. THE EHR INCENTIVE: A LOOK BACK
CMS published the final rule for its Medicare and Medicaid EHR incentive programs to the Federal Register on July 28, 2010. Enacted in the Health Information Technology for Economic and Clinical Health (HITECH) Act — part September 2012 | Physicians Practice |
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Gadgets go for
Cool Tech Toys for any Activity
The Lytro camera lets you create “living” pictures, meaning you can refocus and rework them after you click the shutter button. You can work with the photo on the camera’s touch screen or from your computer once the photo is imported. Lytro.com purchase price: $399 to $499
Physician stress is rising, so it’s important to cultivate your personal interests and unwind at the end of your workday. To help, we’ve assembled great nonmedical gadgets you might find appealing depending on your particular interests and hobbies. Just browse by your personal interests:
Stay warm
Take great photos
This Nest Learning Thermostat is a lot more stylish than your old device, and it’s a lot smarter too. You can control it from your computer or phone using a mobile app. Over time, the Nest learns your schedule and preferences and adjusts itself accordingly to help you save energy. Nest.com purchase price: $249
The iRobot Mint+ 5200 automatic floor cleaning robot helps keep your floors spotless — effortlessly. Set it to sweep or mop mode and sit back and relax. The automatic cleaner even has a navigation system that works like a GPS, so it remembers where it has already cleaned and where it needs to go. iRobot.com purchase price: $299.99
Be entertained With the 3M Streaming Projector Powered by Roku you can watch TV and movies on the big screen anywhere, anytime. Insert the Roku Streaming Stick into the projector and you have access to any channels found on the Roku platform, including Netflix and Hulu Plus. The projector comes with rechargeable batteries and built-in speakers. With a strong Wi-Fi connection and an area to project the stream you’ll be good to go. Amazon.com list price: $299.99 Photo courtesy: Nikon Corporation; Delphi Automotive LLP; Leatherman Tool Group, Inc.; 3M; Fitbit Inc.; iRobot Corporation; Bushnell Outdoor Products; Camelbak Prodcuts, LLC.; Lytro, Inc.; MilestonePod; Beats Electronics LLC; GlobaTrac, LLC; PowerStick.com; Nest Labs, Inc.; Kohler Co.; HAPILABS Ltd.; The Sharper Image
re l ax
Cut down your to-do list
The Nikon COOLPIX S800c is a Wi-Fi-enabled Android smart device. You can edit your photos and videos and upload them to Facebook or YouTube, transfer them to a laptop or mobile device, or e-mail them. Users can also surf the Web or download applications and games. Nikonusa.com purchase price: $349.95
Exercise
Go for a run The MilestonePod helps runners track their stats and stay safe. The pod clips to the laces of your running shoes, so you never need to worry about forgetting it when heading out for a jog. If you connect it to a USB-enabled device, you can store your personal health and emergency contact information in the pod. The MilestonePod was not yet available at press time, but the company was accepting preorders.
Go for a long drive This gadget fits on your keychain but contains seven potentially lifesaving tools. The 7-in-1 Emergency Auto Tool features an automatic glass breaker, stainless steel safety blade seat belt cutter, sonic alarm, red emergency flasher, LED flashlight, thermometer, and digital tire gauge. Sharperimage. com purchase price: $29.99
If you love your old car, but wish it were equipped with the same vehicle diagnostics as newer models, it can be. Vehicle Diagnostics by Delphi is a gadget that plugs into the OBD-II port found in any vehicle built since 1996. Once connected, you can unlock and lock your car and access its driving data and mechanical condition through a smartphone or computer. Got a teen driver at home? Set up notification alerts to inform you if your car leaves a certain area or starts speeding. Verzionwireless.com purchase price: $249.99
E x p lo r e
Stay on track Love adventures but have a habit of getting lost? Carry the Bushnell BackTrack D-TOUR with you, and this small, handheld device will lead the way home. It can store up to five locations and logs up to 48 hours of trip data. Bushnell.com purchase price: $119
Find an adventure For hiking, camping, fishing, or hunting, the Leatherman OHT multi-tool is like a Swiss army knife on steroids. The one-handoperable tool features spring-loaded pliers, wire-cutters, multiple screwdrivers, a knife, a saw, a strap cutter, and a can opener. It even has an oxygen tank wrench. REI.com purchase price: $82
Have peace of mind Sick of worrying about the airline losing your luggage? The Trakdot Luggage device is a palm-sized GPS gadget that you can throw into your suitcase before checking your bags. Users can receive baggage location information from the tracker via e-mail, SMS messages, or a special app. Available June 24th for $49.99 via Trakdot.com
Lighten your load The PowerTrip is a handheld, portable, battery-powered charging device that can receive a full charge from a wall outlet, a supplemental charge through a USB port, and a top-up charge from its attached solar panel. The device is equipped with three connectors for charging multiple gadgets. Powerstick.com purchase price: $99
Go on a long hike
T r av e l Eliminate distractions The Beats Executive headphones are made for travelers, and they use battery-powered noise cancellation to keep your music flowing without interruption, no matter what’s happening around you. They even fold flat for easy packing. Beatsbydre.com purchase price: $299.95
Track your fitness progress Ready to step up your fitness activity? The Fitbit One Wireless Activity & Sleep Tracker is just the ticket. This tiny gadget can be stored in your pocket or clipped to your clothing and it tracks your distance traveled, calories burned (based on your personal profile), stairs climbed, and sleep cycle. It even syncs to your computer and some smartphones so you can monitor your progress and meet your fitness goals. Fitbit.com purchase price: $99.95
Change your eating habits Simple but smart, this electronic fork helps monitor and track your eating habits. Use the HAPIfork when eating and it logs how long you eat, your “fork servings” per minute, and the pauses you take between servings. It even lights up if you are eating too fast. The information compiled by the fork can be uploaded via USB to your online dashboard. The HAPIfork was not yet available at press time, but the company was accepting preorders.
The CamelBak All Clear is a must-have for outdoorsmen. It uses UV technology to neutralize microbiological contaminants in any tap or clear a natural water source to EPA standards in 60 seconds. It even has a built-in LCD to confirm when your water is safe to drink. CamelBak.com purchase price: $99
In Practice Why your practice should pay attention to online reviews, and what it can do about them By Aubrey Westgate
Many of you may be tempted to ignore what patients are writing about you online. After all, actively monitoring rating and review websites will take up more of your already limited time and energy. Plus, there’s the fear of what you might find. Reading negative comments about yourself and your practice is probably not your idea of a good time. But experts say that in the case of online ratings and reviews from patients, ignorance is not bliss. The more aware you are of what patients are writing about you, the more able you will be to improve your online reputation. That online reputation may be playing a bigger role in your practice’s well-being than you think. Take Los Angeles-based solo www.physicianspractice.com
OB/GYN David Ghozland as an example. He says 50 percent of his new patients point to online reviews and rating sites, such as Yelp and ZocDoc, as their referral sources. “... Where once our referrals were in large part from other physicians, we find that our biggest referral basis today is the online referral,” he says. While your practice may not have experienced such a dramatic shift in referrals, it’s likely that online ratings and reviews are playing a bigger role in your ability to attract new patients. A 2012 survey of more than 2,000 individuals found that 59 percent considered online reviews and ratings at least “somewhat important” when choosing a new doctor; and nearly 25 percent had actively sought out physician rat-
ings when choosing a primary-care physician in the previous year. The survey findings appeared in a recent JAMA article based on research from the University of Michigan Health System, School of Public Health, and Gerald R. Ford School of Public Policy. Another survey, conducted by healthcare technology company Digital Assent in 2013, found that 72 percent of 341 respondents said that bad reviews would prevent them from going to see a particular doctor. Given the growing role online ratings and reviews are playing in new patient acquisition, it’s time to take a more active role in managing your online reputation. But it can be difficult to determine how to begin. To help, we asked online reputation management experts to weigh in. Here are five simple steps you can June 2014 | Physicians Practice |
21
Politics
Rate the
2012 Presidential Candidates Here’s how the two men vying for the Oval Office compare when it comes to issues facing today’s physicians
By Keith L. Martin
No matter who wins the White House on Election Day, the way you practice medicine today is destined for change.
only to the scope and pace of change in healthcare, not to the fact of change itself or its general direction.
In the wake of the Supreme Court’s decision to uphold the Affordable Care Act (ACA), the Republican nominee for president, Mitt Romney, has said he’ll work to repeal the law if he’s elected. President Obama would, of course, press forward with the ACA. But observers argue that the outcome of the election may matter
Robert B. Doherty, senior vice president for governmental affairs and public policy for the American College of Physicians, says, “the pressures on small practices, the rising cost, the pressure on payers to deliver care more efficiently, the pressures of EHRs — those all will still be there with or without the law.”
Sources: Mitt Romney for President (www.mittromney.com); Obama for America (www.barackobama.com); American College of Physicians Candidate Position papers (www.acponline.org/advocacy/election_2012/)
• ACA establishes several pilot programs, including Comprehensive Primary Care Initiative and accountable care organizations • Several pilot programs, promotion of health IT initiatives, featured in the ACA. EHR adoption incentives, included in the stimulus of 2009, already underway. • “Individual mandate” begins in 2014, expanding insurance options and penalizing those who do not purchase insurance
Here’s a breakdown of where each candidate stands on various issues facing today ’s physicians:
Romney
Obama • Fully implement all provisions of the Affordable Care Act
“Healthcare in this country is in crisis mode and regardless of what happens in November, our system in this country still needs overhaul, well beyond what the Affordable Care Act does,” says Gregory Moore, who chairs the international health group for the Washington, D.C.-based law firm Clark Hill. “
Healthcare Reform Fee-for-service Alternatives
Health IT Promotion
Reduce Uninsured Rolls
• Repeal ACA • Restore state-based healthcare leadership vs. federal oversight • “Promote” alternatives; no further specifics • “Facilitate IT interoperability”; no furthe details provided • Promote state-based initiatives, including private-public partnerships, exchanges, and subsidies
• Expand program to low income individuals with incomes at or below 133 percent of federal poverty level
Medicaid Expansion
• Block grants to states to fund program and aid uninsured
• ACA has established annual wellness visits, “doughnut hole” protections. Obama opposes making Medicare a defined contribution program.
Medicare Reform
• Supports Paul Ryan plan to restructure Medicare by capping amount for either Medicare or private plan payments
Tort Reform
• Cap non-economic damages in medical malpractice lawsuits
• Does not support caps on non-economic damages; initial support for health courts and other initiatives • Expressed support for repealing SGR
Reform Medicare SGR Formula
• Has not made formal proposal / statement on issue
Keith L. Martin is managing editor at Physicians Practice. He can be reached at keith.martin@ubm.com. 22
| Physicians Practice | October 2012
www.physicianspractice.com
Technology
C’MON
Get
H e a lt h AliveECG
This app is for use with AliveCor’s FDAapproved heart monitor to record, display, store, and transfer single-channel electrocardiogram (ECG) rhythm strips. Available in both the iTunes Store and on Google Play, patients can text or e-mail their rhythm strip to a physician for interpretation. AliveCor also offers interpretations to consumers for a fee.
Pill Reminder
There are several free pill reminder apps available for both Apple and Android devices. One is Pill Reminder offered by Drugs.com, which in addition to serving as a pill and refill reminder, also touts itself as a comprehensive personal medication record app allowing tracking of multiple medications for multiple users. 20
| Physicians Practice | October 2014
iHealth BPM
While the app, available exclusively in the iTunes Store, is free, it only works in conjunction with the iHealth Blood Pressure Dock, which retails for between $80 and $100. By using their iPhones, patients can record and track blood pressure data and even have that information e-mailed to their practice if they require ongoing monitoring.
Skype
You likely know about Skype and may have concerns about using it with patients due to issues surrounding HIPAA. But at least one of the physician advisory board members says he uses Skype, available for both Apple and Android devices, and some payers do reimburse for services under the 99444 billing code (for e-visits). The physician says Skype is most helpful for follow-up visits for established patients away at college.
fitness MyFitnessPal
A majority of our board members recommended the MyFitnessPal app to aid weight loss and help count calories. The app, available in both the iTunes Store and on Google Play, boasts the largest food database of any calorie counter (over 3 million foods) and also features more than 350 exercises to assist patients with weight loss.
Lose It!
One of the most popular weight loss/calorie counter apps on the market, it features a barcode scanner, recipe planner, and has interoperability with several other health and fitness apps. Available in the iTunes Store and Google Play, the app also features a social element, allowing digital support from friends, families, and peers, as well as a challenge feature, allowing patients to compete against others in their wellness goals. www.physicianspractice.com
It may seem that every patient entering your practice is tethered to a smartphone or tablet. So why not use that to your advantage and recommend some health and fitness apps to help them improve their well-being? Here are 10 favorite apps from Physicians Practice’s Physician Advisory Board.
App-y AppGoMeals
Like similar apps, GoMeals tracks calories and offers a robust database of food items, including restaurant menu items. But the app, available for Apple and Android devices, was recommended by physicians who see patients with conditions like diabetes, which requires checking blood sugar levels on a regular basis. GoMeals not only helps patients make better food choices, but also includes a location to record and track glucose levels to share with physicians.
fun Omvana
This one could easily also qualify as fitness, but the Omvana app provides users with thousands of customizable meditation, relaxation, and motivational audio tracks. Available in the iTunes Store, the app is free, but most of www.physicianspractice.com
the tracks — for everything from helping sleep to hearing self-help messages — must be purchased. Nonetheless, it’s helpful if your patients need some help getting rest or getting motivated.
SongPop
Welcome to the 21st century version of “Name That Tune.” SongPop, available in both the iTunes Store and on Google Play, lets users guess the artist or song for over 300 genres of music. Plus, users can challenge friends or complete strangers and wow them with their musical prowess. The app is a great way for patients to pass time, stay sharp, and have some fun, according to our advisory board physicians.
Fit Brains Trainer
This app, available from Rosetta Stone in the iTunes Store and on Google Play, can help your patients enhance memory, processing speed, concentration, and other mental skills. The trial version of the app is free, but an enhanced “lifetime” version will require a subscription. The app uses an index to measure users’ cognitive performance across five major brain areas and lets them compare results with other users that share the same age and gender. Keith L. Martin is group editorial direc-
tor for Physicians Practice. He can be reached at keith.martin@ubm.com.
Looking for an app for your practice? Get practice management advice for free via the Physicians Practice app for the iPad. October 2014 | Physicians Practice |
21
In Practice Magnolia Merit:
Mississippi Top for docs again
Not every physician wants the same things, but they all want a favorable practice environment. Here’s where to find it. By Erica Sprey
Wade Dowell is a family physician who practices in the small town of Indianola, Miss., population 13,000, and a true native son of Mississippi. Dowell, who is also immediate past president of the Mississippi Academy of Family Physicians, says, “I have lived within 30 miles of [Indianola] my entire life, other than medical school and residency. … I like the rural setting.” When he’s not treating patients you might find him with a hunting rifle: he’s an avid outdoorsman who thoroughly enjoys the varied op22
| Physicians Practice | October 2014
portunities for fishing and hunting along the rivers and lakes of Mississippi. So it’s clear to see that he likes practicing medicine in Mississippi. We think it is a great place to practice, too. According to Physicians Practice’s annual “Best States to Practice” rankings, Mississippi places at the top of the pack in 2014, as it did last year. Alabama, Texas, and Nevada round out the top four states in the latest rankings, but that shouldn’t mean they are the only desirable places to hang up www.physicianspractice.com
a shingle. The following states also did well in our ranking: Tennessee, South Carolina, Indiana, South Dakota, Arkansas, and Oklahoma. If you are curious about practice conditions in our top four states, or just wondering why they are so darn physician-friendly, here are the results of our 2014 analysis. METHODS
While it is hard to definitively identify the “best” places to practice, we looked at key factors that can affect a medical practice’s financial health. Factors such as: cost of living, disciplinary actions taken against physicians, tax burden per capita, Medicare’s Geographic Practice Cost Index (which adjusts reimbursement amounts to reflect the variation in practice costs from area to area), physician density, and malpractice award payouts per capita. Rather than produce a purely numbers-driven ranking, we also looked at the number of times a
in summary Each year Physicians Practice conducts its analysis of “The Best States to Practice,” and each year many states in New England and the Mid-Atlantic region are consistently ranked at the bottom of our list. Why? The usual culprits: a high cost of living, high physician density, greater physician disciplinary actions, and a high tax burden to name a few. Aside from Hawaii, the remaining four worst states to practice are located on the East Coast. In order from worst to not-so-bad they are:
• New York • Maine • New Hampshire • Maryland
www.physicianspractice.com
ral part of the state. That jives with our ranking, placing Nevada fifth in physician density, ranking from lowest to highest. It also makes our short list for low disciplinary actions and low malpractice payouts. Because of the demographic differences in the state, the southern part of Nevada has a greater managedcare penetration; making it harder for physicians to negotiate contracts. However Farrimond says the picture is much rosier in northern Nevada. “I think it is a favorable place … to negotiate contracts. … They really haven’t intro“I’m an old-school duced capitation up here family physician. I think in the northern parts. So income preservation … that family doctors should is fairly nice.” have the opportunity Nevada boasts grand vistas, mountain ranges, to do anything they are and Lake Tahoe, escapable of doing.” sentially making it an Wade Dowell, MD outdoorsman’s paradise; which was a big draw for Farrimond. In fact, after a year out of state following his residency, he returned to Nevada to stay. “I acIf your state is not highlighted tually love living in Nevada,” he says. here, a more in-depth look at how “If you really enjoy rock-climbing each state (and the District of and skiing and fishing and hunting … Columbia) performs in each data category appears at bit.ly/beststates. I don’t think there could be a much better place to live.” particular state placed in the top-10 for each category, to gain an overall picture of physician-friendliness. And, as much as we would have liked to include lifestyle factors such as proximity to world-class museums, professional sports teams, skiing, or rock climbing, we realize that individual physicians have different tastes.
Open Road
NEVADA: THE GREAT OUTDOORS
Nevada is a tale of two regions: the more urban, northern half of the state, which includes Reno and Carson City, and the southern, more rural half. According to Donald Farrimond, a family physician practicing in Reno and president of the Nevada Academy of Family Physicians, there is a significant shortage of primary-care physicians in the ru-
ALABAMA: COMMUNITY DOCS
Family practice physician Julia Boothe says the best thing about Alabama is its sense of community. Boothe, who practices in Reform, Ala., a town of about 3,000 people, says, “I’m not from the community in which I practice, but I was very easily taken in — [members of the community] see you at the local ball games … You October 2014 | Physicians Practice |
23
in practice
Dowell has enjoyed his relationship with his employer and feels that it has allowed his practice much more autonomy. “In this clinic we do a full range of family
says that in rural Oklahoma she did everything from delivering babies, performing C-sections, and caring for children and adults in the hospital. But in the Dallas-Ft. Worth metropolitan area, she has much more choice in how “Insurance … not just she structures her malpractice … but practice. Another benefit of practicpersonal insurance and ing in Texas? “The malpractice workers’ comp, all the [insurance] was things that go into running astonishing. It was probably a a business, it’s more quarter of what I paid in Oklabusiness-friendly [here] homa,” says Seythan it is in other states.” mour, a member of the Physicians Elizabeth Seymour, MD Practice Physician Advisory Board. Texas did very well in our analymedicine, including obstetrics and sis, with a low physician density, operative obstetrics. And we are low cost of living, and a low tax able to do that because we are a burden. Oh, and did we mention public hospital,” he explains. the “astonishing” malpractice rates? He says his clinic is one of only Seymour concurs with our analysis, two in the state that permit their saying that practice conditions in family physicians to deliver babies. He notes, “I’m an old-school family the Lone Star State are favorable to physicians and business owners in physician. I think that family docgeneral. “Insurance … not just maltors should have the opportunity to practice … but personal insurance do anything they are capable of doing.” However, Dowell thinks those and workers’ comp, all the things that go into running a business, it’s days are numbered as the cost of more business-friendly [here] than malpractice insurance for obstetrics it is in other states,” she adds, “I has become prohibitive. have the freedom to do whatever I TEXAS: PRACTICE FREEDOM want,” practice-wise. Family physician Elizabeth Seymour And she does not have the Texas completed her residency in OklaMedical Board looking over her shoulhoma and practiced rural medicine der, either. What could be better? n there for two years. But she missed home. So she pulled up stakes and Erica Sprey is associate editor at reestablished her practice in DenPhysicians Practice. She may be ton, Texas, a suburb of Dallas. She reached at erica.sprey@ubm.com.
PRO BUSINESS
are accepted much quicker than you would be in other places.” Boothe also believes that medical education is a strong point for the Cotton State. She notes that Alabama has two allopathic medical schools and an osteopathic medical school, which plans to open a branch campus in Auburn. Boothe, who is also president of the Alabama Academy of Family Physicians, is active in medical education herself; she is an associate professor at the University of Alabama, Tuscaloosa campus. “I have nurse practitioner students [and] residents coming through my office,” she notes. “Anytime you have an increase in education, you have … more opportunities to stretch yourself, as well.” Alabama has done very well in our analysis for several years running; this year it placed in the top-10 for all factors except disciplinary actions and Medicare GCPI. MISSISSIPPI: FLEXIBLE FAMILY DOCS
There are numerous reasons why the Magnolia State is a favorable place to practice medicine. Not the least of which is that it has consistently placed at the top of our list for several years running. Why? Next to liberal amounts of Southern hospitality, Mississippi has a low physician density, which places physicians’ skills in greater demand. Mississippi also ranks in the No. 1 position for lowest cost of living and tax burden; combine that with very low malpractice payouts and you have an ideal environment to set up a practice. The state has also been largely sheltered from the effects of managed care, until recently, according to Dowell. He says because there’s no pressure from managed-care organizations, his group practice, Indianola Family Medical Group, which is owned by South Sunflower County Hospital, has “had [the] freedom to practice medicine as it should be practiced, with the patient coming first.” 24
| Physicians Practice | October 2014
Scan this code with the QR reader on your smartphone or tablet for complete rankings of this year’s Best States to Practice, including our interactive map and tool that ranks the states by your own personal preferences. www.physicianspractice.com
Best States to practice 2010
Looking for the Land of Smiling Physicians? Our “traffic light guide” to state-level data on conditions affecting physicians’ wallets should help. For each state, we present numbers on cost of living, Medicare pay, taxes, malpractice premiums, and more — each color-coded traffic-light style. Lots of green boxes means go. Lots of red — put the brakes on that move.
Work State GPCI
Medical Liability Avg. Premiums Physicians Medical Board Cost-of- State Living Income per 100,000 Discplinary Actions Internal General OB/GYN Index Tax Rates Residents Medicine Surgery per 1,000 Physicians
Alabama 0.982 91.86
5% on $3K
Alaska 1.5 133.93 0% 4.54% on Arizona 0.988 104.27 $150K 7% on Arkansas 0.961 90.18 $33K North: 1.055; 131.46 9.55% California South: on $47K 1.034 4.63% Colorado 0.986 100.83 on all income
$8K $31K $42K $9K
$33K
$20K
$52K-$92K $67K-$103K
$56K
218.0 2.55 228.0
6.54
210.0
5.12
$8K $25K $43K
203.0 3.61
$7K-$20K $23K-$68K $30K-$90K
269.0 2.37
$13K $47K $55K
260.0
4.54
Connecticut 1.038 128.8
3% on $10K; $15K-$35K 6.6% on $500K
Delaware 1.011 100.45
6.95% on $60K
$13K-$17K $41K-$58K $76K
251.0
3.15
District of 1.047 137.9 Columbia
8.5% on $40K
$24K $73K $147K
807.2
3.81
$65K-$81K $107K-$170K 376.0
1.97
Florida 0.987 97.99 0% $21K-$55K $74K-$215K
$105K-$239K
248.0 2.35
Georgia
$68K-$93K
217.0
2.4
$10K $37K $62K
317.0
4.04
$7K
169.0
3.07
$17K-$41K $43K-$127K $60K-$178K
280.0
3.9
$10K
$35K-$45K $54K-$73K
217.0
2.73
$7K
$18K-$34K $27K-$46K
189.0
4.56
0.994
92.41
6% on $7K
Hawaii 0.998 163 Idaho 0.967 92.07 Illinois 1.002 97.5
9% on $150K; 11% on $200K 7.8% on $26K 3% on all income
Indiana 0.986 95.02 Iowa 0.965 94.77 Kansas 0.969 91.48
3.4% on all income 8.98% on $63K 6.45% on $30K
Kentucky 0.969 89.18 Louisiana 0.978 96.91
6% on $75K 6% on $50K
Maine 0.971 119.2 Maryland 1.003 125.4 Massachusetts 1.018 117.1 Michigan 1.017 97.6
8.5% on $20K 2% on $1K; 6.25% on $1 million 5.3% on all income 4.35% on all income
Minnesota 0.992 101.58
7.85% on $75K
$10K-$16K
$30K-$60K
$20K-$29K $33K-$48K
$10K $35K $49K-$52K 223.0
2.57
$11K $45K $60K-$70K 232.0
5.87
$18K
$56K-$64K $78K-$88K
262.0
4.74
$8K-$10K $26K-$31K $43K-$50K
278.0
4.44
$13K-$21K $48K-$81K $91K-$158K
421.0
2.2
$13K $40K $97K
469.0
2.46
$9K-$38K $36K-$143K $36K-$136K
250.0
2.49
$4K
293.0
0.95
$11K-$17K $17K-$23K
Work GPCI: CMS’ Geographic Practice Cost Index is an adjustment in Medicare pay. Median: 1.0.
KEY
Cost-of-Living Index: Computed by the federal government. Median: 100. State Income Tax Rates: From the Federation of Tax Administrators; many states have graduated income tax rates. Medical Liability Average Premiums: From MyMedicalPracticeInsurance.com; ranges supplied for where averages
vary widely by location and insurer.
Physicians per capita: From the U.S. Census, reflects competition level. Medical Board Disciplinary Actions: From Public Citizen, reflects physician autonomy.
www.physicianspractice.com
continued on next page
September 2010 | Physicians Practice |
11
Best States to practice 2010 continued Work State GPCI
5% on Mississippi 0.959 91.43 $10K 6% on Missouri 0.977 96.1 $9K
$6K-$17K $41K-$58K $56K-$82K
178.0
1.87
$11K-$26K $28K-$132K $47K-$132K
246.0
2.96
6.9% on Montana 0.955 101.3 $15K 6.84% on Nebraska 0.959 91.67 $27K Nevada 1.002 102.5 0% New Hampshire 0.982 117.1 0% 1.4% on New Jersey 1.05 127.23 $20K; 10.75% on $1 million 4.9% on New Mexico 0.973 99.9 $16K NYC & Suburbs: 4% on $8K; New York 1.04; 128.02 8.97% on Rest $500K of NY: 0.997
$15K
221.0
3.38
$5K $15K $23K
245.0
4.34
$8K-$34K $9K-$17K
$29K-$118K $37K-$49K
188.0 275.0
2.63 2.1
$19K
$42K-$64K $50K-$171K 316.0
$56K-$62K $71K-$93K
$42K-$169K $60K-$77K
2.44
$11K $59K $74K
244.0
3.14
$9K-$33K
$30K-$106K $50K-$195K
396.0
3.41
7.75% on North Carolina 0.972 96.43 $60K 1.84% on $34K; North Dakota 0.947 94.7 4.86% on $374K 0.68% on $5K; Ohio 0.993 93.64 6.25% on $200K
$10K
$33K-$53K $42K-$82K
254.0
4.02
$6K-$13K $18K-$37K $27K-$44K
244.0
4.99
$13K-$40K $40K-$141K $56K-$171K
267.0
5.33
5.5% on Oklahoma 0.964 89.48 $9K 9% on $8K; Oregon 0.985 105.03 11% on $250K Pennsylvania 1.005 100.87 3.07% on all income 9% on $172K; Rhode Island 1.013 121.7 9.9% on $373K South Carolina 0.975 98.62 7% on $13K South Dakota 0.942 92.8 0%
$12K-$15K $39K-$51K $56K-$63K
174.0
5.02
$9K
$28K-$37K $36K-$64K
275.0
3.88
$7K-$27K
$22K-$137K $35K-$172K
305.0
2.66
Tennessee 0.978 Houston: 1.016; Texas Rest of Texas: 0.994
89.05
0%
91.26 0%
$12K-$16K $44K-$57K $111K-$117K 376.0
2.85
$9K-$11K $4K
$41K-$45K $13K
$45K-$49K $20K-$21K
230.0 219.0
1.23 2.57
$9K-$11K
$36K-$41K
$51K-$60K
264.0
2.44
$9K-$32K
$20K-$107K $27K-$152K
214.0
2.6
5% on Utah 0.977 95.25 all income 9% on $172K; Vermont 0.968 119.9 9.5% on $373K Virginia 0.982 98 5.75% on $17K Washington 1.001 103.59 0%
$9K-$13K $44K-$68K $62K-$95K
208.0
3.36
$7K-$10K $23K-$28K $44K-$52K
374.0
3.28
$13K
$45K-$59K
$61K-$72K
274.5
2.96
$13K-$15K
$45K-$59K
$61K-$72K
270.0
2.46
6.5% on West Virginia 0.973 94.68 $60K 4.6% on $10K; Wisconsin 0.988 96.81 7.75% on $225K Wyoming 0.956 98.3 0%
$21K-$23K $58K-$79K $80K-$113K 232.0
3.11
$6K
$14K-$23K $18K-$35K
259.0
1.64
$17K-$22K
$59K-$78K
184.0
4.16
KEY 12
Medical Liability Avg. Premiums Physicians Medical Board Cost-of- State Living Income per 100,000 Discplinary Actions Internal General OB/GYN Index Tax Rates Residents Medicine Surgery per 1,000 Physicians
$84K-$97K
Work GPCI: CMS’ Geographic Practice Cost Index is an adjustment in Medicare pay. Median: 1.0. Cost-of-Living Index: Computed by the federal government. Median: 100. State Income Tax Rates: From the Federation of Tax Administrators; many states have graduated income tax rates. Medical Liability Average Premiums: From MyMedicalPracticeInsurance.com; ranges supplied for where averages
vary widely by location and insurer.
Physicians per capita: From the U.S. Census, reflects competition level. Medical Board Disciplinary Actions: From Public Citizen, reflects physician autonomy.
| Physicians Practice | September 2010
www.physicianspractice.com
2
easy
PLEASERS
How can you ensure your patients leave your practice feeling healthier and happier? We asked 10 patients for their tips.
1
GOOD TIMES “I
like doctors’ offices that have Wi-Fi, sports magazines, and beer — though I know that last one isn’t possible.”
A SENSE OF HUMOR “Unless
PERSONAL NATURE
“I appreciate when nurses and the doctor treat you like an individual, not just another patient filing through the office for an appointment. Asking some personal questions and genuinely taking interest in what’s going on with me goes a long way.”
you’re telling me that I have cancer or that mole on my shoulder is a rare African flesheating virus, lighten up for a change! Too many doctors carry the weight of the world on their shoulders while probing whether I eat enough leafy vegetables or if I’m doing enough cardio (I am).”
3
9
ACCESSIBILITY
4 7
“I enjoy a waiting room with decent magazines of interest to wide audiences.” GOOD READS
“One thing that makes my visits to my doctor more enjoyable is that her waiting room has a coffee machine with different types of coffee, and a little fridge filled with small water bottles available to anyone who’s waiting.”
SOOTHING ATMOSPHERE
“If the exam room is painted in a color rather than stark white walls, I always feel calmer.”
SUSTENANCE
“I like when doctors actually listen to and repeat back my concerns to me before acting. They’re supposed to do this with every patient, but many do not.” THOUGHTFUL REACTIONS
10
5
“I was a bit nervous about a dental procedure I had to have done, and when I called the office to ask questions, the periodontist gave me her cell phone number and was able to talk with me later that day to provide some answers. It’s great when doctors go out of their way to be accessible!”
8
6
DISTRACTIONS “I love the pictures on the ceiling at the [OBGYN].”
COLORFUL CLOTHES “I like when the nurses and aides are dressed in cheerful, colorful uniforms — it makes me feel happy and not stressed.”
Marisa Torrieri is an associate editor at Physicians
Aubrey Westgate is an associate editor at Physicians
Practice. She can be reached at marisa.torrieri@ubm.com.
Practice. She can be reached at aubrey.westgate@ubm.com.
www.physicianspractice.com
April 2012 | Physicians Practice |
13
ways to go green at your practice
Make this Earth Day, April 22, 2013, count. Here are some quick and easy suggestions from physicians and practice managers to make your practice more environmentally friendly:
Ditch plastic. n Don’t supply staff members with
plastic water bottles; ask them to bring in their own reusable bottles and install water coolers in your office. n Place recycling bins throughout the office, including in the reception area. n Maintain HIPAA compliance and go green at the same time. On a regular basis, have an outside company shred and recycle your discarded paper.
Clean greener. n Do the ozone and your staff
a favor. Use eco-friendly cleaning products. n Use tissues, toilet paper, and paper towels made from 100 percent recycled paper. n Don’t throw away old equipment — donate it.
Be energy efficient. Change the environment. n Plant some fruit
trees. They’re good for the environment, and it’s also a great hint to patients to eat more fruit. n If possible, install a skylight. Sunlight is much easier on the eyes and on energy costs. Install solar panels at your practice and use them to power your hot-water heater.
n Install an automated thermostat at your
practice to ensure peak efficiency. n Equip exam rooms with motion sensor lighting. n Use power strips to turn technology off at night or when not in use.
Get everyone involved. n Start a “Green Team” and appoint a few
resourceful staff members to find ways to make the office more environmentally friendly. n Support local agriculture: Find a local farm share or Community Supported Agriculture (CSA) organization, and ask it to put up a flyer in your office offering patients a discount. n Consider making your office the weekly pickup location to foster community interconnection. n Have quarterly in-office lunches to reward employees for helping keep the office green.
Contributors: Derrick Berger, MD; P.J. Cloud-Moulds; Steve Kwon, MD; Audrey “Christie” McLaughlin, RN; Dustin Sulak, MD; and Christopher Tashjian, MD
Marisa Torrieri is an associate editor at Physicians
Aubrey Westgate is an associate editor at Physicians
Practice. She can be reached at marisa.torrieri@ubm.com.
Practice. She can be reached at aubrey.westgate@ubm.com.
6
| Physicians Practice | April 2013
www.physicianspractice.com
Life is short — don’t let anxiety keep you from enjoying it Find time to play. Play with your
kids, work on a craft, paint, draw, or write. Getting your creative juices flowing will get your mind off your worries. When play time is over, you will feel recharged and ready to greet the day. Live in the moment. When
stress overwhelms you, it’s important to maintain perspective. Step back and focus on appreciating what is happening around you. As one of our Facebook fans says, “Taking time to enjoy the love of my children takes all the stress away.”
Write a “gratitude” list.
Multiple studies have shown that the happiest people in the world aren’t stressing over what they don’t have; they feel grateful for what they do have. By writing a daily gratitude list of things you’re grateful for, you may see there’s less to stress about — and that you’re not doing too badly!
Escape. Whether it’s getting lost in
the latest reality TV drama or flipping through a travel magazine, we all need a little mental break from our daily routine. Our Facebook fans cited everything from indulging in a good book to listening to music as foolproof ways to escape on hectic days. 6
| Physicians Practice | March 2014
Meditate. Take a few minutes to calm your mind each day. One popular meditation technique to try: Sit still, close your eyes, and focus only on the sound and feel of your breathing. Learn to say no. Attention people pleasers: This one’s for you. If baking cookies for your office party means you will have to stay up until midnight to get them done, don’t offer to bake them. If you don’t have time to make a fantastic meal for your kids, relax and order a pizza. Remember: Sometimes you need to put yourself first in order to give others your best self. Eat healthy. When you’re feeling over-
whelmed, the temptation to dive into a box of donuts or chocolate-covered caramels is hard to resist. But indulging in fatty and sugar-laden foods will do little more than offer temporary relief. Opt for healthier fare such as fresh fruit and you’ll enjoy more long-term, stress-relieving benefits.
Don’t bottle it up. Don’t let your worries
run rampant through your mind all day — and night. Take a few minutes to write down what is stressing you out or vent to a friend. Once you’ve let it out, you will be surprised at how much more manageable everything seems.
Exercise. Hit the gym, go for a run, or
take a walk around the block. Exercise, in any form, will help clear your head and put you in a better mood. A great workout will also help you sleep better, which, in turn, will reduce your stress levels.
Don’t eat at your desk. We all get a little too busy now and then. But even on the most intense, work-laden days, it’s important to at least try to consume your lunch away from your workstation. Take time to savor you meal as your worries float away. If going out for lunch is too costly or time-consuming, find a colleague to buddy up with and eat your brown-bagged goods with good conversation.
Marisa Torrieri is an associate
editor at Physicians Practice. She can be reached at marisa. torrieri@ubm.com. Aubrey Westgate is senior
editor at Physicians Practice. She can be reached at aubrey. westgate@ubm.com. www.physicianspractice.com
10
Things I’ll Stop Using in the Next Five Years’ Which of the trusty, everyday tools you use in your practice are edging toward extinction? Here are some of the things you told us you’ll probably stop using in the next five years. Disinfectant spray and paper towels. Chances are
your practice has been using hand sanitizer since the late 1990s as an easy, convenient alternative to soap and water. Now, UV sanitizers are gaining physician fans for their ability to disinfect everything from mobile phones to keyboards with the simple push of a button. And because sanitizers don’t require water, users save on paper towels, too. Traditional stethoscopes.
The iconic symbol of medicine is getting a makeover. More and more doctors are opting for high-tech stethoscopes.
Many practices are trading clunky servers for cloud computing, and it’s easy to see why. Outsourcing data storage reduces headaches, opens some physical space, and eliminates your risk of data loss in case of flood, fire, or natural disaster. All you need is an Internet connection.
In-house servers.
Keyboards. If the soaring popularity of the iPad and other touch-screen mobile gadgets is any indication — not to mention the growth of EHRs with mobile functionality — your future could be keyboard-free. One physician told us he’ll be using “touch and voice commands” completely to activate his EHR in the next five years.
Pagers. Even in the era of tablets, there are still physicians who’ve yet to trash their beepers. But if studies are correct, in the next few years more and more will opt for upgrades, and pagers may be relegated to history. Fax machines.
You’ll replace those big, energy-sapping machines that earned their fame in the 1980s with efficient scanner systems that allow you to send documents via the Internet.
Medical transcriptionists. Voice
recognition technology is more efficient and less expensive than transcription services — and physicians are noticing. According to our 2011 Technology Survey, 23 percent of you use voice recognition technology. That percentage will only continue to grow.
Translation services. More
than half of practices that treat non-English speaking patients use interpreter services, according to a 2010 report by the Center for Studying Health System Change. But that might change soon. Pennsylvania-based internist Joseph Kim says instead of using translation services “we’ll be translating through our mobile phones.”
Traditional copy machines. Here’s
what you told us: The big, clunky copy machine is out, while smaller, more efficient multi-use scanners, copiers, and printers are in.
Paper charts.
Enough said.
Marisa Torrieri is an associate editor at Physicians
Aubrey Westgate is an associate editor at Physicians
Practice. She can be reached at marisa.torrieri@ubm.com.
Practice. She can be reached at aubrey.westgate@ubm.com.
36
| Physicians Practice | May 2012
www.physicianspractice.com
Not-SoObvious Roles Docs Play You may be thinking, “I already know what I do — I’m a doctor, and I treat and care for people on a daily basis.” Well, yes. But you’re so much more. Being a doctor affords you the opportunity to make a difference in a number of other ways, too, leveraging your knowledge, skills, and compassion to help folks in big ways and small. You’re not just a doctor. You’re also a vital: Disaster relief worker:
When Hurricane Katrina and the earthquake in Haiti struck, doctors willing to work onsite provided muchneeded and highly effective help. While many volunteers are sidelined waiting for instruction, doctors can get right in the mix, treating the injured on the scene.
Community health promoter: Your medical education provides
you with tons of knowledge that pertains to the quality and length of life of your fellow humans. By sharing that information — on everything from hand washing to STDs to smoking cessation — at local wellness fairs or free clinics, or by speaking at prisons, community centers, or schools, you improve the health and well-being of your community.
Patient advocate: Follow-up
Mentor: You’re also able to have
a significant impact on the future of your vocation. Many practicing docs moonlight as medical school instructors, train residents at the local hospital, or take younger partners under their wings.
calls, appointment reminders, e-mails — these little patient services might not seem like much to you, but they mean the world to your patients. These acts tell them that they are not alone in the healthcare wilderness. It can also make a big difference to their health: effective patient follow-up leads to better clinical outcomes and early detection of new symptoms.
Resource provider: Unfortunately,
you’re not always the bearer of good news. Sometimes you have to deliver the blow that a patient has a life-threatening disease, a chronic illness, or a debilitating injury. As patients grapple with their diagnoses, many docs help alleviate their fear and worry by providing resources to help patients get reliable information about their condition and its treatment, as well as about local and national support groups.
Compassionate listener: If you surf patient chat rooms and physician rating sites, the common thread
in stories about why patients like their physicians or feel a doc “changed their life” is compassion. On one site a patient wrote of her favorite doc: “I swear she actually cares how I feel when she asks me.” For many people, being sick or even going to the doctor’s office is a scary, uncomfortable experience. The simple act of listening to a patient’s concerns with your full attention and offering advice or reassurance makes a bigger difference to many of your patients than you probably realize. Way to go, doc!
28
Abigail Beckel is managing editor for Physicians Practice.
Sara Michael is senior editor for Physicians Practice.
She can be reached at abigail.beckel@ubm.com.
She can be reached at sara.michael@ubm.com.
| Physicians Practice | September 2010
www.physicianspractice.com
Models Seeking Marrow Flip through any magazine and you’ll see attractive female models used to market everything from watches to cologne. So it is no surprise that a company in New Hampshire thought they had found the perfect way to promote bone marrow donation to male customers. Or so they thought. State law enforcement officials began investigating a bone marrow registry affiliated with the University of Massachusetts Medical Center, which paid female models $60,000 per week to recruit potential donors at shopping malls and sporting events, according to The New York Times. New Hampshire officials said the registry hired models based on their photographs and gave them “explicit instructions” to wear heels, short skirts, and for some, electric-blue wigs to encourage men to donate a DNA swab, the report notes. The problem, however, was that once the swab was collected by registry employees, insurance companies were billed up to $4,300 per test, unbeknownst to the potential donors. The registry says it recruited more than 185,000 In its television ads, Corona is seen as potential donors in New England, using the modthe no-worries, relaxing-on-the-beach beer els to “help acquaint the public on how they can of choice for people with their backs to the contribute to this lifesaving effort.” The registry camera. Perhaps now we know why you also said it is no longer hiring models nor collectdon’t see their faces, or much of their ing DNA in New Hampshire, amid an investigation skin for that matter. into its marketing and billing practices. Scott Flugman, a New York dermatologist, recently discussed the possibility of contracting “Mexican beer dermatitis” from the popular beverage, thanks to the lime wedge frequently served as Corona’s companion. According to Flugman’s research, published in the Archives of Dermatology, when a Corona drinker plunges the lime into the beer and mixes it up with his thumb over the top of the bottle, there is the possibility that the beer and lime blend could spill onto his skin. The result of such a spill — when exposed to sunlight — can be a skin reaction akin to poison ivy or a jellyfish sting caused by the substance psoralen. Percentage of physicians Percentage of physicians who say they are confi- who blame “lack of substanThe solution? Remove any “spritz” that dent they will qualify for tive support” from their could be exposed to the sun, or if you federal “meaningful use” vendors, for not qualifying aren’t near a sink and don’t want to halt incentives by this spring. for “meaningful use.” your relaxation, “throw a towel over it.”
Maybe Just Stick With Tequila
Source: market research firm Black Book Rankings
Stat:
2
| Physicians Practice | February 2011
10 93
www.physicianspractice.com
Can You Bite Me Now? Since the age of 14, Stephen Hirst experienced excruciating pain and loss of hearing in his right ear. Imagine his shock — and that of medical staff — when the source of the problem was discovered: a rogue tooth in his ear canal. Hirst, now 47, recently had the tooth removed from his ear at a Sheffield, England, hospital after what he said was repeated visits to ear, nose, and throat clinics, according to the Daily Mail. Hirst finally went to the hospital, where a nurse cleaned out the ear and used a pair of tweezers to extract the tooth, which is the only one the former miner had. He’d had all the ones in his mouth removed years ago. Doctors say the tooth is likely one of the front incisors, with Hirst saying he probably “pushed it in” as a kid, perhaps when he hit the back of his ear while swinging between two desks as a schoolchild. While his right eardrum has disintegrated, Hirst said he is glad the pain is now gone, noting that it is “better late than never” that the tooth finally made its way to the surface, so to speak.
Recommended Site/Resource Love Is in the Air for Physicians, Hospitals Seeing as this is our February edition, what better resource than a look at the growing romance between physicians and hospitals sparked by federal health reform? “From courtship to marriage: Why health reform is driving physicians and hospitals closer together,” by Pricewaterhouse Coopers is the first of a twopart series on physician-hospital alignment. In examining these new courtships, PwC even has a section entitled “The heart of the matter,” where it indicates nearly three-fourths of docs are in financial relationships with hospitals, while more than half “say they want to move closer financially.” Ah, amore. To access the report, go to www.pwc. com and search using the report’s title.
Happy Wife, Happy Life Married people: Would you say you’re a happier person than your spouse, or less happy? Either way, you’re wrong, if recent research from the University of British Columbia, Canada, is to be believed. According to researchers, most married folks are at the same level of happiness as their better half, and as one spouse’s happiness ebbs and rises, so does the other’s. Lead author Christiane Hoppmann, a professor of psychology, told MSNBC that future studies on how happy an individual is should also incorporate the happiness of their spouse, since they share the same environment, for the most part. She also said it is unclear whether these same emotional ups and downs are similarly tied in friendships, or in individuals who share a lot of joint experiences.
Eye in the Back of His Head Discontented with the two eyes placed in the front of his head, a New York University arts professor has decided to add a new one. Wafaa Bilal had a digital camera, two inches in diameter, surgically implanted in the back of his head to capture images for a new project entitled “The 3rd I.” Bilal told the Associated Press that the third eye will capture “the things we don’t see and leave behind.” Images from the camera — taken at a rate of one per minute — will be transmitted to the Arab Museum of Modern Art in Doha, Qatar, in real-time, as well as to a Web site: www.3rdi.me. Bilal would not comment about the surgery to implant the camera in his head, but we’re sure he had one heck of a time getting his health plan to foot the bill. February 2011 | Physicians Practice |
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Can’t Sleep? Don’t Go To Vegas Neurologists at two Duke University Medical Schools found that sleep-deprived individuals experience increased optimism. Sounds great, right? Well, here’s the rub: As a result, they tend to make risky decisions. Using a functional MRI, the neurologists tracked brain signals in 29 study participants — once after a normal night of sleep, and once after a night of sleep deprivation. They found that tiredness leads to increased activity in brain regions that assess positive outcomes, while reducing activity in brain areas that analyze negative outcomes. The combination: increased optimism and a higher tolerance for risk. In a series of monetary decision-making tasks related to gambling, the sleep-deprived study participants tended to make choices that emphasized monetary gain, and they were less likely to make choices that reduced loss. The more exhausted they were, they less likely they were to (literally) hedge their bets. The study was published in the Journal of Neuroscience.
Coffee Buzz, Brain Buzz
Coffee drinkers, rejoice. That early morning kick you so desire may not be so bad a habit after all. In fact, it may actually be helping your brain. A study conducted at the University of South Florida and published in the Journal of Alzheimer’s Disease found that forgetful mice (they had been bred to develop symptoms mimicking Alzheimer’s)
experienced memory gains after drinking coffee. But not just any coffee — it had to be caffeinated. The caffeinated coffee increased blood levels of GCSF in the mice (the substance decreased in human Alzheimer’s patients). The mice with higher GCSF, in a series of tests, displayed better memories.
Quoteable:
“There is nothing worse than ending an interview, and finding an extraordinary comment in your notes — for which there is not a shred of supporting evidence.” –Bob Levoy, Physicians Practice Pearls, “Tested Tips for Interviewing,” page 10
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| Physicians Practice | September 2011
Stat
The Marriage Perk — for Men
The percentage of every dollar physicians receive from patients that goes toward covering the cost of “excessive administrative complexity” in billing processes. Source: Health Affairs
It’s already clear that being married decreases the risk of death from cardiovascular causes — but why? Canadian researchers think they found one reason. In a study of heart attack victims published in The Canadian Medical Association Journal, researchers found that married individuals sought treatment for heart attack symptoms faster than singles. But when the researchers analyzed the data they found a surprising trend. While married men were 60 percent more likely to arrive at hospitals sooner than single men, there was no significant difference in arrival times between married and single women. Why? Perhaps women push their husbands to seek help sooner when health problems arise.
Comic Therapy
Recommended Website: Nearly 40 percent of American adults use at least one form of alternative medicine, and they seldom discuss this usage with their physicians, according to the National Institutes of Health. To help providers deal with such issues, NIH launched a new website earlier this year, http://nccam.nih.gov/health/providers/, to help physicians learn about the efficacy and safety of alternative treatments. The site is filled with evidence-based resources such as research results and clinical practice guidelines, on topics such as dietary supplements, herbs, acupuncture, chiropractic medicine, and massage, for physicians and patients to discuss together.
Healthcare providers are using comics to help treat patients and better relate to them. Earlier this year, physicians attended a conference entitled “Comics & Medicine: The Sequential Art of Illness,” at Northwestern’s medical and law schools in Chicago. The attendees discussed ways to use comic strips to create visual representations of emotions, health problems, and health crises. The hope is that viewing images, and creating them, can help patients better process health issues; and help physicians empathize with patients. The conference was sponsored in part by Jean Schulz, widow of Charles M. Schulz, the “Peanuts” creator.
Why You Should Blog In a recent PhysiciansPractice.com blog post, Dr. Craig Koniver writes that blogging is the “best tool” for physicians to market themselves to current and prospective patients. Here’s why: • It makes you an individual: It showcases what sets you apart from other providers. • It makes you human: It allows patients to relate to you and trust your advice. • It builds rapport: It helps patients feel comfortable with you. www.physicianspractice.com
September 2011 | Physicians Practice |
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Physician Fraudster
Quotable:
A Dallas-area physician recently made headlines for allegedly masterminding the largest healthcare fraud scheme by a single physician practice ever. He and his co-conspirators are accused of working with hundreds of home health agencies to sign up new patients for home health services, according to NPR. Their patient recruitment tactics allegedly included buying groceries for people in exchange for their signatures, and parking at homeless shelters to get the homeless to sign up. Ultimately, over a six-year period ending in 2011, the physician and his colleagues certified more Medicare patients for home health services than any other practice in the country: 11,000 patients. Then, the physician allegedly submitted a staggering $374 million worth of false claims to Medicare and Medicaid for services to these patients.
“You almost need two languages, one that you use with your colleagues and a second vocabulary you use with your patients.”
– Paul D. Smith, MD, professor of family medicine, University of Wisconsin School of Medicine and Public Health Source: American Medical News
“The notion that your needs for healthcare are best met by seeing a doctor a couple times a year is probably wrong. There is obvious value in knowing more.” – Dr. Joseph Smith of the West Wireless Health Institute, which seeks to lower healthcare costs through technology like wireless medical devices. Source: Marin Independent Journal
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| Physicians Practice | May 2012
Preemie Prevention An innovative program may reduce the number of premature births and infant deaths in North Carolina. The Pregnancy Medical Home model, much like Patient-Centered Medical Homes, focuses on prevention and care coordination. Participating physicians receive incentives for taking extra steps to ensure smoother patient pregnancies, including screening all pregnant Medicaid-eligible patients to see if they are
at risk for complications, according to Stateline. When a patient is highrisk, a care coordinator is assigned to work with the patient to help her successfully navigate the pregnancy. According to the state’s Medicaid director, the number of emergency room visits by pregnant women and usage of neonatal intensive care units have decreased since the program was implemented. www.physicianspractice.com
Motivational Tips Practice Notes blogger and consultant P.J. Cloud-Moulds recently identified key ways to keep your staff happy and thriving. Start by creating a “strengths and opportunities” list for each employee. Then, “reinterview” each staff member and ask about their talents and special skills. Be sure to ask what they want to do that they are not currently doing. Then, review your original list of strengths and opportunities and consider whether staff members are serving in the right position, if they are assigned the right roles, if there is a special project you can offer them, etc. “There are gems hidden in all of us,” says Cloud-Moulds. “Your staff needs you to be a treasure hunter for their skills.”
Why do you stay? Private practice certainly has its struggles, but that doesn’t mean it has lost its allure. Physicians Practice recently polled our private-practice readers on why they opt-out of employment. Here’s what they said: 0 10 20 30 40 50 60 70 80 90 100
Autonomy (45%) I like to be my own boss and make the decisions Comfort (11%) This is all I know Flexibility (34%) I have more power over my own schedule
Stat
20 20 The percentage of physicians who say they have not fully disclosed a medical error to a patient in the previous year due to fear of a malpractice lawsuit. Source: Health Affairs
Culture (10%) It’s more laid back and family-friendly
5 Ways to Exploit Social Media
New Old Opportunities
A robust social media network of professional colleagues can:
The physician shortage is becoming an old problem — literally. As the baby boomers age, it’s critical that more geriatricians are available to treat them. That bodes well for physicians looking for a change. More and more geriatric training and fellowship programs are opening their doors to practicing physicians. Brown University for instance, offers psychiatrists a one-year geriatric fellowship training program; and some hospitals, like Boston Medical Center, offer weekend geriatric immersion programs for doctors, according to the New York Times.
1. Shed light on new employment opportunities within your field; 2. Steer you toward nonclinical opportunities to pursue upon retiring, like consulting; 3. Help you identify opportunities for colleagues; 4. Expand your knowledge by exposing you to a wide range of links and talking points; and 5. Provide you with leads for a career transition. Source: Internist and entrepreneur Joseph Kim, in a blog appearing on KevinMD.com
May 2012 | Physicians Practice |
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EHRs and the Solo Physician
Kudos to Telehealth Telemedicine is often touted for saving physicians and patients money and time, and now it looks like there are other benefits. Telehealth chronic-disease, selfmanagement programs can boost care access to isolated areas, according to research published earlier this year in Telemedicine and e-Health. Researchers studied 19 chronicdisease, self-management programs delivered via telehealth to 13 rural communities. They found statistically significant improvements from baseline to four-month follow-up in several areas including exercise behavior, cognitive symptom management, communication with physicians, and psychological well-being, FierceHealthIT reported.
If you’re a solo physician, you’re about half as likely to adopt an EHR than your peers in larger primary-care practices, says a new report from The Commonwealth Fund. According to the report — based on data from the 2012 and 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians — 90 percent of medical groups with 20 or more physicians have adopted EHRs, while only about half of solo doctors have, EHR Intelligence noted. A few reasons why? Solo docs may be discouraged from taking on new technology after reading bankruptcy horror stories, and those who are older or close to retirement may see little reason to invest in technology that’s hard to learn, researchers suggest.
Buyout Banned In a decision that could influence the future of hospital-physician practice buyouts, a federal judge ruled in January 2014 that Idahobased St. Luke’s Health System violated antitrust laws when it purchased the state’s largest independent physician practice, FierceHealthcare reported. The plaintiffs argued that the acquisition would give St. Luke’s an unfair and illegal marketplace 2
| Physicians Practice | April 2014
advantage by dominating primary care in Canyon County. Christy Neuhoff, St. Luke’s chief legal counsel, told FierceHealthcare after the ruling that St. Luke’s was likely to appeal the decision. “We are extremely disappointed that the judge has ordered the parties to unwind the relationship and that the court defined the market so narrowly,” she said.
Percentage of eligible professionals that had registered to participate in CMS’ EHR incentive programs, as of January 2014. Source: CMS
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Viewing Time
Clouded Visions Think you know everything about cloud computing? According to IT consultant Marion Jenkins, a contributor to Practice Notes, Physicians Practice’s blog, even the most tech-savvy physicians can fall prey to misconceptions. One example: The belief that the cloud is “cheaper” than having an in-house server. “Properly designed and configured cloud services can be less expensive, depending on the circumstances, but if it’s a significant difference then you likely don’t have the whole story,” Jenkins wrote. For more cloud myth busters, see bit.ly/cloud_myth.
A new HHS rule released earlier this year will allow patients to view their lab results directly at their request. While doctors can still access results for patients, the new rule offers patients an alternative method for obtaining results while maintaining their privacy, EHR Intelligence noted. “The right to access personal health information is a cornerstone of the [HIPAA] Privacy Rule,” said HHS Secretary Kathleen Sebelius in a statement. “Information like lab results can empower patients to track their health progress, make decisions with their healthcare professionals, and adhere to important treatment plans.”
Physician Segregation? We’ve come a long way since the days when hospitals had separate wards for white and black patients, but a new study published in JAMA Internal Medicine suggests that “de facto segregation” still exists, Bloomberg Businessweek reported. Findings show that when minority patients get medical care, they are more likely to
App of the Month: UpToDate Mobile Medicine is always changing — and that’s why up-to-date information is a must for physicians. The latest version of UpToDate Mobile, literally, provides just that. What makes it different from other reference apps is that it synthesizes research from more than 450 journals into accessible topics clinicians can use. Another differentiator is that most of those topics include recommendations from UpToDate’s full-time staff physicians who are recognized experts in their specialties. The result: Physicians can not only research a topic, they can get expert insight on diagnosis and treatment. The free app is available for download on iOS, Android, or Windows8, and requires a $499 subscription ($449 annual renewal). www.physicianspractice.com
see doctors who are minorities. According to the study, based on an analysis of 7,070 patient surveys from 2010, non-white doctors cared for about 54 percent of minority patients. But minority doctors account for only one-quarter of the U.S. physician workforce, according to a report from the Association of American Medical Colleges.
Don’t be cowed by t h i s. D o c s s h o u l d n’t t a k e t h i s l y i n g d o w n. Ophthalmologist Steven Thornquist, in an interview with Physicians Practice, on why docs cut from health plans should fight back (bit.ly/network-cut).
Obamacare, the ‘law of the land,’ contains ever-changing-at-the-whim-of-HHS politically-expedient mandates, rewards, penalties, rules, and regulations with which I cannot rationally or morally treat my patients and run a practice, much less interpret, implement, or comply [with].” Ophthalmologist Kristin Held, cofounder of AmericanDoctors4Truth.org, in an open letter to an insurer on why she can no longer see its patients.
April 2014 | Physicians Practice |
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Your Phone Is Watching You
Wooing Quality Physician Assistants Even as dire predictions of physician shortages continue to dominate the news, recruiting agencies are speculating that finding and hiring physician assistants could become a problem as well; especially as patient demand amplifies because of newly available health insurance. According to David Doyle, CEO of CRT Medical Systems and a Practice Notes blogger, practices should consider working with a recruiter to hire top PAs. Doyle says, “A good recruiter can save your practice time and money by taking on all aspects of the recruitment and hiring process…” If that isn’t in your budget, he suggests serving as a clinical rotation site. That way you’ll likely get first dibs on promising new graduates. To learn more, visit bit.ly/recruit-top-pa.
50 2 million Stat
$
The amount of money spent on Oregon’s failed health insurance exchange website.
The nascent field of patient-generated health data is picking up steam as technology companies like Apple and Samsung are developing new products to monitor and track patient health remotely, according to Kaiser Health News. New devices can do everything from monitor patient breathing through sensors under a mattress to record a patient’s pulse and heart rhythm through a portable EKG built into a smartphone case. Insurers and EHR vendors are collaborating with creators of devices like mobile apps that will record and upload patient data to the cloud for storage and remote access by physicians. However, many physicians are reticent to embrace patient data generated through apps because they are not regulated by the FDA. And, there is the question of data security, which must comply with HIPAA regulations.
‘Lethal Painkiller’ Approved by FDA Zohydro ER is a long-acting version of the popular painkiller hydrocodone. It also belongs to the most troublesome class of drugs in the United States: addictive prescription pain meds. Yet, the FDA has approved Zohydro for manufacture over the objections of its own advisory committee, according to The New York Times. Such is the outcry that “29 state attorneys general have asked the FDA to reconsider its approval,” the Times reports. While the drug could be a boon to chronic pain sufferers, detractors say it has significant drawbacks: It will be available in strengths up to five times greater than short-acting versions, and it will be sold in capsule form, which increases the potential for abuse.
Source: WebMD 2
| Physicians Practice | June 2014
www.physicianspractice.com
Rushing to Regret In a busy medical practice, an empty spot on your team line-up is anathema. But don’t rush to fill open staff positions. If you make a bad selection, you could incur significant “soft” costs to your bottom line: lost productivity, increased overtime, and added resources devoted to interviewing. Practice management consultant and Practice Notes blogger P.J. Cloud-Moulds advises practices to take their time and carefully define their needs. She outlines six steps to smart hiring: define your requirements, describe your ideal candidate, make adjustments to your expectations, establish a process to weed out poor candidates, verify application data, and make it easy to “call it quits.” To learn more about hiring great medical staff, visit bit.ly/hire-great-staff.
Shaming Payers on Twitter During the mad dash to purchase health insurance through the exchanges, things got a little hairy for Anthem Blue Cross of California customers, according to ProPublica. Anthem said it informed its customers by letter that it planned to cancel any insurance products that were noncompliant with the Affordable Care Act and enroll those customers in compliant plans; continuing automatic withdrawals from bank accounts to pay monthly premiums. Most
customers didn’t read the whole letter and just assumed their coverage through Anthem was terminated. When they discovered the switch in plans, many irate customers tried, but were unable, to contact Anthem, so they turned to Twitter. For example, “@kevinwchat: Way to blame the Affordable Care Act for the reason why you won’t pick up the phone during business hours, @AnthemPR_CA. Classy.”
Don’t Get Rid of My ‘Obamacare’ In the South, President Obama’s healthcare overhaul is not a well-liked program: 64 percent of survey respondents from Arkansas said they disapproved of the president’s “handling of healthcare,” according to a poll conducted by The New York Times and Kaiser Family Foundation in April. While the poll shows that residents in Kentucky, Louisiana, and North Carolina strongly dislike the law as well, they don’t want to chuck it. Quite the contrary: They’d really like to get the bugs out. Want Congress to Improve it
North Carolina Kentucky Louisiana Arkansas
60% 52% 52% 48%
Want it Repealed and Replaced
35% 41% 44% 46%
Total sample of 4,152 adults in these four states
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App of the Month:
Omnio for Smartphones The popular medical reference application Omnio is now available for smartphones. Physicians Interactive Inc. offers free versions of the app for iPhone devices running iOS7 or greater through iTunes, and Android devices running Android 2.2 or greater through Google Play. Both versions offer a free three-month trial of The Merck Manual for Healthcare Professions. Features include 500 medical calculators, medical news feeds, links to clinical journals, and an extensive drug guide. The app is highly customizable, using tabbed navigation to allow users to arrange the home screen to favor their preferences and work flows. For more information: http://omnio.com/. June 2014 | Physicians Practice |
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Wal-Mart Competing with Rural Docs Wal-Mart has opened six primary-care clinics in South Carolina and Texas, according to Forbes. If all goes well, the retailer plans to open six more clinics by year’s end. Wal-Mart plans to provide primarycare services in rural areas that traditionally have limited access to physicians. Each clinic will be staffed with NPs and PAs provided through a partnership with QuadMed, a workplace primary-care clinic provider. Keeping with Wal-Mart’s low prices, patients will be charged $40 for an office visit, while employees who are covered through the retailer’s insurance plan will pay only $4 a visit. Currently, the clinics do not accept third-party insurance, but do take Medicare and some Medicaid patients.
Where Are the Nurses?
Small Practices, Better Outcomes Researchers at Weill Cornell Medical College in New York found that smaller primary-care practices have lower rates of preventable hospital admissions, according to the journal Health Affairs. The study looked at 1,045 primary-care practices with fewer than 19 physicians. Using Medicare data, they found that practices with three to nine physicians had 27 percent fewer preventable admissions when compared to practices with 10 to 19 physicians. Practices with one to two physicians did even better: They had 33 percent fewer preventable admissions than the largest practices. The study also found that physician-owned practices had fewer preventable admissions than those that were owned by a hospital. App of the Month
L’Allegro App
Federal regulation enacted 17 years ago requires nursing homes to have a registered nurse on-site for only eight hours a day. Current state law varies widely: 13 states require 24-hour coverage by an RN, according to The New York Times. But in other states, that requirement varies according to the size of the nursing home. The American Association of Nurse Assessment Coordination reviewed 2012 data available on Medicare’s Nursing Home Compare Site. It found that at least 1,777 nursing homes, or 11.4 percent, do not have 24-hour RN coverage. In response to the findings, U.S. Rep. Jan Schakowsky (DIll.) has introduced legislation to “require that a direct-care RN [not an administrator] be present 24 hours a day.”
L’Allegro version 1.1, “the antidepressant chooser for primary-care physicians,” was designed by Stanford University family-medicine clinical instructor Steven Lin. Lin based his app on evidence-based guidelines for choosing antidepressant drugs. The app uses point-of-care decision support to help physicians make treatment choices in the management of unipolar major depressive disorder. The app is available for free on iTunes. 10
| Physicians Practice | October 2014
www.physicianspractice.com
DIY Sleep Monitoring The gold standard for diagnosing obstructive sleep apnea is an overnight study conducted in a sleep laboratory. However, for many patients, health insurance won’t cover this test, which can cost as much as $1,000. However, most people can safely use a portable sleep monitor to diagnose sleep apnea, according to new guidelines released by the American College of Physicians. Critical care pulmonologist Jon-Erik Holty, coauthor of the guidelines, says the portable monitors have become more common because of their lower cost, from $200 to $250, and are a viable alternative for patients who don’t live near a sleep lab, reports WebMD.com.
Patient Survey Problems Payers are increasingly holding practices accountable for patient satisfaction. Knowing how your patients feel about your staff can definitely help your practice improve the way it delivers care, but finding out may not be straightforward. Practice Notes blogger and practice consultant Carol Stryker cautions that the way you craft your patient satisfaction
surveys could keep you from gleaning quality feedback from patients. She shares four pitfalls to avoid, including: The survey is not designed to answer a specific question or questions. Stryker advises, “Ask questions that elicit pertinent, unambiguous responses.” To find out more visit bit.ly/four-problems-surveys.
Shopping for a Bargain Lab Test Researchers at the University of California San Francisco found a thousand-fold difference in the cost of laboratory tests done at hospitals across the state, according to Kaiser Health News. Renee Hsia, associate professor at the university, and her colleagues chose to compare the cost of routine blood tests because they are automated and not subject to variations like technician skill or equipment capabilities. They found that a cholesterol panel ranged from $10 to $10,169, and a basic metabolic panel went for $35 to $7,303. The study looked at 150 California hospitals, which by law, are required to report what they charge for a random sample of the most common outpatient tests.
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70%%
Physicians e-prescribing using an EHR on the Surescripts network by April 2014, according to the ONC Data Brief, “E-Prescribing Trends in the United States.”
More Medicaid Patients Approximately 66 million adults and children are enrolled in either Medicaid or the Children’s Health Insurance Program as of June 2014, according to data released by CMS. That’s an increase of 7.2 million people since the healthcare exchanges opened last year. But what is more notable is the number of people enrolling for these programs in states that have not expanded Medicaid eligibility; a total of nearly 975,000 people since open enrollment began, according to The New York Times. Why the increase? Experts point to a phenomenon called the “welcome mat effect.” Due to the promotional efforts around health reform, many people who already qualified for Medicaid coverage finally decided to sign up. October 2014 | Physicians Practice |
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