May 2008

Human Resources | Legal | Operations | Practice Management | Reimbursement | Technology

Human Resources

The Foolproof Way to Hire Medical Office Staff

Physicians working in solo practices or small group practices play a major part in recruiting new employees, and because the process involves a lot of time and money, they should take care to implement hiring policies that ensure the right person is hired for the job. When a position opens up, office managers should look over recently received resumes, inquire about recent graduates from medical assisting schools, seek referrals from other staff members, and place advertisements in the newspaper and on the Internet. Practices with the money for an employment agency can shorten the recruitment process, as these firms screen applicants before they are recommended for interviews. When looking over resumes, the office manager should make sure applicants have the right education and work experience, but they would be wise to pass over those who want more than the practice can pay or change jobs often. Phone calls should be placed to the best candidates, with the office manager explaining the position and gauging the candidate's personality. When candidates come to the office for an interview, they should be presented with a written job description and asked to complete an employment application to determine their salary requirements, past wages, and desired benefits, among other things. The interview should be used to figure out whether candidates are capable of multitasking, whether they can handle pressure, and whether they possess other characteristics necessary to meet the practice's needs. Finally, the office manager should check the candidate's references, inquiring about punctuality, their willingness to work with others, and their ability to appropriately serve customers.

From the article of the same title
Medical Economics (03/21/08) Kagan, Jeffrey M.

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Operations

Smartphone Computing Moving Into Docs' Offices

Although physicians increasingly are employing smartphones, few of them are integrating the gadgets into their clinical practices due to the difficulties of inputting data using handwriting recognition and the lack of IT support from hospitals. Several software vendors have rolled out programs specifically for use by doctors on handheld devices, such as Epocrates' drug reference software and Skyscrape's medical textbooks. However, hospitals and other healthcare facilities are concerned about the spread of infection by clothes and devices, and experts insist there are other more important tools to bring into exam rooms. Even so, experts believe smartphone usage will increase in the future, as the devices allow physicians to easily access the Web, send and receive emails, make phone calls, and enter data into electronic medical records systems.

From the article of the same title
iHealthBeat (03/31/08) Al-Ubaydli, Mohammad

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Your Future Chief of Staff?

Dr. Jay Parkinson has met the challenge of creating a virtual physician's office by integrating off-the-shelf equipment and software. Having no office or staff, he answers patient queries via cell phone or email and has a Web site where appointments can be made for house or office calls. "A lot of my friends are artists and freelancers, and if you make $40,000 a year and health insurance costs $950 a month like it does in New York you are kind of screwed," says the doctor. "To succeed, I had to create something that these people would want enough to pay for it. So I asked myself, 'What would I want?'" If patients need a service that Parkinson cannot provide, they are referred to a list he has compiled of prices for services offered at various clinics, hospitals, and medical offices across New York City. Not all medical practices are likely to jump on board, say experts, though some larger organizations already have online visit capabilities of their own. E-visits can address the looming physician shortage and are in tune with Generation Y's fixation on technology. "Generation Y consumers don't just want online access, they expect it," says Paul Keckley, executive director of the Deloitte Center for Health Solutions. "When they buy a new MP3 player, they're not just comfortable Googling it to find out what's available and ordering online, they prefer it to going shopping. They are likely to do the same when they need health care," he adds.

From the article of the same title
Hospitals & Health Networks (03/08) Larkin, Howard

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Practice Management

Selling Your Medical Practice in a Buyer's Market

No longer can primary-care physicians guarantee that their practices can be sold to hospitals at top dollar, though The Halley Consulting Group President and CEO Marc Halley says hospitals continue to snap up practices to gain a competitive edge. There are several things physicians can do to ensure they get a good deal, such as sprucing up their practices. Not only does this involve making cosmetic improvements and upgrading old equipment, but it also means working with consultants to improve the practice's performance with regard to productivity, gross collection ratios, cash flow, percentage of net revenue from ancillary procedures, and accounts receivable. An independent appraisal typically is required to determine the practice's fair market value and includes equipment, furniture, office space, and other tangible assets, plus intangible assets, such as goodwill, or the practice's competitive advantage in the market. Goodwill can be determined using The Health Care Group's Goodwill Registry or by looking at how much more the buyer will earn by purchasing the practice than working elsewhere. Physicians also must hire a broker with experience in selling medical practices, carefully assess prospective buyers for "cultural fit," and work with an accountant to determine the tax consequences of the sale. Moreover, the buy/sell agreement should spell out such things as the payout schedule, the transfer of patient records and who will cover the costs, and indemnifications to safeguard the seller from the buyer's pre-sale liabilities and safeguard the buyer from liability incurred by the seller. Physicians also should draw up a separate agreement covering compensation, benefits, profit-sharing, noncompete restrictions, and malpractice and tail insurance if they stay on as an employee or independent contractor.

From the article of the same title
Medical Economics (03/21/08) Guglielmo, Wayne J.

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Leadership: The Most Crucial Element of Physician Dispensing

Physicians that employ in-house medication dispensing can cut overhead and boost profits, but such initiatives are successful only when physicians pave the way for a full integration into the practice. It is important for physicians to assume the role of leader when implementing medication dispensing, gaining the support of office staff. Physician leaders must communicate procedures, roles, and changes associated with the medication dispensing system and ensure they are understood by all staff members. They must be able to adapt when issues emerge and provide encouragement to staff hesitant about the new system. Finally, physicians should play an instrumental role in selecting the dispensing company, ensuring that the vendor will provide support over the long term.

From the article of the same title
American Chronicle (04/14/08) Moseley, Warren

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21st Century Primary Care

Dr. Richard Baron of Greenhouse Internists PC in Philadelphia and Dr. Christine Cassel of the American Board of Internal Medicine argue that the fee-for-service payment model undermines primary care because it puts more emphasis on visits to the doctor's office, procedures, and hospitalizations and draws attention away from patient-centered, multidimensional primary care practices. They note that insurers use fee-for-service models to boost healthcare and practice efficiency and reduce medical costs, promoting increased coordination of care as a way to accomplish these goals. However, Baron and Cassel point out that small physician practices cannot cover infrastructure and other expenses with fee-for-service payments. Moreover, practice revenue will take an additional hit due to increased care coordination, which will reduce office visits, hospitalizations, and redundant tests. This comes at a time when primary care medicine already is experiencing a shortage of doctors, as many look to higher-paying specialties or lack the skills necessary to manage primary care practices. The American Board of Internal Medicine is taking steps to ensure that primary care physicians are trained in core competencies necessary to run "efficient, well-organized practices," such as systems-based practice and practice-based learning and improvement. Numerous innovative practice models have emerged in recent years, such as the patient-centered medical home; the ambulatory intensive caring unit, which tiers care access and takes advantage of nonphysician clinicians and staff so that physicians can concentrate on direct clinical care and team management; and concierge medicine, which requires patients to pay retainers plus fee-for-service payments in exchange for more time with their doctors. Whatever models are selected should ensure that primary care continues to provide value to patients and the healthcare delivery system

From the article of the same title
Journal of the American Medical Association (JAMA) (04/02/2008) Vol. 299, No. 13, P. 1595; Baron, Richard J.; Cassel, Christine K.

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'Convenient Care Clinics' Growing, But Not All Doctors Like Them

Much to the chagrin of many primary care doctors, patients increasingly are seeking treatment at convenient care clinics, which handle a variety of minor conditions for less than the cost of a traditional doctor's visit or a trip to the emergency room. Patients treated at Target Corp.'s clinics in the Baltimore area spend about $49 to $69, and the visits also are covered by certain insurance plans. According to the Convenient Care Association, between 30 percent and 40 percent of patients who visit such clinics lack primary care doctors. Other patients turn to convenient care clinics because they offer appointments on a moment's notice and are open on weeknights and weekends. Some doctors are critical of these clinics, stating that they disrupt the continuity of care; but the American Medical Association does not oppose them as long as they are staffed by credentialed clinicians and abide by treatment protocols.

From the article of the same title
Maryland Daily Record (04/03/08) Buckelew, Karen

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Reimbursement

Place of Service Affects Your Reimbursement

Following an announcement from the Department of Health and Human Services' Office of Inspector General, federal bodies will be reviewing physician coding to determine if the codes accurately represent the places of service on claims. Reimbursements are affected by the place of service, according to Relative Value Units that Medicare uses as a standard for assessing the type of service and location. The RVU is divided into categories of work, practice expense, and malpractice, and differences within these categories can vary greatly depending upon whether or not service occurred in a facility or nonfacility setting. Physicians can consult the Medicare Fee Schedule on each carrier's Web site to determine the different coding between facility and nonfacility practice expense RVUs, which are assigned according to both the AAOS and surveys about the preferred service location. Reimbursements can also vary based on place of service in the arrangement of contracting with a private payor. In 2006, the Tax Relief and Health Care Act and Deficit Reduction Act introduced the Budget Neutrality adjustor, which reduced Medicare reimbursements depending on the work component of total Medicare payment. Though commercial carriers might not employ a work RVU BN adjustor, physicians should consult their carrier to ascertain if a RUV BN adjustor is applicable; the BN adjustor is Medicare-specific, thereby independent of RVUs for procedures.

From the article of the same title
AAOS Now (04/08) LeGrand, Mary

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Charting Your Patients' Insurance: It's All in a Simple Grid

Rick Langosch, consultant and CFO of the Atlanta-based healthcare consulting firm Coker Group, says fewer than 20 percent of physician practices take a proactive approach to insurers' pre-authorization requirements. According to Langosch, most practices bill the insurer and handle problems when the claims are denied. However, Evergreen Park, Ill.-based Vista Family Medicine discovered that posting an 8.5-inch by 11-inch piece of paper detailing pre-authorization requirements for such things as referrals and laboratory testing for each of the health plans it deals with saves up to 10 minutes per patient for referrals alone. The "Insurance Grid" is a Microsoft Excel file that is updated monthly by Sue Sarhage, Vista Family Medicine's practice manager. Given that health plans change their requirements so often, Sarhage says the 3,000-patient practice might have to hire more staff. She notes, "What I'm finding is everyone is trying to cope with these changes, but unless you have a mother hen at each practice saying, 'We're going to a have a plan,' I see a lot of administrators really floundering trying to get on top of these rulings and specifications."

From the article of the same title
American Medical News (02/25/08) Berry, Emily

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Technology

Physicians See Digital Records as Key to Healthcare Reform

Of the 1,000 physicians polled as part of Jackson & Coker's 2008 Healthcare Professionals' Opinions on Presidential Health Plans email survey, 46 percent think healthcare efficiency could be improved by automating patient records. The Alpharetta, Ga.-based physician recruitment firm asked 26 questions about universal healthcare, healthcare reform, and each presidential candidate's healthcare proposals. The survey reveals that 51 percent of respondents believe expanding access to low-cost prescription drugs would streamline healthcare, while 46 percent said boosting the efficiency of electronic medical records would accomplish this goal. Another 43 percent said healthcare efficiency could be bolstered by doctors devoting more time to patients, and 6 percent suggested more standardized patient care regulations. The doctors who participated in the survey generally agreed that the uninsured should have better access to healthcare; medical costs and prescription drug prices should be lowered; and all aspects of healthcare delivery need to be more efficient.

From the article of the same title
Healthcare IT News (04/04/08) Monegain, Bernie

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It's No LOL: Few US Doctors Answer E-Mails from Patients

Recent surveys indicate that less than 33 percent of physicians nationwide keep in touch with patients via email, due to concerns about heavier workloads, lack of insurance reimbursement for such services, privacy issues, or worries that they could be held liable if emergency messages are not immediately answered. However, Cigna Corp. and Aetna Inc. have broadened pilot programs that reimburse doctors for virtual house calls, which could boost the number of doctors using email for patient communication. Some physicians who use email note that they are not reimbursed for phone calls, but acknowledge that both forms of communication are valuable. Dr. Daniel Sands of Harvard Medical School checks his email every four hours; and while he says most messages involve updates from patients with chronic conditions or patients asking about particular symptoms, he has had experiences in which patients send a flood of messages and become threatening. "Any message that takes more than two volleys back and forth should not be done by email," Sands remarks. Some studies indicate that email boosts physician productivity and reduces the number of unnecessary office visits, but the American Medical Association stresses the importance of face-to-face interaction with patients. Experts underscore the importance of training physicians on digital privacy issues, covering such topics as properly filing messages in electronic health records.

From the article of the same title
Associated Press (04/22/08) Chang, Alicia

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Doing What Has Always Worked

Dr. Sanford Brown, who runs a solo practice in Mendocino, Calif., accepted an offer of a free computer and laser printer from an insurer even though he says the upgraded tools were not necessary. Before replacing his old computer, he made sure his existing practice management software was compatible with the operating system running on the new computer, and he used a zip drive to transfer the program over to the new machine. After the switch was made, Brown and his office staff saw an immediate jump in productivity, especially with regard to the faster laser printer. However, problems emerged after one week, when he noticed a few claims that needed to be fixed and resent because the claim was not dated--a process that the system should handle automatically. Brown concluded that in the process of moving the system from the old computer to the new machine, some data was damaged. Ultimately, he spent four hours inputting dates in claims that already were sent out, replacing office visit information no longer displayed, and restoring the data onto his old computer. Brown says the experience taught him not to upgrade systems unless an upgrade is needed.

From the article of the same title
Medscape (04/02/08) Brown, Sanford J.

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