The New York Times cited that twenty-five percent of Net use on work computers isn’t actually work-related. Although it is unknown how severe the problem is in medical practices, the trend continues to grow.

Beyond basic productivity loss, there are other dangers which result from employees abusing the Internet at work. At one company a staff person was fired for visiting adult websites and distributing the content to co-workers. Apart from the potential embarrassment over such an incident, a practice could be liable to sexual harassment lawsuits. But even if your employees use the Internet in a ‘decent’ manner, simply downloading personal data onto a work computer can increase costs for your practice in terms of bandwidth and storage.

So what can you do about it?

Create clear policies for network use. Does your company have a well understood policy regarding Internet use on work computers? And is this tied to a clearly-delineated disciplinary process? These policies should be included in the employee manual. These same policies are great protection for your practice in the instance of a lawsuit. Also, be sure to get acquainted with applicable privacy laws, normally found under the jurisdiction of state laws, since these vary state to state. [see more about privacy issues in MySpace in the Workplace

You should understand your rights and limitations as an employer. If you have doubts about a particular issue, contact a lawyer who specializes in employment law. In general, all the computers that staff use, along with the content, are company property. In the case of legal issues, as in allegations of harassment or discrimination, e-mail correspondence can be subpoenaed.

Make sure you understand your options before deciding to monitor Internet use. There are third-party monitoring software solutions, but the value of this depends on the size of your practice. Keep in mind that monitoring will add both complexity and cost to your day-to-day operations. Although there are free software solutions available for monitoring your network, operation and installation costs could make monitoring more of a hassle than it is worth.

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Post tags: computer network, cyber-slacking, medical practice management, Network, privacy, spying, Technology

CLICK HERE to download the PDF

Although it does present the topic from a technical perspective, it does also cover issues important to the CIO or Director of IT such as assessing the financial incentives weighed against implementation costs and a discussion about the importance of the ‘people factor’ as I have previously discussed: (see How to Prepare Your Team for EMR Implementation and The Right People for Your EMR Implementation)

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Post tags: ARRA, CHIME, EMR implementation, meaningful use

This first in a series of white papers offers a basic description of the final rules. We covered some of the specifics in previous posts CMS Final Rule Part 1, Part 2, and Part 3.

But if you are new to all of this and just want to get your feet wet, here is a good place to start:

CLICK HERE to download the PDF

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Post tags: AHIMA, EHR, EMR, meaningful use

Needless to say, patients went gaga for this ‘great new company.’ Smaller practices had no choice but to sign up as well, for pennies on the dollar of the usual Medicare rates. Other doctors in our specialty signed up under these new rates as well, but we held our ground. We were the only group practice in our specialty in town and we refused to bite off on their low reimbursements.

Eventually they signed up several thousand of our patients. We reconsidered but we drove a hard bargain. Finally they offered us a premium over the other practices since we had the only subspecialists in the area. Worse than Medicare rates but something we could live with.

As soon as our practice signed up with this insurance company, the flood gates really opened. They used our practice on their marketing materials to sign even more patients. I think you can figure out what happened next.

About eight months later, this insurance company called to inform us that they were renegotiating our terms on a capitated basis, which would come out to about 50% of the Medicare rates. Naturally we refused to accept this. At which point we were told that “since we had decided to cancel our agreement” we could no longer see our patients enrolled in their plan.

This did not sit well with one of my partners, who had to deal with patients with significant medical and surgical issues and had no outside physician still on the plan who was qualified to take over the care for these patients. Which made him ultimately liable for their well-being. Unfortunately, he expressed his disgust of the insurance company to some of these patients and told them to complain to the their carrier for dropping their doctors. This is when we received a call from their legal department with a stern “cease-and-desist” warning: we were not to discuss the details of the termination of the contract; we were simply to tell patients that it was a “mutual decision.”

The practice that was enrolled to take care of these patients was based in another city. They placed itinerant physicians in a little rented office a couple of days a week. The service was sub-standard. The medical care was thin. Oh, and they also ripped off the name of our practice (they changed it after we got some copyright lawyers involved). A couple of their doctors actually called us to complain about the company they were working for and apologized for the situation that their company put us in.

Fast forward a year and you know what comes next: the Medicare Advantage plan has pulled the plug on their operation here and left several thousand patients in the lurch. These patients were not able to change insurance until the end of the year, when open enrollment rolled around, and had to go out of town if they wanted surgery. They are now slowly trickling back  into our practice, albeit in many cases with inadequately controlled disease or worse.

Have you had a similar experience with a Managed Care company? Leave us a comment below. Oh, and this point bears repeating: make sure someone in your office with expertise in insurance opens all correspondence from insurance companies, managed care companies in particular. Read Dirty Tactics of Those Medicare Advantage Plans.

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Post tags: capitation, Insurance, managed care, practice management

What’s the catch? There isn’t one really. It’s a totally free service for you. SoftwareAdvice receives a “finder’s fee” if they successfully match you with an EMR software company. As an affiliate, Medical Practice Trends gets a cut of that. Hey, we have to pay our electric bills, too.

So, here’s what to do:

First, if you haven’t already started your EMR project, get our free report (located in the right-hand sidebar) “Getting Through the EMR Maze”. This will give you an overview of EMR implementation and help you avoid making costly mistakes.

Next, CLICK HERE to go to the EMR Checklist page. Fill out the information and then you can download a PDF of the checklist so you can get started doing your research right away. Good luck!

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Post tags: EHR, electronic medical record, EMR

A recent report by the American Hospital Assn. on the effects of the recession found that 72% of hospitals reported a decline in the number of elective procedures, and 70% reported a drop in patient volume from 2009.

A major criterion of meaningful use is proving the ability to communicate and share health information electronically. For hospitals, this means demonstrating that they are sharing this information with physicians. And the quickest way to achieve that is to help doctors get up-to-speed with EMR. Experts say that this also a good way for hospitals to strengthen relationships with the very physicians they count on for referrals.

Other experts urge caution on the part of medical practices. Hire a consultant and make sure the potential system fits in with your overall EMR implementation strategy. As J. Ryan Williams, a healthcare attorney from Cleveland points out:

You could be in a position of accepting the donated technology, share in that cost, then one, two or three years down the road that technology, God forbid, doesn’t allow you to meet your meaningful use criteria. [Then] what good have you done?

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Post tags: EHR, electronic medical records, EMR, EMR implementation, meaningful use, medical practice management

Insurers are noticing this as well. According to the article, Aetna President Mark Bertolini told analysts:

We are seeing it everywhere, in every segment of the business at this time. There are a number of impacts, but the economy does definitely have an impact here.

And a BlueCross BlueShield of North Carolina survey…

… found that 15% to 17% of those surveyed were skipping routine checkups and preventive care….[and] twice as many were taking fewer prescriptions, skipping prescription doses or not filling prescriptions because of cost.

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Post tags: economics, Insurance, medical practice management, recession

Not long ago, we interviewed a physician for possible partnership in our practice. After showing him around our town, some of us partners had dinner with him to discuss business. He was a quite pleasant fellow, well trained, and seemed to be a good ‘fit’ for our practice. As dessert was being served, he said he needed to get one more thing off his chest: he prays aloud in the operating room before starting each surgical case. If we couldn’t allow him to do this, it would be a “deal-breaker.”

So, what would you have done?

Ultimately, there were a number of unrelated reasons why this doctor decided not to move to town and join our group. But it brought up an interesting topic of discussion: how does a medical practice balance the needs of the individual to express his beliefs with the needs of the practice to maintain a work environment tolerant to all? In part, it depends on just who that individual is.

According to federal legislation, reasonable accommodations must be made for employees to express their religious beliefs. Those accommodations can be considered reasonable if they do not have a significant impact on the functioning of the business. Unfortunately, this is wide open to interpretation.  Each state differs when it comes to employees’ rights – some states require greater accommodation than others – so you should consult with an attorney who specializes in labor and employment law in your state for specific advice.

The rules are different if you are the owner of a business. Using our story as an example, a physician-owner of a practice can, by virtue of expressing his religious beliefs, create a workplace which could be considered ‘hostile’ to an employee who doesn’t share the same beliefs. Hostile may sound like a harsh word, but that is the term used in this area of employment law. Interestingly enough, this does not apply to patients, since they have the freedom to walk and take their business elsewhere. Employees, on the other hand, are compelled to work in the environment created by their supervisors. To complicate things even further, employees who are in a supervisory role can fall within a gray zone: as employees they should have allowances made for their beliefs, but as supervisors they should not impose these beliefs on their subordinates.

To most doctors not acquainted with the issue of religious accommodation in the workplace, this might seem like employees get all the rights while the business owner gets none. In essence, this is true. Perhaps, like many things in this country, the pendulum has a habit of swinging to one extreme or the other. But, whether we like it or not, it is the reality of running a business.

All of this can put the physician-owner or administrator in a tough situation, balancing the needs of the individual with the need to maintain a ‘non-hostile’ workplace. The best advice is to get good legal advice. Following consultation, you should have a formal policy as part of your employee manual so that there are no misunderstandings or worse.

Have you had a similar experience? Leave us a comment below.

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Post tags: discrimination, labor law, practice management, religion

The Health Information Technology Extension for Behavioral Health Services Act also would expand the Medicare hospital incentive to include inpatient psychiatric hospitals, and extend Medicaid hospital bonuses to community health centers, mental health treatment facilities, psychiatric hospitals, and substance abuse treatment facilities. The bill was introduced on Aug. 5 by Sen. Sheldon Whitehouse (D, R.I.), and a companion bill was introduced in the House by Rep. Patrick Kennedy (D, R.I.).

Whitehouse said his legislation “will give mental health professionals access to comprehensive and up-to-date medical histories, enhancing the precision of diagnoses and reducing medication errors.”

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Post tags: EHR, electronic medical records, HITECH

Click here to view the embedded video.

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Post tags: electronic medical records, EMR, healthcare IT, server-based emr system, video