Blog - Medical Practice Trends

The Conservative Case for the Individual Mandate

December 19, 2011 By Peter Polack Leave a Comment

‘Tis the season of election campaigning and there is nothing quite so entertaining as watching politicians pensively reconsider their stances on important issues (er, I mean flip-flop). One of the biggest bones of contention in healthcare reform is the so-called individual mandate, seen as Big Brother imposing his socialist grip on freedom-loving Americans.

So where exactly does that mean? And who came up with that idea?

In an LA Times blog post, Walter Zelman, Chairman of the Department of Public Health for Los Angeles County, poses the question,

Would conservatives rather have government impose a financial requirement on people who choose not to buy healthcare, or have those who behave responsibly bear the financial burden of a few?

Although many conservatives today see the individual mandate as another example of government over-reach, the idea originated with moderate Republicans in the 1980s and 1990s, with Senators John Chafee (R – RI) and Bob Dole (R – KS) among them (as well as one Congressman Newt Gingrich). Their argument is that every adult that can afford insurance should buy it or else face some sort of penalty, else the rest of society has to pick up the tab. “Is it fair for the responsible to have to pay more in order to protect the rights of the irresponsible?”

Concierge Model Criticized for Worsening Doctor Shortage

December 12, 2011 By Peter Polack Leave a Comment

With looming reimbursement cuts a perpetual end-of-year drama, more physicians are foregoing insurance plans altogether and going into the ‘concierge medicine’ business.

But as an article on Fierce EMR reports, some are blaming this trend on a growing shortage of physicians.

In Vermont, one of a few states considering a single-payer system, the number of primary care physicians is becoming evident. Although the number of concierge practitioners is small – on the order of a few thousand – this has doubled in the past two years.

Doctors who are dropping Medicare are reporting less stress and more professional satisfaction, but apparently this is leading to many patients who can’t afford the cash-pay model to be dropped by their doctors.

Grandma and the Big, Bad SGR

December 8, 2011 By Peter Polack Leave a Comment

This video from the Texas Medical Association shows us the Medicare reimbursement issue from a child’s perspective.

Grandma and the Big Bad SGR!
A huge Medicare cut looms for doctors and Medicare patients. Who might that affect? People like grandma – and those who love her, as the child in this video shows. Unless Congress acts, on Jan. 1 doctors who care for Medicare patients face a 27.4-percent pay cut, because of a flawed funding formula called the SGR. Then millions of seniors (like grandma) and people with disabilities — and military families whose insurance is TRICARE — might have trouble finding a doctor´s care.

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Debate Over Whether Medicare Pay Cuts Will Hurt Doctors’ Practices, Patients

December 7, 2011 By Peter Polack Leave a Comment

An article in the Washington Post discusses a rising debate over whether or not reimbursement cuts in Medicare will have a drastic effect on physicians or their patients as many medical advocacy groups are warning.

Some prominent healthcare analysts – including some from an independent agency advising Congress – say that the

…the problem is not that doctors will be short-changed, but that most will continue to be paid too much. And when it comes to hospitals, other experts contend the impending cuts are marginal enough to be easily absorbed and could even encourage more efficient care.

Much of this discussion centers on specialists, whom the experts quoted say always seem to make up for Medicare cuts by increasing revenue by other means. But “the picture is less rosy for primary care doctors, who have fewer opportunities to make up for stagnant fees by increasing their patient load or offering more costly treatments.”

Hospitals, on the other hand, were willing to go along with some of these cuts in return for supporting healthcare reform, since that would result in the addition to millions of newly insured patients. However, with many politicians vowing to repeal the legislation, and the Supreme Court about to review its constitutionality, hospitals could end up getting a double-whammy.

How Doctors Die

December 6, 2011 By Peter Polack Leave a Comment

A post on Zocalo Public Square by Ken Murray discusses the issue of how doctors handle terminal illness. Surprisingly, to me anyway, is that most physicians surveyed forego heroic measures in contrast to the advice they typically give their own patients.

As I commented on their site, most physicians don’t get enough training in end-of-life issues. This, coupled with a legally-charged environment, makes most doctors and hospitals become enablers of mostly futile efforts to prolong the life of patients who either didn’t want it or who were no longer in a position to make well-informed decisions about it.

Apart from the fact that a significant amount of money is spent on the last few months of the typical Medicare patient – yes, some will yell, ‘I smell rationing’ – the medical community needs to learn to have frank but compassionate discussions with patients who have terminal illness. Being a doctor isn’t always about prolonging the length of someone’s life but instead improving their quality of life.

Current Trends in EMR

November 30, 2011 By Peter Polack Leave a Comment

Guest Post: Emily Matthews

Electronic medical records (EMRs) in the medical office setting are growing at a faster pace than ever before. With rapidly advancing technological features and integration capabilities, it doesn’t take a master’s degree to see that using EMRs allow for more efficient and profitable management of today’s medical practice. EMRs benefit you and your patients by improving the quality of care, reducing administrative costs and allowing you to focus your time and management skills on patients and not paperwork.

Projected Growth

Analysts predict 12% annual growth in the use of EMRs in physician practices each year for the next five years. This growth and change in attitude about EMRs is mainly due to technological advances in EMRs as well as increased financial incentives for their utilization through federal and state programs. CMS currently offers incentives for the use of EMRs in both Medicare and Medicaid billing.

Technological Features

Today’s EMR is not the same as EMRs of a few years ago. Recent technological advances and added features make EMRs more useful to the efficient and expanding medical practice, especially those within medical networks. EMR interfaces are now compatible with mobile or handheld devices. This allows you or any physician or assistant in your practice to access a patient’s complete record no matter what the location or time of day. Integration features allow you as a physician to access all aspects of a patient’s chart, including pharmacy orders, radiology results, laboratory results, discharge and transfer orders and allows you to communicate electronically with payers as well. Advances in interoperability between EMRs are at the forefront of healthcare technology and are high on the priority list at the federal level. The cost of implementing EMRs has decreased, especially for practices that join as a group or within a network or health system.

Benefits to Practice Management

One of the greatest advantages to implementing EMRs in your medical practice is the reduction of cost of operating your business. By entering into an EMR system as a partnership with other physicians or practices or as a partnership with a health system, this reduces the cost of implementation and purchase of the software. While EMR software may cost an average $6,000 per physician in your office, even with a practice of ten physicians, this is less than the cost of hiring a single employee to manage hard copies of medical records for you. As your office implements an EMR, you might experience a temporary decrease in productivity as records are scanned or transferred into the system. However, this short-term loss of efficiency more than makes up for itself as the nurses, physicians and other staff in your practice familiarize themselves with the new system.

Your patients will benefit from improved quality of care as your practice implements EMRs. Improved communication between your office, coordinating facilities and payers improves the technical aspects of managing a medical practice. EMRs are at the forefront of healthcare and computing technology, and bringing this advantage into your medical practice readies you for the future.

[Emily Matthews is currently applying to masters degree programs across the U.S., and loves to read about new research into health care, gender issues, and literature. She lives and writes in Seattle, Washington.]

Blame-free System Increases Medical Error Reports

November 29, 2011 By Peter Polack Leave a Comment

According to an article on Reuters Health, “Flagging medical errors through a system that emphasizes a lack of punishment and maintains anonymity yields more reports than a traditional method of reporting errors, a team of doctors has found.”

After introducing the new system at a pediatric clinic in North Carolina, the number of reported mistakes jumped from five to 86 per year on average.

“Getting reports doesn’t mean we’re in an unsafe practice, it means we’re addressing flaws to make us a better practice,” said Dr. Daniel Neuspiel, the lead author of the study and the director of ambulatory pediatrics at Levine Children’s Hospital in Charlotte, North Carolina.

10 Things You Hate About EMR

November 23, 2011 By Peter Polack Leave a Comment

From the HealthcareIT News blog comes an article on the top 10 things that readers hate about electronic medical records via a Twitter thread:

It doesn’t measure up to paper
It’s hard to use
It doesn’t provide the basics
It’s cumbersome
It’s ineffective
It doesn’t allow for patient interaction
It doesn’t protect patient privacy
It doesn’t have a viable, rapid feedback loop
It’s not patient-friendly
It’s outdated

And then came responses from other readers who had these six reactions to those complaints:

Re: It’s outdated. Most software systems are based on programming that is “outdated.”
Re: Paper vs electronic. You really cannot compare the two, especially given the advantages that EMR has over a paper chart.
Re: It’s cumbersome. You don’t have to live with these issues. Get educated and choose a system that does what you need it to do.
Re: It’s hard to use. You had to learn how to use an iPhone the first time you used it.
Complaint about using Twitter to solicit comments.
Complaint about how EMR systems are not ready for prime time.

Bottom line: a lot of whining from physicians who probably didn’t perform enough due diligence and now are suffering from buyer’s remorse.

Any things you have to add to this list? Responses to the responses?

HITECH Act and Medicare Incentives

November 21, 2011 By Peter Polack Leave a Comment

From the Fox Group, a point by point overview for physician practices regarding the incentives, eligibility rules, and deadlines in the HITECH Act.

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Beware the RACs

November 16, 2011 By Peter Polack Leave a Comment

Below is an actual letter received – and almost thrown away – by an employee of a medical practice. They almost threw it away because it looked like junk mail.

It turned out to be a letter from a RAC (Recovery Audit Contractor) who was auditing their practice. They figured that the letter was purposefully designed in such a way as to encourage disposal and thus possibly trigger additional charges and penalties. That practice now carefully combs through every piece of seemingly innocuous mail and they recommended for other practices to do the same.