Doctor's Digest

If your practice is seeing more uninsured patients these days, and if you're therefore experiencing a sharp decline in revenue, you're hardly alone. As recent surveys have shown, economic hard times have had profound effects on both physicians and patients across the country. But the good news is that there are things you can do to make it easier for patients to pay their bills—and to increase your own revenue as a result.

Many say that reforming Medicare and shoring up the physician payment system are going to be the real key to any reform effort. As James Rohack, MD, president of the American Medical Association, points out, “When payments don't cover the cost of providing 21st century medical care, it is difficult for physicians to continue to care for all Medicare patients and make quality improvements to their practice.”

What effects has the economic recession had on patient care? Plenty. Despite the wishful thinking of some who believe that medicine is impervious to economic downturns, it's likely that you've been seeing a number of effects in your own practice: empty gaps in your schedule, maybe, or problems in collecting payments, or patients who show up sicker because they've postponed their preventive care in order to cut corners.

The recession and its aftermath have inspired many physicians to reconsider changes in their practice that they would have either ignored or discounted before. Some of those changes may make enough business sense for you to retain even after the economy makes a full recovery.

Given the alarmingly high number of medication errors, how hard is it to ensure medication safety for your patients? As it turns out, it may be easier than you might imagine, given today's tools like electronic prescribing and medication reconciliation.

According to the Consumers Union 2009 Safe Patient Project, “More than 100,000 patients still needlessly die every year in U.S. hospitals and healthcare settings–infected because of sloppy compliance with basic cleanliness policies, injured by failure to follow simple checklists for safety.”

How much do you know about the requirements for reporting errors made in your primary care practice? A good place to update what you know is the Patient Safety and Quality Improvement Act of 2005.

Why has it been so difficult to create a healthcare system that can prevent medical harm? As a recent report from the Consumers Union stated, “There have been countless task forces, conferences, editorials, and even episodes of Oprah focused on patient safety. But action...has been sluggish, leaving us without reliable means to track our progress or hold the local healthcare systems accountable for ending preventable patient harm.”

Have you ever considered creating your own blog? An online blog is an excellent way to establish your reputation as a trusted source of information on a specific healthcare topic. If you have a well-written blog that you update frequently, this device can build your credibility in the local community and serve as a stepping-stone to regional or even national opportunities in speaking, specialty leadership, or publishing.

It's not easy to stay on top of online trends: What's hot today may shift quickly in the fast-moving world of technology. But there is one bottom line that you can ignore only at your own peril: the fact that every medical professional should have a Website.

Many doctors not only think they don't have to market themselves; they think it's somehow inappropriate for the profession. But as Patrick Buckley, president and CEO of PB Healthcare Business Solutions in Wisconsin, and author of Physician Entrepreneurs, says, that's just not the case: “The market is changing. All of a sudden you're going to get up in the morning and say, ‘A third of my patients are going to Walgreens. How did this happen?'”

Put simply, your “brand” is your practice's personality, and it reflects how you will describe your practice to current and future patients. It's the thread that forms the basis of your message and permeates everything you will do to market yourself.

Converting your practice to the medical home model can be an ambitious project—but it will offer some impressive benefits: better, more integrated care for your patients; a more streamlined day; and fuller use of technology, among others. Your own role will change rather dramatically as routine care shifts from you to your nurses, medical assistants, and others, freeing you to deal with more complex issues.

The concept of the “medical home” is built on the idea of patient-centered care that will enable you to focus on your patients rather than the total volume of patients you see. Primary care physicians have supported this idea for some time, but only now is it gaining steam as government payers and insurance companies search for an approach that will make primary care more effective, more accessible, and more affordable. Nothing less than the future of primary care may lie in the balance.

If your practice is converting to the medical home model, you will benefit from using computers extensively for the two vital components of the medical home: information and communication. A starting point would be having electronic medical records, or EMRs. In addition, electronic tools like e-mail and text messaging can supplement or even replace phone calls, and in the near future your patients are likely to expect to be able to access their medical information over the Internet.

When it comes to e-mail, which kind of doctor are you: one who accepts e-mail as an unavoidable part of your professional life and deals with it accordingly, or one who would prefer to get rid of it altogether? If e-mail is going to remain a part of your life, and most likely it is, then it may make sense to become as proficient as possible in dealing with it.

The broad range of your professional activities makes it a real challenge to stick to a strict schedule of 15-minute appointments day after day. Fortunately, there is more than one way to schedule your workday. The trick is finding a method that meets your own needs as well as those of your patients.

If you’re like almost every other doctor, saving a little time each day is a goal that is perpetually just outside your reach. But if you can take a few minutes out to put some simple time-savers into play, you may be surprised by the increase in your efficiency and the time you save. Here are ten suggestions from the experts

It may be a little surprising, but physician-patient communication doesn’t always happen between the physician and the patient. Sometimes that communication is well under way before you even say hello. Kris Baird, a healthcare practice consultant in Fort Atkinson, Wisconsin, tells her clients, “Everything speaks.” She explains that everything your patients see and experience helps form an overall view of your practice.

In the field of patient communication, nothing’s more important than the clinical interview. Until the 1970s, there was no model for the interview: the physician simply asked the patient questions about signs and symptoms, and tried to put it all together to come up with a diagnosis. But now there’s been an explosion of research into physician-patient communication, and as a result, you can now choose from at least eighteen different models for the clinical interview.

Today we realize that communication skills can be taught, and learning them is not about being a nicer doctor; it’s about being a better doctor. The first formal studies of patient communications were done about thirty years ago, and they have slowly led to enormous changes in the medical school curriculum.

With the advent of consumer-driven healthcare, or CDHC, your patients may now find themselves in the unique position of making a lot more of their own medical decisions than in the past. The questions then arise: how prepared are patients to assume this responsibility? And how can they get the information they need to help them choose healthcare?

The American health insurance system faces the vexing challenge of supporting high-quality medical care while trying to control rising costs. In recent years, physicians have had to cope with an alphabet soup of insurance innovations, from HMOs and PPOs to DRGs and RBVUs. And now there’s still another ingredient in the mix: CDHC.

Are your patients turning into consumers? For a lot of people, the word “patient” implies sub-servience, while the word “consumer” acknowledges the important role that people can play inchoosing their own healthcare. Since physicians think of themselves as healers rather than sales people, this shift in terminology may represent a pretty revolutionary change in the way patients and physicians interact.

Volunteering is a wonderful way for a physician to reach new heights of personal satisfaction and growth. The reasons for volunteering are as diverse as the people who do it. Their main motive is usually to help other people, but there are plenty of other benefits as well.

Stress management experts are seeing consistent signs of stress among medical personnel, including marriage troubles, overeating, and physical problems like insomnia, headaches, and lower back pain. One thing you can count on: the stress of practicing medicine will always be there. So it’s going to be up to you to recharge your battery on a daily basis.

Although we're all familiar with the health benefits, exercise is a hard sell within the physician community. There's just not enough time in the day for it, we tell ourselves with a shrug, and we let it go at that. But there are ways that you can fit exercise into your daily routine no matter how busy you are, if you just make up your mind to do it.

What does your office need to do to prepare for an emergency? The answer to that question will depend on the structure and focus of your particular practice. Obviously, an ambulatory surgery center will have more complicated needs than a small outpatient practice. But the important thing is to ask yourself various contingency questions, such as this: How would we contact our patients if they were suddenly forced to leave town? And how would we access patient records if our office had to shut down?

No preparedness plan can ignore the fact that, in an emergency, some staff members may be less accessible, less able, or even less willing to shoulder the burden than others. A recent study of over six thousand healthcare workers analyzed willingness to respond versus ability to respond. The study found that healthcare workers would be most willing to help out in a mass casualty incident or an environmental disaster. They would be least willing to respond to a smallpox epidemic, a radiological event, or an outbreak of SARS.

Polls have shown that nearly three-quarters of the American public are concerned that there may be another terrorist attack. Yet nearly two-thirds of the population have made no emergency plans. That’s one of many reasons why it’s important for you to develop an emergency plan for your own practice.

Exactly how you decide to apply EBM will vary greatly depending on the size and nature of your practice.

EBM gives physicians a reliable framework for explaining medical information to patients. EBM can also work in the opposite way: it can help you explain to your patient why a treatment that worked for his friend may not be suitable for him.

Evidence-based databases offer time-saving efficiency and a reliable shortcut to reach the latest and most pertinent evidence you need in making decisions for your patients.

Once a physician makes the decision to scale back to part-time, the question becomes how to do it.

CME can also offer doctors a chance to stay clinically current, challenged, and invigorated.

Beyond physician burnout-the best course is to avoid burnout in the first place.