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Wednesday, April 29, 2009

Is your practice compliant with Red Flag?

Beginning May 1, all medical practices must take steps to ensure compliance with "the red flag" rule.

In essence, we have been deemed creditors and must have policies in place to prevent identity theft. You must identify risk areas, address them, then develop policies to minimize the risk. Failure to do can result in thousands of dollars in fines.

While HIPAA may not have had teeth, my understanding is that Red Flag will, since it is the FTC that enforces it.

Feel free to contact me if you have any questions.
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Tuesday, April 28, 2009

Some observations about urology

Many urologists with whom I spoke are doing very well, yet our collective ill-ease is palpable. Fears over increasing government intrusion into our lives pervades our thoughts. As always, our Sisyphean battles with commercial payers continue.

Of the hundreds of urologists that I spoke with, only a handful are in solo practice. I guess I am bucking a big trend. I do not know if I can survive or not, but I do feel that my survival will be in many ways tied to success of lobbying efforts by large groups.

So I wish them luck.

Over the years, technological advancements have made the AUA meeting more user friendly. Courses, sessions, and lectures are now available on DVD, continuing medical education credits can be downloaded from the Internet, and the AUA now keeps track of the CME credits using bar code scanners.

Many, if not most, practices have EMRs. All have problems with their products and expressed frustration to me. However, all those that use EMRs see the benefits of the technology and just need to learn to successfully implement it.

Many of my friends and acquaintances are in academic practices. Most seem happy. Academics produces 3 types of doctors: the superstar, the worker-bee, and the former academician. Superstars have busy clinical practices, serve on committees, and give courses and lectures. They teach others and make policy.

Private practitioners in general do not serve in that capacity. I think this is because they are not invited to participate in policy making committees. This is a shame and a disservice to the very same urologists affected most intimately by policy changes.

I call upon the AUA to include us in the process.

Today is my last day in Chicago, a city that I love. All things considered, I find that Chicago is the best US city. I am glad that the AUA comes here very few years. My experience at the AUA meeting has been positive. I have learned a great deal, networked, and re-charged my drained batteries. Though costs of attendance at the AUA can get a bit pricey, the benefits far outweigh them.

Monday, April 27, 2009

Poster session at the AUA

Good stuff, good stuff.
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Sunday, April 26, 2009

My junior resident

Dr Dan Williams MD

Male Infertility Expert, University of Wisconsin at Madison.

Northwestern Urology Alum.

Nice job buddy!

Friday, April 24, 2009

Good morning from Chicago

In town for the AUA, a urologist's version of the Oscars.
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I am in Chicago for the annual meeting of the American Urological Association. I arrived on Thursday so I could attend the practice managers meeting Friday and Saturday. Here are some things I learned, business-wise:

  • Urologists are public enemy number one and targeted for cuts on all-ends.
  • e-prescribe will be mandatory by 2011, after which practices that do not e-prescribe will lose 1 to 2% of Medicare reimbursements.
  • PQRI requires participating doctors from any specialty to enter data on 80% of appropriate cases or forfeit all bonuses.
  • e-prescribing needs to only be done on 20 or 25% of cases to meet criteria.
  • MGMA data suggest that higher operating expenses translate into more profit for doctors, so long as the expenses are in ancillary services, health information technology, and staff.
  • Medicare Advantage Plans are run by commercial payers arrangement costs the taxpayer an extra 13%, on average, over straight Medicare.
  • Medicare Advantage Plans are not required to follow Medicare's rules and are not under state jurisdiction.
  • The speaker recommended that urology practices avoid the Medicare Advantage plans.
  • A physician's most valuae resource is his time.
  • For efficiency's sake, doctors need to delegate everything that can be to employees or non-physician providers.
  • The speaker, a professional consultant, stated that practices should answer phones at times that patients are likely to call, ie during lunch, before work, after work, etc.
  • Practices need to understand performance metrics and adjust accordingly.

Thursday, April 16, 2009

DIY EMR vs The Big Boys

Here are some of my thoughts on this whole EMR business , now that I have "upgraded" to one of those products worthy of a government seal of approval.

EMRs do some things really well. Some of these things benefit the doctor. Others benefit bean counters. Other's benefit patients. A few of these things benefit doctor, payer, and patient simultaneously. I think this is an unintended consequence of an EMR, to be honest.
  1. EMR's handle prescriptions really, really well, and that is regardless of an eRx module or not. The good EMR's have built in prescription writing software--actually the software is from a third party vendor--that simplifies the new and refill process so much that a medical assistant with a little bit of training can do it without mistake. This helps doctor, payer, and patient through efficiency and accuracy. My little DIY EMR was terrible at this.
  2. EMR's handle coding very well. The good products have CMS coding rules pre-programmed. When the doctor sees an encounter, the system can suggest an accurate level of coding that reflects the documentation. This helps doctor and bean counter at the same time, though it does not help the patient at all. My DIY EMR was not sufficient in this regard, but I could have made it so if I had the knowledge then that I have now.
  3. EMR's handle documentation extremely well. Notes are well written and chock-full of information and free from handwriting issues. This helps the bean counter though not the doctor or the patient as much as you might expect. You see the notes seem to lack the essence of what was on the doctor's mind. I find them difficult to sift through, to be honest. In fact I just got documentation faxed from a local urologist to whom I referred a patient. The computer note was difficult to interpret, albeit beautiful. Had the urologist not called me in addition to the fax, I'd have not known what he was planning. I found that quick, short, scribbled notes (typed even better) provided the best form of documentation from a pure patient care perspective. Ironically, my little DIY EMR was superior in this capacity.
  4. EMR's enhance billing processes. Good EMR's can seamlessly merge EMR data with billing data and facilitate claim generation and turn-around time. Coding, ie programming, requirements for this were light-years ahead of my little DIY EMR. This feature of an EMR helps doctors only.
  5. Correspondence: Good EMR's facilitate correspondence with providers. Ironically, this might not really help the receiver, since these systems tend to inundate them with paper. I have had a number doctors mention this to me with regard to my system and other popular systems. Perhaps this is just a customization issue. In this regard, looking back, my little DIY EMR was superior.
  6. Document management: When properly interfacted with participating labs and radiology centers, document management with a good EMR is a snap. These interfaces don't come cheap, however, and if your EMR and local lab/radiologist etc cannot work together, you are screwed. My little DIY EMR was vastly superior in this regard since it worked with everyone, cheaply. There were no interface issues.
  7. Intra-office communication: Good EMRs, though probably even cheap ones, have secure email features for intra-office communications. I have found this feature, even in my small office, to be a huge improvement over my previous way of doing business. If I was a better software designer, I could have configured my little DIY EMR to do the same thing. But I didn't.
  8. Customization: Good EMR's can be customized and programmed to reflect "best practice" guidelines. My little DIY EMR did not do this. I actually see a sinister motive in the government's and industries pushing this "best practice"agenda. Ultimately, the powers-to-be will use this to empower midlevels and pay doctors less.
All in all, my little DIY EMR was damn good. Not perfect, but nothing is. If I was cash only practice, I'd still be using it. But in the RAC, HIPAA, P4P era, it no longer was sufficient for my needs.

Still, not bad at all.

Dr Schoor MD FACS

Urologist and Owner of iLabTQM, a CLIA compliance software company.

Wednesday, April 08, 2009

Happy Passover

Be thankful for your freedom and wish freedom for those without it.
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Sunday, April 05, 2009

The 5 P's of EMR

I have now had my new one for 6 weeks. Here's my advice for success with an EMR conversion.
1: Persistence: The process does not come easily but takes lots of work.
2: Patience: See above, plus time.
3: Patients: The EMR conversion is best done in a live environment, under real life conditions, with real patients.
4: Paranoia: You can't put blind trust in the EMR to dot all I's and cross all t's. You still need a brain.
5: Payment: The good ones don't come cheap, at least not if they have good support. Be prepared to cough it up.
Good luck, and a 6th "P" for the Stimulus plan--Please--reimburse me for my investment.
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