A vasectomy consult with Dr Richard A Schoor MD FACS

I had this video made for my vasectomy patients.

http://www.youtube.com/watch?v=Q6DlGNeQEZ4&feature=youtube_gdata_player

Richard A Schoor MD FACS
www.schoorurology.com

Spousal consent prior to a vasectomy?

Vasectomy Complications

Count your jewels

A jeweler, on the way home from a business trip runs into a merchant friend of his. The merchant has some diamonds he needs to sell to the jeweler. The jeweler, having just made a purchase, does not have much money remaining. But the merchant is really offering a good deal. So the jeweler looks through his wallet and decides that he can make the purchase, but he'll have to travel home coach, when he is accustomed to first class, luxurious travel.
On the way home, the jeweler sees another friend. The friend asks the jeweler why he is in coach and not first class. Has the jeweler fallen on hard times?
The jeweler responds that when he feels cramped and uncomfortable, and when his back and legs hurt, and when he is hungry, he gets his bag of jewels and counts them, and he feels better.
When is the last time you counted yours?

Richard A Schoor MD FACS
www.schoorurology.com

Make a business plan

Even if your practice is up and running it is probably worth while to look at your business plan. If you are just now planning to start a new practice, having a business plan is essential.
A formal business plan contains many parts. You can get a template free from the US Governments Small Business website. It is a great and free resource. The business plan is your chance to plan for as much contingencies as possible before you spend the money. Brainstorm all the what if's. List them all. Then add up how much money worst case will cost.
Then compute the upside--the most you can make with the business.
Is your business still worth the risk?

Behave!

If you work in the same community I'm which you live, you better behave. You never know that the person you are mouthing off to may have been a future client or patient or customer.
These things happen.

Who is your best worker?

Miguel was beloved. He was an icon. Over his tenure, he became an institution at my temple.
But Miguel was really a slacker. Raul, his underling. was the gem. When Miguel left. Raul rose to the occasion and has out shined his former boss in all respects.
Are you honoring your true gem?

Richard A Schoor MD FACS
www.schoorurology.com

Semen analysis: what is normal?

The WHO recently re-analyzed "normal" values for semen analysis. Without boring you with statistics, I think that the results can be summarized as follows:

More is better.

Let me elaborate.
10 million sperm is better than 5 million sperm and 20 million is better than 10 million. To go further, 50 million beats 30 million while 100 million beats 50 million. In other words, the probability that a couple will conceive within a year increases as sperm counts increase. Same with motility and morphology.

Do what is my job? My job as a male infertility specialist is to help you produce more and better quality sperm.

Order Sets

Order sets go by several names but essentially they encompass all the pertinent diagnostic and treatment options indicated for any given disease process. Any EHR worth its price will come hardwired with datasets and will also allow you to customize your own. Datasets should ideally come from evidence based medicine and your society's best practice guidelines.
Does your EHR have them?

The IU.

Patient Satisfaction Surveys

Collecting data on how your practice performs in customer service is important. But there is a right way to get the data and many wring ways.
Wrong way: leave surveys in the office and hope people complete them

Wrong way: embed survey in website and hope people complete them

Wrong way: mail patients surveys and hope they complete them

Right way: ?

The problem with all surveys is wether or not the information is useful and accurate and unbiased. Doing surveys the wrong way will get you inaccurate biased and useless data.

Do it right or not at all.

Richard A Schoor MD FACS
www.schoorurology.com

EHR Slow Down

Do EHRs slow down physicians? Yes and no. EHRs force docs to be more complete, more thorough. If that slows you down then perhaps you needed to slow down. Ultimately though, as the doctor masters the templates and the flow of the EHR, he or she can actually speed up yet remain thorough.
A win win.

Richard A Schoor MD FACS
www.schoorurology.com

Live close to work. Work close to life.

One day you may be tempted to get a job or take call at a hospital greater than 30 minutes from your house. If at all possible, don't do it.

You may make some more money but you'll miss life.

Richard A Schoor MD FACS
www.schoorurology.com

Remember this when things are slow

When the phone keeps ringing
When patients keep showing up
When you have to see yet another
When you have to return another call
When you have to sign off another lab
When. . .

Richard A Schoor MD FACS
www.schoorurology.com

What is your plan?

Now is the time to start planning for next year. How are you going to:

Increase revenue
Decrease overhead
Get more new patients
Decrease risk
Decrease staff turnover

Now is time to plan.

Richard A Schoor MD FACS
www.schoorurology.com

Adding labs

An in office lab runs at razor thin margins. Here is what you need to consider before adding a test.

Number if tests ordered
Cost per test
Reimbursement per test
Cost of controls per testing day
Cost of proficiency testing
Cost of interface with EHR
Staff Time required to run each test
Ease of use of instrument
Space requirement of instrument
Calibration costs
Aggravation factor

Add them all up then decide. Simple math. No emotion.

Richard A Schoor MD FACS
www.schoorurology.com

Consumer vs Pro

The temptation is to spend less money. Resist it. If you are deciding between the consumer vs the professional model for you practice, definitely go pro. Ultimately that decision will save you big-time.

Printers
Computers
Scanners
Software
Telephones

Consumer models just don't work in a business.

Good luck.

Richard A Schoor MD FACS
www.schoorurology.com

Meaningful Use: BS or Not?

To achieve meaningful use, EHR users must jump through a lot of hoops, at least 23 to be exact. Are the hoops just busy work or are they worthy in creating a safer medical environment for our patients? I have been an EHR user for several years, long before MU came to be. I have been a meaningful user, ie I do all 23 hoops, for the past few months. What do I think? I think some of the objectives are worthy and others are busy work. On the balance I think MU is good and worthy. Dr Schoor www.schoorurology.com

Stressed Out

I was talking to a colleague of mine today. She told ms she was stressed about all the non-medical stuff that goes along with being a doctor. What kinds of things I wonder?

Documentation
Coding
Billing
Risk management
Practice management

Yeh, lots of stuff. But why get stressed. The challenge is the fun part. Rise above it and enjoy the journey.

Richard A Schoor MD FACS
www.schoorurology.com

A urology-eye view of an earthquake

I first learned of the earthquake after returning from a hike in which I was out of cellphone contact. The first emails from my urologist and practice manager colleagues were of the "did you feel that " nature. The quake occurred during office hours for most practices. A colleague in Indiana felt the quake. So did one in Staten Island and another Rhode Island. My own office I'm Smithtown Long Island shook for 3 minutes. My staff evacuated. I was not present.
I wonder is there were any surgical mishaps caused by the quake.

Richard A Schoor MD FACS
www.schoorurology.com

From up here it all seems so silly

Important skills for a physician-manager

Collect copays
Get deductibles
Correct coding
Streamline work flow
Automate what you can
Optimize staff work

Richard A Schoor MD FACS
www.schoorurology.com

EHR Success-5 Tips

A successful EHR adoption is within everyone's reach. Just do the following:

Master the templates
Tweak the templates
Adapt your workflow
Connect to lab and instruments
Stick with it

The benefits are simply amazing.

Richard A Schoor MD FACS
www.schoorurology.com

Patient Portals

Do patients want online access?

I offer it.

Very few take me up on it.

I'd prefer it.

The patients seem to prefer the phone.

Online is efficient and inexpensive for me.

Perhaps the phone is efficient and inexpensive for them.

I guess people call when they have time, ie from their cell phones while driving.

Dr Schoor

www.schoorurology.com

3 things that gave me happiness today

A good sushi meal
A busy day in the office
Watching my daughter play tennis

Richard A Schoor MD FACS
www.schoorurology.com

Still Kicking

After a long break from blogging, I think I have found my voice again. Why is that? Well I think that I am inspired by hardship, difficulty, and challenge. Being in solo practice in 2011 in the USA, I have all 3 of those things in abundance.

Currently, I am confronting:

high rent
high insurance
high payroll
high technology costs
low reimbursement
Many doctors have either joined forces and formed large single or multi-specialty groups or have given up their independent practices to be part of a hospital setting.

I remain solo.
I remain independent.

For me and my situation, no white horse is coming.
I am on my own.

What I do have on my side is:
very effective system of new patient acquisition
a great reputation in the community
a solid existing patient base
a very efficient E.H.R. system
a good office and dedicated staff
a devoted and loyal wife and family
incredible drive to succeed
What is the long term outlook for us "so-low" doctors? Don't know.

Revised Prostate cancer screening guidelines

revised guidelines say

Because of these complex issues, the American Cancer Society recommends that doctors more heavily involve patients in the decision of whether to get screened for prostate cancer. To that end, ACS's revised guidelines recommend that men use decision-making tools to help them make an informed choice about testing. The guidelines also identify the type of information that should be given to men to help them make this decision.

ACS recommends that men with no symptoms of prostate cancer who are in relatively good health and can expect to live at least 10 more years have the opportunity to make an informed decision with their doctor about screening after learning about the uncertainties, risks, and potential benefits associated with prostate cancer screening. These talks should start at age 50. Men with no symptoms who are not expected to live more than 10 years (because of age or poor health) should not be offered prostate cancer screening. For them, the risks likely outweigh the benefits, researchers have concluded.

As in earlier guidelines, ACS recommends men at high risk—African-American men and men who have a father, brother, or son diagnosed with prostate cancer before age 65—begin those conversations earlier, at age 45. Men at higher risk—those with multiple family members affected by the disease before age 65—should start even earlier, at age 40.

For men who are unable to make a decision about screening after these conversations, ACS recommends the doctor make the call based on his or her knowledge of the patient's health preferences and values.

For men who choose to be screened after discussing the pros and cons with their doctor, the new guidelines make the digital rectal exam (DRE) optional and offer the option of extending the time between screening for men with low PSA levels.

Above from: http://www.cancer.org/cancer/news/news/revised-prostate-cancer-screening-guidelines