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

Happy New Year

EMR securuty

Switch To EHRs Raising Some Privacy Concerns.

I don't think the concerns below are warranted, really.  Paper is much less secure than electronic communications which can be password protected and given user level security. 

The Fort Worth Star Telegram (12/19, Branch) reports, "As the transition from paper to electronic medical records gains momentum, so have concerns that more confidential patient information will fall into the wrong hands. Privacy advocates warn that without proper safeguards, digital records could make large caches of personal medical data vulnerable to theft or improper use, such as discrimination by employers." Psychiatrist Dr. Deborah Peel, who is also the "founder of Austin-based Patient Privacy Rights and an outspoken critic of how digital records are being implemented," said, "The security issues are extreme. .. Some of these systems are very poorly protected, and you are going to have patients without control over who is looking at their health information."

A new pediatric urgent care establishment opened in Smithtown, not far from my urology office.  I saw some things I liked. . .and some I did not.

I liked:

• Ample parking
• Nice building
• Electronic medical record system
• Advanced "feel" to the office

I did not like:

• Unfriendly staff

Will all the good outweigh the one negative?

We'll see.

The case for an answering service

I finally did. I got an answering service. Almost 5 years since I opened my doors and probably 1000 calls answered myself, I hit the wall. I am too tired of answering my own phones.

Unfortunately it was not until after I ticked off a patient and was fired as their doctor.

Need to Train Staff-Make A Video

It is just easier.

Don't even try to compete

Another practice's website can be slicker than yours.
Another's can be prettier than yours.
Another's can be cheaper than yours.
And another's can be faster than yours.

But does your site do what you need it to do?

Make it easy for people...
. . .to pay
. . .to schedule
. . .to refill
. . .to get results
. . .to give your name out

Do things things, and you'll do OK.

Middle-ware: The Independent Way

For those of us with EMRs, one common challenge that exists is how to interface in-office lab analyzer data with your EMR software.   Basically, there are 4 ways to get lab data into your EMR:

1. Manually: Inefficient, slow, error prone.  DO NOT do it this way.
2. Scan results: Time consuming, error prone 
3. Middle-ware: If you are fortunate to have an analyzer that interfaces seamlessly with your specific EMR, this is the best solution.
4. Customized software: If your analyzer outputs data in a digital format, you can develop a solution easily and inexpensively, even if you have no programming knowledge yourself.  I recently developed one for my semen analyzer.

Your goal should be to efficiently and automatically get data into your EMR where you can sign off on the result and act accordingly.  Electronically is the best way to do this.

Good luck

Dr S

Tips for staying sane and viable through the tough times

This is one challenging economy.  Here's how you can manage to stay in good shape.

Avoid these pitfalls:

• Over-extending: good times don't last forever
• Over-contracting: neither do bad times
• Panicking: don't jump at your first rescue option, it may not be the best one
• Putting your head in the sand: the payment system is changing.  You'll need to adapt or die.
• Second guessing: too much wasted energy better spent on planning and acting.

Good luck,

Dr S
s

Why Do I Use a Different Pool Guy Every Year?

I have a pool--which I don't recommend.  The house came with it.  I maintain but have a service open and close it for me.  Every year it seems we use a different service.  Why is this?  For the most part, it is because the pool companies have not been following up with us through the winter.  We lose their numbers and forget their names and have to look up another one every May.
Crazy!  And in this economy.
Don't run your medical office like that.  Reach out to your patients, the active and the inactive ones on a routine basis.  Doing this is neither difficult nor expensive.
Just do it.
Dr Schoor

A Cost of Woking for Someone Else

These doctors assumed someone else would take care of their insurance needs.

I've said it before.  I'll say again.

Your practice, your problems, even if you work for someone else.

Dr Schoor

5 Key Practices to Help You Through This Recession

This is a tough recession--the worst I've been through certainly.  Only the fittest will survive this one.  Here are some survival tips that you can use:

1. Focus on collections: Obtain deductible information prior to seeing the patient and collect up-front if your contract allows.  If not, use a service like this. 
2. Scutinize all costs: Trim some and expand others--cost center vs profit center.
3. Smarten up your office hours: Avoid overtime while maximizing office visits.  Use your data to figure when patients "want" to be seen and staff heavily at these times, light at others.
4. Leverage technology: EHR, smart phones, VOIP, webforms, sms, etc
5. Answer your phones

Good luck.
Dr Schoor

Miami Urologist takes a stand

This urologist's patients are welcome in my office!

http://www.nytimes.com/2010/04/03/us/03doctor.html?ref=health

History

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History in the making

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21% Cuts: The perfect storm?

If you have had your head in the sand or too immersed in patient care issues, our fearless lesaders have let the Medicare's SGR proceed and with it a 21% cut in Medicare reimbursements to doctors across the board.  Whether you take Medicare or not, no matter what your payer mix may be, this affects you dramatically.  For many, if not most of us, our private payer contracts are tied to Medicare rates.  So  in essence, you can expect a 21% cut in gross payments while the private insurance companies have just recieved a 21% windfall.

Do you have chest pain yet?

How will you survive?

Well, you may not.  This may reresent the perfect storm, the trifecta of bad luck that has befallen the American doctor: rising liaility inurance rates, falling reimbursements, a severe recession. 

Or you could try some of the following:

1. Stop seeing Medicare patients.  Not out of protest, but because these patients are too sick and labor intensive to care for and still make money.
2. Increase volume.
3. Go ou of network with some private plans.  This works better if you are a primary care doctor or a specialist that sees emegency room patients.
4. Re-negotiate your contractswith the private payers.  Good luck with this one, but you never know.
5. Merge, merge, merge.  If the other strategies don't work, this drastic move may be the only viable approach. 

Good luck and let me know how it goes.

Dr Schoor

Well, the whole day is not lost!

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Prevent the Cuts!

Contact congress now.  If you live in Long Island, see these links.

Congressman Israel, from Huntington:  http://israel.house.gov/

Congressman Bishop, Smithtown and Brookhaven: http://timbishop.house.gov/

The Speaker of the House: http://www.house.gov/pelosi/

Senator Schumer, NY: http://schumer.senate.gov/

Senator Gillebrand, NY: http://gillibrand.senate.gov/


These people work for you!  Contact them and ask them to reverse these devastating cuts.

Dr Schoor