What To Do About Patient No-Shows at Your Radiology Practice

Published on the Dec. 19, 2011 DiagnosticImaging.com website

By Whitney L.J. Howell

It can happen to any practice. You have a full patient load scheduled for the day, but then a patient — or two — doesn’t show up for a study. Suddenly, not only is your schedule thrown off, but you’re also out the cost of any supplies dedicated to that appointment.

Patient no-shows have long plagued the industry, according to experts, with anywhere from 1 percent to 20 percent of patients either failing to cancel or simply failing to appear for scheduled visits. Anecdotally, radiology leaders estimate most practices have between a 2 percent and 5 percent no-show rate, and these absences can cause significant problems, they said. The Medical Group Management Association puts the national average for all specialties at 5.5 percent.

“I do think patient no-shows can be a tremendous disruption to practices,” said Christine Mayo, vice president of operations for PremierScan, a San Jose-based MRI/CT imaging center. “Some practices consistently see offenders from the same payer source or referring physicians. Regardless of the reason, it’s a great hassle.”

Why Patients Stay Away

A 2004 Annals of Family Medicine study pointed to three main reasons why patients don’t show up to see their providers. Some harbor negative feelings about seeing a doctor; others feel the clinic staff doesn’t respect their time and emotions; and many don’t understand the havoc a missed appointment can wreak on a practice.

But Casey Wheeler, a mobile PET/CT technologist with Idaho-based IsoScan, LLC, chalks a significant portion of patient no-shows up to one factor: human nature.

“People are afraid of bad news, so they operate on ‘If I don’t deal with it, then it’s not there,’” Wheeler said. “Many people don’t show up because they feel like they take back some control over their lives if they don’t get the test done. It doesn’t make sense.”

Others, he said, may view the studies as unnecessary. Those who have undergone repeated scans often contend an additional test won’t show anything new and opt to skip it.

The current economic climate also plays a role in many patients’ healthcare decisions, practice management consultant Elizabeth Woodcock wrote in a column for Medscape News. Lack of insurance or an inability to pay medical bills could push patients to forgo preventive services or delay elective procedures, such as diagnostic imaging tests.

What Happens When Patients Don’t Show

A practice with a daily (and common) average of four no-shows stands to lose nearly $150,000 annually, according to a 2009 Physicians Practice article. While all radiology practices feel the financial pinch when patients miss appointments, nuclear medicine practitioners are often at the greatest financial risk, Wheeler said. Unused radiopharmaceuticals, he said, can’t be used for studies at a later date. It’s a medical supply and money down the drain.

To read the remainder of the article: http://www.diagnosticimaging.com/practice-management/content/article/113619/2008579

 

Accountable Care: Let the Work Begin

Published in the Dec. 12, 2011, Billian’s HealthDATA/Porter Research Hub e-newsletter

By Whitney L.J. Howell

One of the hottest topics in the health sector today is accountable care. The premise seems simple: Providers and clinical settings of all types will closely collaborate and share responsibility for providing patient care. Implementation, however, can be challenging, according to many hospital leaders and industry experts.

The Centers for Medicare & Medicaid Services (CMS) released its final rule on accountable care organizations (ACOs) in October, detailing how its version of an ACO – the Medicare Shared Savings Plan – should be structured. If facilities choose to enroll in this program, they must offer services to at least 5,000 Medicare recipients for at least three years. Providers and clinical settings are also free to design and implement their own collaborative care model that uses a network of physicians and facilities to provide coordinated care.

Past attempts at managed care have failed, and there is still a chance the U.S. Supreme Court could declare ACOs unconstitutional. But that hasn’t stopped some in healthcare from working toward more team-based care. They are advocates of a new form of healthcare – one that ultimately focuses on the health of the patient rather than the bottom line. They are betting that the changes that come with accountable care, repealed or not, will help to usher in and get providers comfortable with this more team-based approach.

“The path forward to accountable care seems brighter and more achievable to many health systems, community providers and small practices,” said Justin Barnes, Vice President of Marketing, Industry, and Government Affairs at Greenway Medical Technologies Inc. “There is flexibility within creating a model for accountable care; and, with the final rule, many care providers are seeing that accountable care is the future of where healthcare is going.”

Barnes was also central to the formation of  the Accountable Care Community of Practice, a group of healthcare information technology providers committed to helping providers and facilities successfully design and implement either a formal ACO business model or less formal accountable care strategy.

Although this care model is getting significant attention, Barnes said, much still needs to shake out before it can be declared a success. In the meantime, many providers are putting the pieces that will support it – healthcare IT, shared-risk plans and provider networks – in place.

Mentors can Make the Difference

However, pivoting from a fee-for-service delivery model to one that prizes teamwork and increased quality at a lower cost isn’t necessarily intuitive. Many hospitals – large, small, urban and rural – need guidance, said Julie Sanderson-Austin, RN, a quality management professional with the American Medical Group Association (AMGA).

“The ACO model and even accountable care are very different animals,” she said. “It’s clear that this isn’t business-as-usual and that the change to healthcare is significant.”

To support facilities moving toward team-based care, the AMGA launched its learning collaboratives program last year. The goal, Sanderson-Austin said, is to help hospitals design ACO models that fit their specific needs by pairing facilities just embarking on accountable care conversations with mentor institutions that are further along in implementation.

Defining and Addressing Challenges

Hospitals just approaching accountable care voice some of the same concerns and encounter similar challenges, Sanderson-Austin said. For many, the biggest problem is integrating their data across care settings to offer patients a complete continuum of care. Having an electronic health record (EHR) connecting the hospital to its outpatient clinics is a good start, but it isn’t enough.

“It’s great to have an EHR that connects to ambulatory sites, but it has to be connected to your other sites, as well,” she said. “Otherwise, how are you going to get data from your nursing homes or home health agencies? If your patients either have to or elect to go to a nursing facility, you need a way to access their information for any possible future care needs.”

The initial capital investment needed to acquire good technology or build fluid health information exchanges can also present substantial problems, especially for smaller facilities, said Erik Johnson, Senior Vice President of consulting firm Avalere Health.

Although physicians are slated to play a vital role in any collaborative model, they can also be a significant sticking point for administrators looking to re-vamp how their facilities provide services. Even hospitals that began looking to a more team-based approach years ago have struggled to bring any changes to fruition.

“Improving engagement between physicians and hospitals continues to be an up-at-night problem for hospital executives,” Johnson said. “It’s difficult to get this kind of alignment.”

The Greenville Hospital System University Medical Center (GHSUMC) encountered this problem when it first considered its own type of ACO roughly a decade ago. According to Chief Medical Officer Angelo Sinopoli, M.D., convincing the doctors was an uphill battle.

“It took 10 years for physicians to embrace the model,” he said. “The concept is foreign because physicians train as individuals and are not accustomed to working in teams.”

However, administrators repeated the facility’s long-term goal and worked to educate the doctors on the benefits of working with other providers. Eventually, Sinopoli said, the physicians became champions of the hospital’s new care model.

Laying the Groundwork

Even though these challenges exist, hospitals can lay the groundwork for accountable care success, said Eric Bieber, M.D., President of the Accountable Care Organization at University Hospitals in Cleveland.

“Creating a collaborative care system that works well requires a high-functioning, multidisciplinary team to work across the organization,” Bieber said. “This team will be responsible for negotiating how the different groups within the hospital come together and divide risk.”

In January, University Hospitals launched its own accountable care model – a self-insurance plan that covers approximately 24,000 people. The facility is still in the process of identifying what works well and what doesn’t, but Bieber said institutions looking to follow in his hospital’s footsteps should bring together representatives from human resources and the legal department, as well as case managers, to discuss best strategies.

Industry management consultants at Kurt Salmon Associates also recommend hospital administrators focus on a few fundamental changes to position their facilities ahead of the curve.

Perhaps the biggest shift for hospitals, according to Kurt Salmon consultants Kate Lovrien and Luke Peterson, will be that pivot from concentrating on what the facility provides to honing in on what the community needs. With the ultimate goal of preventing inpatient admissions, the hospital is no longer the center of healthcare.

“There needs to be a dramatic change in organizational culture from the inside-out thinking of ‘my care, my time, my location’ to the outside-in thinking of ‘right care, right time, right location,’” Lovrien and Peterson wrote in a statement about ACO preparations, adding that this altered view constitutes a vision change for many facilities, and to do it well, administrators must secure buy-in from their board and staff members.

In addition, a facility’s business model must change. Under accountable care, success will no longer be measured in patient volume or the amount of services provided. Instead, efficiency and efficacy will be based on how well facilities control their costs while providing superior quality. Lovrien and Peterson seem to agree with Bieber – outlining how responsibilities will be divided and shared is a critical step. This move will give the hospital a clear organizational model, bolstering the ambulatory care system and streamlining the continuum of care across settings. The result, they said, will be improved quality and cost control.

Physicians must also turn from being the biggest hindrances to accountable care to being the most enthusiastic foot soldiers in the ramp up to the new care model, they said.  With their knowledge of the interplay between clinical activities, healthcare economics, and provider-patient engagement, doctors can strengthen the bonds across care settings.

Lastly, success will also come easier if hospitals tailor any EHR system to quality measures that are unique to the populations they serve.

Whatever strategies hospitals choose to employ, all facilities would be wise to start giving serious thought to what their accountable care model might look like, Bieber said. Waiting for Congress to announce a directive would be a waste of time.

“Regardless of the result of the elections in November 2012, there’s real support on both sides of the aisle for accountable care concepts,” he said. “It would behoove all organizations to begin to think about a system that focuses on maintaining wellness and managing chronic disease.”

To see the article at its original location: http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2011/December/Accountable_Carex_Let_the_Work_Begin.html

Mobile System Aims to Improve Cardiac Care

Published in the December 2011 Hospitals & Health Networks Magazine

By Whitney L.J. Howell

Hospitals link with paramedics to get real-time information to clinicians

Surviving a heart attack in rural locations always has been an iffy prospect. Long travel distances to the local hospital often thwart timely delivery of crucial clinical interventions or life-saving drugs. Hospital systems from Virginia to California are trying to harness the power of mobile technology to improve care — and, it’s hoped, reduce mortality — for heart attack victims even before they get to the emergency department.

In July, 100-bed Howard Young Medical Center, Woodruff, Wis., and 25-bed critical access Eagle River (Wis.) Memorial Hospital, both part of Ministry Health Care, launched the Lifenet program. The system is designed by Physio-Control which, until earlier this year, was a division of Medtronic. It cost around $35,000 and allows paramedics to instantly send the results of a patient’s 12-lead echocardiogram to emergency physicians awaiting the patient’s arrival. Sentara Healthcare in Norfolk, Va., launched the system in February in partnership with local EMS councils. El Camino Hospital, Mountain View, Calif., deployed it in 2010.

“It cannot be overstated that when it comes to a heart attack, time is muscle,” says Carl Hartman, M.D., medical director of Sentara Heart Hospital.

In large service areas like northern Wisconsin, every second counts. Roderick Brodhead, M.D., emergency services director for Howard Young and Eagle River, says getting timely information to clinicians lets them make quicker and better care decisions.

Cardiovascular disease is the No. 1 killer of Wisconsin’s men and women of all races and ethnicities, totaling 32 percent of the state’s annual deaths, according to a Wisconsin Heart Disease and Stroke Prevention Program 2010 report.

All hospital-associated 911-response vehicles are linked electronically to a bay station in the Howard Young emergency department. Once paramedics transmit a picture of an EKG, emergency physicians decide which treatments to have ready, Brodhead says.

The hospitals want to expand the service so paramedics can carry and administer thrombolytics. However, this is years away, he says, because the hospitals must study what type of training paramedics need to use these clot-busting drugs without any life-threatening complications.

To read this article in its original location: http://hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/12DEC2011/1211HHN_Inbox_technology&domain=HHNMAG

Survey: Residents Hold the Cards in Job Search

Published in the December 2011 Hospitals & Health Networks Magazine

By Whitney L.J. Howell

With doc shortage looming, final-year medical students are in high demand

In today’s physician job hunt, it’s a buyer’s market. More than ever, hospitals need qualified doctors, and potential hires, particularly residents, are calling the shots.

Physicians in the younger generation differ significantly from their predecessors in what they want in a job. Location, lifestyle and work-life balance are bigger priorities now than they were 30 years ago, but the shift has become more pronounced in the last decade.

Since 2001, the number of residents interested in hospital-based employment has spiked from 3 to 32 percent, according to the Merritt Hawkins 2011 Final-Year Medical Resident Survey.

“It’s about economic security. Residents like the safety of hospital salaries, and they appreciate someone else covering malpractice insurance,” says Kurt Mosley, Merritt Hawkins vice president of strategic alliances.

As employees, physicians don’t have direct responsibilities for practice management, including many of the regulatory burdens that pose significant financial constraints. Some residents also choose specialties with little on-call time, such as radiology, ophthalmology and dermatology, Mosley says.

Regardless of specialty, the survey demonstrates that health care is already feeling a crunch from a physician shortage that’s expected to hit 160,000 by 2025. Looming vacancies have employers recruiting aggressively — more than half of survey respondents said they’d received more than 100 recruitment contacts during their training.

Most employers recruit via email, says Katie Imborek, M.D., an assistant professor at the University of Iowa who finished her family medicine residency in April. Others are more aggressive.

“Not a day went by that we didn’t receive emails about jobs,” she says. “Some recruiters were more persistent — they wanted to meet with us in smaller groups. Others asked to take us to dinner one-on-one.”

A growing number of hospitals and practice groups have Twitter feeds and LinkedIn groups as ways to court residents.

“Like most places, our biggest need is primary care,” says Kevin Robinson, Southwestern Vermont Health Care communications director. “At the core, we need physicians to serve the entire community and increase access.”

But it’s more than the steady salary and low on-call time pulling residents away from private practice toward hospitals. Many institutions offer loan repayment assistance, says Joanne Conroy, chief health care officer for the Association of American Medical Colleges.

“For residents who graduate with an average of $180,000 in debt, these programs are like music to their ears,” Conroy says.

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Hiring a Doc? Maybe It’s Time to Tweet

The rise of social media has forced job recruiters to rethink how they attract the best and the brightest. LinkedIn, Facebook and even Twitter are becoming integral parts of recruitment strategies at many hospitals.

A 2010 New England Journal of Medicine study found more than 40 percent of physicians would job-hunt through social media. The number of employers following suit is small, but the ranks are growing.

“Social media strategies won’t replace traditional efforts, but as add-ons they can enhance recruitment,” says Chris Boyer, digital marketing and communications director for Inova Health System in Fairfax, Va. “The key is that you have social media users among your doctors, your medical staff and your nurses.”

According to experts at Georgia-based physician recruitment firm Jackson & Coker, including social media in recruiting efforts can produce a multipronged, cost-effective strategy. But they caution that each job posting be identical across platforms, and employers must take steps to eliminate any possibility for discrimination.

Inova launched its social media recruiting with a LinkedIn group that posts all jobs, and it can broaden or target searches as necessary. When recruiting specialists, however, Inova contacts individuals directly to discuss potential employment, Boyer says. To reach Twitter users, Inova will go live in December with its own Twitter feed of all open positions. Boyer recommends hospitals create RSS feeds internally for Twitter and route each job to their human resource departments. Inova also has dedicated social networking for residents. Through the free service SocialGo, residents can access resources during training, and the site transitions to help them find employment.

There are other successful online methods. In 2007, Southwestern Vermont Health Care created a microsite dedicated to finding physicians. “We had 22 openings for a staff of 140,” says Kevin Robinson, communications director. “Within two months of going live, we had more than 100 applicants. We filled nearly all vacancies by fiscal year-end.”

SVHC used direct mailing and contextual advertising to announce its microsite. With final-year residents as targets, Robinson says, the site lists all open jobs, offers available housing information, details popular leisure spots and restaurants, and includes information about activities.

“We included information about things residents said were important to them,” Robinson adds. “And it’s working. Doctors come to us because they find the quality colleagues, lifestyle, and work-life balance here.”

To read the article at its original location: http://hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/12DEC2011/1211HHN_Inbox_physicians&domain=HHNMAG

Medical Schools Get Creative With Child Care Benefits

Published in the December 2011 AAMC Reporter

By Whitney L.J Howell

As a surgeon, Robert Feezor, M.D., never expected he would eat earthworms at work. But as a father, he was thrilled to have the chance.

“It was Father’s Day, and they gave the dads earthworm ice cream,” said Feezor, assistant professor of vascular surgery at the University of Florida College of Medicine. “Basically, it was gummy worms in brownies, so it looked like earthworms in dirt. My son loved giving it to me.”

The treat came courtesy of Baby Gator, the medical center’s on-site day care facility where Feezor sends his three children—ages 5, 3, and 2—daily for a “stimulating educational child care experience.”

Accessible child care is one of the things that can add to the workplace attractiveness of an academic medical center. Baby Gator opened its on-site facility two years ago, joining other academic medical centers that have offered the same benefit—some for as long as 50 years. Many, including Yale and Stanford universities, have housed child care near hospitals and clinics for decades.

According to Sarah Bunton, Ph.D., AAMC research director of organization and management studies, longer hours of operation, close proximity to the hospital or clinic, and the possibility to see a child during the day make on-site day care a priority for faculty—both male and female.

“A dramatic change in the desire for on-site day care has been the increased number of fathers who want to be more involved with arranging care for their kids,” she said. “Through anecdotal reports from faculty affairs administrators and focus groups with select groups of faculty, more male faculty are also asking about and lobbying for this benefit.”

Baby Gator Director Pamela Pallas, Ph.D., said it was the medical school’s dean who first requested a location closer to the hospital.

“The dean called to tell me that top-notch residents were turning him down because he couldn’t guarantee he could offer appropriate child care,” Pallas said. “He was shocked child care was a deal breaker, but he wanted to know how we could get a Baby Gator close to the health sciences center.”

Within six months of opening, Pallas said, the center was at full capacity with112 children. There is now a waiting list 200 children long.

On-site child care is so popular, and the need for quality services so great, that parents scramble to put their children on waiting lists before birth. Some even make the attempt before conception. Jane Grady, Ph.D., associate vice president for human resources at Rush University Medical Center, once had a faculty member contact her upon getting engaged to ask if it was too early to put a yet-to-be-conceived child on the waiting list.

While the question amused Grady, who served as the first director of Rush’s Laurance Armour Day School, she was not surprised. Day care facilities at academic medical centers are more likely than other child care centers to have an educationally focused curriculum, making them a good choice for parents who already value extensive academic training, she said. Facilities on medical center campuses are also more likely to have highly educated staff.

“All our teachers have master’s degrees in early childhood education,” she said. “They are here to help the kids learn and have fun. We want to make sure they are well prepared for school at the same time we provide the excellent care the parents are looking for.”

During the 2008 presidential election, Feezor’s children learned about the various candidates and flags from different countries. When they learned about gardening, his 3-year-old enjoyed showing off the watermelon every time Feezor picked him up on the playground.

From the faculty perspective, paying for medical center-connected on-site day care can be easier than paying a center in the community, Grady said. Faculty can often choose from payroll deduction, using their health savings accounts, or monthly check.

Although these centers are coveted and provide an appreciated benefit to faculty, starting a day care facility is not always simple, said Phillips Kerr, director of compensations and benefits for the University of Massachusetts Medical Center-Worchester, which opened its facility in August 2010. The biggest stumbling block is finding an adequately sized space, as well as the funds to complete renovations, hire staff, and purchase necessary resources. In fact, he said, the best option could be outsourcing the day care’s administration.

“Fortunately, the university owned the space we used for the school,” Kerr said. “But rather than build everything from the ground up, the university decided to partner with an existing company to run the school. It’s been a positive experience.”

To read the article at its original location: https://www.aamc.org/newsroom/reporter/december2011/268878/childcare.html

 

Academic Medicine Explores ACO Model

Published in the December 2011 AAMC Reporter

By Whitney L.J. Howell

The release of the Centers for Medicaid and Medicare Services (CMS) final rule on accountable care organizations (ACOs) in October is helping some AAMC members take a second look at ACOs. Experts are debating whether the final rule, which excludes indirect medical education payments from the shared-savings mix, will help academic medical centers embrace the ACO model.

In an ACO, a network of doctors and hospitals will share responsibility for providing patient care to a minimum of 5,000 Medicare beneficiaries for at least three years. CMS begins accepting applications for the Medicare Shared Savings program in January.

If the U.S. Supreme Court rules that the health reform law is unconstitutional, ACOs and shared savings could become irrelevant. However, many in academic medicine are proactively aligning resources to provide services in quality-focused, collaborative ways to control costs. For some, that means launching multi-disciplinary, patient-centered care centers. For others, changes include integrating health information technology or adding “total health” courses into curricula.

There is no cookie-cutter approach to adopting the ACO model. Academic medical centers must identify strategies that work best for them, but it will be challenging, said Scott Berkowitz, M.D., M.B.A., Johns Hopkins Medicine’s accountable care medical director.

“There will be cultural and financial obstacles,” he said. “But academic medical centers have a golden opportunity to create value in the post-reform era through providing exceptional patient-centered care, engaging in the science of care delivery to supplement more traditional research, and by educating the next generation of health care leaders.”

Johns Hopkins is still reviewing the Shared Savings program but has improved care quality in recent years through several initiatives. The institution expanded its community physician group to more than 250 doctors, including many to augment patient access to both preventive and follow-up care, Berkowitz said.

There are, however, academic leaders who doubt their centers can achieve the ACO model, said John Kastor, M.D., a professor at the University of Maryland School of Medicine. In a February New England Journal of Medicine perspective, Kastor reported that of 37 senior faculty he surveyed nationwide, most believe the ACO structure will prevent care coordination and cost savings.

“Of the people I interviewed, none has figured out how to make this concept work at their center,” Kastor said. “Medical school deans and hospital CEOs often report to different people. Clinical departments tend to be in silos, and training students takes time. These issues will hamper an institution’s ability to form a successful ACO.”

Changing characteristics of teaching hospitals, including paring down didactic resources, to cut costs requires a significant culture shift, he said. But not all would be beneficial. According to AAMC, siphoning money from educational efforts to achieve savings—such as indirect medical education payments—undermines academic medicine’s tripartite mission.

“In our philosophy, these payments are for education and care of the uninsured,” said AAMC Chief Health Care Officer Joanne M. Conroy, M.D. “Excluding them from savings calculations prevents negative impacts on patients, and it stops any gutting of our care system or educational programs.”

However, the onus now weighs heavily on teaching hospitals and health systems to identify cost-saving strategies and demonstrate that they work.

“It’s still a tough road,” Conroy said. “It’s a complex rubric. Academic medical centers must drill down quickly to see what will be successful.”

For Greenville Hospital System University Medical Center in South Carolina, success is already here. According to chief medical officer Angelo Sinopoli, M.D., Greenville began working toward collaborative care nearly seven years ago and first tested the ACO model on its 17,000 employees. Using a $2.7 million Duke Endowment grant, the institution increased preventive care for employees and provided case managers for the sickest patients. The result was a 26 percent drop in emergency department visits and a 55 percent decrease in hospital stays.

The true key to success, Sinopoli said, was when hospital administrators offered on-site health care services to area businesses.

“It was part of our system change. We took our wellness programs to them,” he said. “Depending on the organization’s size, there is a nurse practitioner or physician there to provide a continuum of care, give high-risk patients health education, and eliminate social barriers to care.”

Having a Greenville-affiliated provider in the workplace gives patients more than the typical 20-minute doctor’s visit. They also have access to social workers, case managers, and practitioners who address their needs between appointments.

Achieving this goal was difficult. According to Sinopoli, Greenville faced two challenges when creating its collaborative-care environment. It took 10 years for physicians to embrace the model. The concept is foreign, he said, because physicians train as individuals and are not accustomed to working in teams.

The medical center also purchased health information technology to track accurate patient data, integrate it between sites, and make it readily available to providers. Along with an electronic health record system, the medical center installed a data warehouse so practitioners can mine existing data.

The institution is a newcomer to academic medicine, having joined South Carolina’s University HealthSystem Consortium in 2006, but it pivoted easily to train students about team-based care.

“Our curriculum and students are oriented to total health,” Sinopoli said. “Instead of teaching just the biochemistry of heart failure and what drugs treat it, our curriculum teaches how to coordinate care for a congestive heart failure patient and what resources and evidence-based practices can keep that patient from being readmitted.”

Greenville is still considering whether to apply for the Medicare Shared Savings program, he said. Regardless of the institution’s eventual route, Sinopoli said one thing is certain: Leaders in academic medicine must continuously promote culture change to create a true shift toward patient-centered care.

To read the article at its original location: https://www.aamc.org/newsroom/reporter/december2011/268852/aco.html

 

Life After Residency: Be Nice, Brush Up on Business, Go High-Tech

Published on the Dec. 6, 2011 DiagnosticImaging.com web site

By Whitney L.J. Howell

Over the past 20 years, not only has clinical instruction during radiology residency changed, but so has the practice life that comes after it. Even as a growing number of medical students select radiology as a specialty, practice-setting preferences have shifted for your younger colleagues. They also have a different set of priorities to consider.

Unlike generations past, most radiology residents don’t transition directly into practice. Almost all continue on to fellowship training, preparing themselves for sub-specialty practice. The extra training prepares young practitioners for clinical care, but it does little to get them ready for the realities and complexities of day-to-day practice.

“As an industry, radiology doesn’t do enough to prepare our residents,” said Keith Smith, MD, former director of the radiology residency program at the University of North Carolina at Chapel Hill School of Medicine. “Largely, residents are very focused on passing their board exams and have very little mental energy left for other things. We do talk about life in private practice and billing and documentation, however.”

And, from those conversations, he said, it’s appears that the majority of radiology residents are forgoing private practice for the security of an employment position with a hospital or larger physician practice.

Be Cordial and Cooperative

After residency, the first priority for new practitioners must be changing how their view relationships with referring physicians, Smith said. Residents often maintain an “us versus them” mentality, fostering contentious interactions.

“Many residents look at requests for service from other departments as additional burdens,” he said. “They react with dread when asked to do things when, once they’re out in practice, they begin to see it as a paycheck. Having a good working relationship with referring physicians and understanding their needs can be very helpful.”

Ben Huang, MD, a UNC radiologist who finished residency in 2005, said he once viewed requests from referring physicians as a waste of his time. As an attending today, however, he appreciates the need for collegiality between radiologists and other specialties.

“When I was a resident, I tended to be more obstructionist,” Huang said. “I let the attendings make the final calls, so it didn’t matter if I were diplomatic with the referring physicians.”

But cultivating relationships with referring physicians has been advantageous for him. Primary care providers and other physicians have gotten a clear sense of who he is as a radiologist over time and are comfortable sending their patients to him for diagnostic imaging services. This is increasingly more important as radiologists are becoming a more involved partner in patient care, advising on image appropriateness, a new role spurred by healthcare reform and patient safety initiatives.

To read the remainder of the article: http://www.diagnosticimaging.com/practice-management/content/article/113619/2001863

 

Medical Office Architect

Published in December 2011 MedMonthly Magazine as Cover Story

By Whitney L.J. Howell

Step inside an office in a long-standing San Francisco financial building, and you’ll see smooth, heavy timber columns and exposed wood joists. The brick walls are accented by modern colors, and three large lamps strike a dramatic image over a wood veneer reception desk.

With this sleek appearance, any visitor would be forgiven for assuming he or she had entered the headquarters of a progressive venture capital firm. But this is, in fact, the home for One Medical Group, a patient-centric, primary care medical office that offers longer, same-day appointments.

“There’s been so much buzz in San Francisco about One Medical Group,” said Justin Martinkovic, principal and co-founder of MMA Medical Architects, a San Francisco-based architectural firm that specializes in designing modern medical offices for all specialties. “People have been known to walk in and think they’re in the wrong space. It’s just not what you expect a doctor’s office to look like.”

And, that’s exactly the intent, he says.

For so long, medical offices have been seen as sterile, functional spaces. Today, however, the health care environment is shifting toward boosting patient satisfaction, and your reimbursement rates will soon be tied to how happy your patients are with the time they spend with you. The impact on your bottom line has prompted many of you to search out innovative ways to set yourselves apart from your competitors.

This is where firms like MMA Medical can help. Over the past decade, they’ve redesigned nearly 50 medical offices.

“We’ve detected a pattern among doctors who are more concerned with how they are perceived and the image they project,” Martinkovic says. “They want to distinguish themselves while still showing patients they have a high level of competency.”

Through a collaborative process, MMA Medical work closely with their doctor-clients to design a welcoming space to not only make existing patients feel more at home, but to also help attract a new, broader clientele.

How It Works

Doctors are often very particular, Martinkovic says. They come to the firm with a clear idea that they want – something. This is where the interview process truly begins. A design team sits down with the physician and runs through a litany of questions. What are your priorities? What is the culture of your office? What specific needs do your staff have? What is the ultimate goal of this redesign? These conversations help the team suss out any space or capital investment challenges.

“The initial interviews are our most intense interaction with the doctors. Through our conversation, we find out what they want and what their routine is,” Martinkovic says. “It’s also a chance for them to really identify what systems they have in place that they like and that work well and what things they need to shed.”

During the next three phases – schematic design, design development, and construction – doctors watch their original office spaces transform into more efficient, patient-focused, streamlined medical facilities. Team members usually present three or four potential designs, and doctors have the final word on which features they want to include, which materials they want to use, and which contractors will do the work.

Beyond that, they can be as involved or as laissez-faire as they choose.

What Changes You Can Expect

At every turn, the health care system is revamping how you practice medicine – the biggest change being the push toward increased health information technology adoption. With the expanding use of digital tools has come a greater need for you to be mobile with laptops, iPads, or tablets.

MMA Medical’s latest design efforts focus on accommodating those needs and making the most efficient use of your space. For example, at Golden Gate Ob/Gyn in San Francisco, most of the private offices have been eliminated. Instead, the design team created work stations – 2 ft x 2 ft spaces with a spot to plug in their laptop and printer – where multiple providers can transfer notes from their mobile devices and input data into patient charts.

Design teams have also made changes to take advantage of cloud-computing. Electronic records once meant you had dedicated space for your system server. Keeping your records in the ether means architects have two options: they can either slice the space devoted to your back-up system to a small closet or move it offsite completely.

“By using the work stations, moving away from private offices, and devoting less space to housing technological equipment, we’re able to focus on patient areas,” Martinkovic says. “Waiting rooms are getting elaborate designs, and it’s all enhancing the patient experience.”

The days of worn upholstery and sliding windows that separate receptionist from patient are gone. Doctors are now looking to infuse part of their personality into the office design, and patients are beginning to expect spaces that are more relaxing and less intimidating.

It’s an added plus, he says, when the design can play off of the doctor’s specialty, as it did with Holland Medical Eye Center in Daly City, Calif. The retail space is often integral to an optometrist’s office, so the architects mimicked the look and feel of glasses when designing the curvature of the walls and desks and orchestrating the lighting so it reflected off surfaces as it does off spectacles.

Healthy Design for the Health Care Provider

Your initial capital investment might be higher, but perhaps one of the biggest benefits that comes with modernizing your office space is the opportunity to go green. Although medical offices are considered to be places that promote health, they have historically been constructed out of “sick” materials, Martinkovic says.

“If you’re going to be charged with keeping people healthy, then a good step is to remove as many toxic pollutants as you can from your office,” he says. “We can also take things a step further and increase an office’s energy efficiency.”

Vinyl flooring, because it is constructed from harmful petrochemicals, is a major culprit in releasing toxins into your office, he says. Any new design should offer you one of three choices for flooring: wood, linoleum, or cork. When properly cleaned and sealed, wood is very resilient. Linoleum is inexpensive and safer than vinyl because it is made from non-toxic linseed oil. Cork can also be easily cleaned and is softer to stand on during an eight-hour day.

In addition, MMA Medical redesigns only use low VOC (volatile organic compound) paints. Removing the VOCs eliminates the chemicals that could induce breathing problems, headache, burning and watery eyes, or nausea in your patients.

Green design can also lower your utility bills. Energy-efficient lights, such as LED or fluorescent lighting, and an energy-efficient HVAC system can reduce your electricity consumption. Martinkovic says designers also build in low-flow water systems to control the amount of water medical offices use each day.

Things to Consider

Giving your office a facelift can be exciting and revitalizing for both you and your staff. But there are many things to consider before you jump in, Martinkovic says.

First, have a frank discussion with your design team about your budget, what the design and construction will cost, and how long it will take. Be prepared for a four-to-six month process. If you haven’t re-outfitted your office before, you could be in for sticker shock. The cost to you will vary by what features you select and by your regional location.

Second, identify your new location and how it will affect your existing and new clients. In this process, you should also determine who your ideal patient is. That model can help you decide which design features will be most appealing to your clientele, he says.

Last, think through the image you want to portray.

“Consider your office to be your suit,” Martinkovic says. “It’s the first impression your patients have of your practice and who you are as a physician.”

To read the story in magazine form: http://issuu.com/medmedia9/docs/mm-decemberweb/27

Call Centers: Your Practice Can Be More Productive

Published in the December 2011MedMonthly Magazine

By Whitney L.J. Howell

Everywhere you look, the recent economic downturn has forced budget cuts. Health care is no different – and it’s likely that your practice or hospital has also been obliged to trim its spending. There are, however, ways to work within your means and still meet the necessary patient care and safety standards.

One hospital system, the University of Iowa Hospitals and Clinics, found its answer in a pathology lab call center. Manned by official lab staff, the call center gives its health system physicians immediate access to expert pathology information without pulling lab scientists away from their duties.

“Asking a scientist to leave his or her work when a call came in left whatever sample was being analyzed just sitting on the table,” says Sue Zaleski, pathology lab manager. “Dedicating people and a space to answering calls helps with efficiency, quality control, and error prevention.”

So, in 2005, with support of her administration, Zaleski launched the call center in a room adjacent to the lab. She hired a telemarketing professional to structure the center and train the scientists to focus on customer

Sue Zaleski, pathology lab manager at the University of Iowa Hospitals and Clinics and developer of the pathology call center.

service. Merging telemarketing expertise with the intricacies of a highly technical environment is the bedrock of why the call center has been so successful, she says.

Each day, 10 certified lab scientists field, on average, more than 150 calls from health care provider offices. The questions vary widely, including inquiries about which type of blood draw is best for a particular test or how to transport certain samples.

The scientists rotate through the call center on a schedule, and these shifts are an added responsibility on top of their work with analyzing samples. Zaleski says she has been surprised by how much taking on call center duties has improved her lab scientists’ job satisfaction.

“The scientists love it when their turn for the rotation comes around,” she says. “It gives them a nice break – the call center is quiet. They can sit down for a few hours, and they get to pair their research skills with their technical knowledge to help people.”

While the scientists enjoy a break from their regular routine, the benefit to the University comes from the increased efficiency in analyzing samples, she says. There’s no cost savings, but boosting the number of samples scrutinized daily is an improvement in lab productivity.

The call center is also valuable because it allows the scientists to focus their attention and speak directly with providers. This is particularly important with urgent requests about high-priority samples. Under federal health care regulations, certified lab scientists can only provide critical value notifications to licensed care providers. The call center’s single focus has helped the lab truncate its response time on high-priority samples to less than 15 minutes.

Fielding calls from health care providers also gives the lab scientists an opportunity to share their pathology knowledge one-on-one. Not only can they pull from their own extensive knowledge, but they have access to an arsenal of research sources that can augment the answers they provide.

Thanks to the telemarketing professional, each scientist has received extensive customer service training, including how to speak articulately and with empathy, listen closely to the caller and master the available reference materials to find information quickly.

Despite being in operation for a few years, Zaleski says the health care providers who contact the call center haven’t offered much feedback. At first, the silence bugged her, but she now says it’s not a negative sign.

“We were initially deflated because no one gave us any idea of what their experience with the call center had been,” she says. “But we soon realized that when you do something well, especially for a group as busy as health care providers are, you don’t leave much of an impression. It’s when you do things poorly that you hear about it. So, we’re taking no reaction as a good thing.”

That doesn’t mean the call center isn’t keeping track of its own performance. Each call is recorded to keep tabs on how long it lasts, the number of times the caller is transferred, and how long it takes the scientist to supply an answer. The audio files are also used to protect the scientists who speak with providers. They can support the accuracy of provided information or reveal if a caller demonstrated problematic behavior, Zaleski says.

If you’re considering a lab call center to increase productivity and smooth communication between your health care providers and the pathology scientists, there are a few points to remember, Zaleski says. First, take a look at your certified lab staff and how they go about their daily work. What do they do with their existing resources? How would the additional responsibility of working in a call center affect their current responsibilities and job satisfaction? If all signs point to the need for a call center, take the idea to your administration and get proper buy-in from facility leaders. Ultimately, the long-term impact for your institution could be very positive.

To read the story in magazine form: http://issuu.com/medmedia9/docs/mm-decemberweb/13