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NMA News

Two additional online continuing medical education activities have been added to the NMA website this month. The first activity is titled “The Role of HPV Vaccine in Genital & Non-Genital Cancers” and features video from the OB-GYN Section’s 2011 Savage Boyce Walton Lecture. The second activity titled “The Right Diabetes Management for Optimal Control” features video segments from the annual Diabetes Management and Certification Symposium held at the NMA Annual Convention and Scientific Assembly.

Project IMPACT Good Clinical Practices Program and Skills Building program held December 10-11, 2011 at the Hyatt Regency Washington hotel was an overwhelming success. Participants were particularly pleased with the quality and expertise of the speakers and the tremendous amount of resources and assistance offered to help build or initiate a clinical trials practice within their current office based practice. Working with the NMA’s Continuing Medical Education program the entire 2-days was videotaped in anticipation of offering it as an on-line continuing medical education activity.

Dr. James Powell, Principal Investigator for the Project was delighted with the question and answer sessions which lasted long past their allotted time. Well after the program had ended speakers and participants were engaged in lengthy and heated discussions. Project IMPACT continues to strive to train well qualified physician investigators and increase the number or African Americans participating in all aspects of biomedical and clinical research.



Mark your calendars for the 2012 National Medical Association Annual Regional Meetings begining this spring. The regional meetings are excellent opportunities to network with state & local society colleagues and earn CME credit through participation in scientific sessions that have special emphasis on health issues of disparate impact in the region.

Region 1: May 24 – 28, 2012 Maho Bay, St. Maarten; Region 2: March 1-4, 2012 White Sulphur Springs, WV; Region 3: May 3-6, 2012 Biloxi, Mississippi; Region 4: June 1-3, 2012 Detroit, Michigan; Region 5: April 12 – 15, 2012 Houston, Texas; Region 6: May 3-6, 2012 Palm Springs, California

If you have any questions please contact the NMA at (202) 347-1895.

Practice Management News

Personal health records (PHRs) must have relevance for both the patient and the healthcare provider, and many providers opt to have the PHR tethered to the electronic medical record so that the data can be connected automatically. "A shared connection [between patients and physicians] is what consumers really want," says the University of Pittsburgh Medical Center's G. Daniel Martich, MD. Engaging both patients and doctors in using the PHR involves educating both parties through tutorials or incentives such as contests, as UPMC has done; Holly Miller, MD, with MedAllies reports that patients with the most diagnoses are likeliest to use a PHR, while participation can be encouraged by permitting patients to link with others, as many patients like being part of a virtual community of people with the same diagnosis.



In October 2012, as part of the federal healthcare reform, Medicare will begin using patient satisfaction scores to calculate a portion of hospital reimbursements. This means that regardless of patient outcomes, hospitals will be paid less if patients are unhappy with the care they received. To provide better care and improve patient engagement, doctors will have to make some changes. They could implement integrative medicine, like massage or acupuncture, especially since patients are spending their money on such treatments already. Doctors also should practice their communication skills, such as using positive body language and listening attentively, and they should make an effort to communicate with patients through blogs, Facebook, and YouTube. By focusing on patient satisfaction, doctors can forge a partnership with patients, who will trust them and seek their advice. Doctors must remember that patients want to be heard, supported, and validated, and paying more attention to patients ultimately will boost their revenue and job satisfaction.



Two separate but related announcements—that the American Medical Association would oppose ICD-10 deployment and that the Centers for Medicare and Medicaid Services would postpone enforcement of its rule requiring use of the Version 5010 data standards—has shaken the healthcare industry overall and its information technology sector specifically. American Hospital Association vice president of policy Don May reports that while 5010 increases the efficiency of the billing process, "we're concerned about how this delay of enforcement might work." May also says ICD-9 is outdated and the transition to a new system is necessary, but he concedes that "hospitals are dealing with ICD-10, meaningful use, accounting for disclosures, bundled payments for accountable care organizations—there are a lot of overlapping burdens put on that same IT department."



A recent survey of 350 healthcare providers and administrators by the Computing Technology Industry Association finds that close to 50 percent of doctors will employ tablets and other mobile devices to access electronic medical records (EMRs) and perform other tasks in the coming year. Tablets already are being used by 25 percent of the providers polled, and 21 percent will begin using the devices in the next year. Meanwhile, 20 percent of respondents plan to use smartphones to access EMRs, following in the footsteps of 33 percent of those who do so already. The federal government is pushing for more than 50 percent of healthcare providers to have electronic health record (EHR) systems in place by 2014, with those demonstrating meaningful use receiving tens of thousands of dollars in reimbursement money. The survey indicates that EHR systems will be in place in 58 percent of small practices by the end of 2012. Additionally, 38 percent of providers have deployed comprehensive EMRs, with 61 percent stating that they are satisfied with their systems, and 17 percent have partial systems or modules in place. However, only 5 percent use cloud services, and just 10 percent plan to use video conferencing to interact with patients in the coming year.



Physicians practices rely heavily on referrals to expand, especially primary care physicians and those in specialties like Ob/Gyn, dermatology, and ophthalmology. Practices should keep non-physician sources in mind when going over their acknowledgment program. However, it is important that the referral acknowledgment gift not be mistaken for a bribe or kickback. Referral sources should be thanked every time they refer the practice with a personal note or call, and should be organized in a computer database. About once or twice a year, the practice should send something nice without mentioning a particular patient to convey that the sources are valued. Consultants recommend perishable gifts like food or flowers. Physicians may also consider something that has proven beneficial to their practice, such business or medical books, coffee table books, articles, or even cartoons. Colleagues who have a nice conference room may appreciate receiving a tray or pitcher etched with the practice's name, logo, or other message.



The National Committee for Quality Assurance has announced a three-tiered accreditation program for healthcare providers to confirm and score their claims that they are accountable care organizations (ACOs). The committee is introducing seven criteria that ACOs will be expected to master, and they will verify their ability to supply that quality of care on onsite polls beginning in March. The criteria include having infrastructure to coordinate providers and collaborating with stakeholders to improve quality of care, patient experience, and manage financial resources; possessing sufficient numbers and types of practitioners to provide timely access and monitoring its effectiveness in meeting patient needs and preferences; supplying patients access to patient-centered medical homes and assessing the ability of primary care practices to deliver that care; respecting patients' rights and privacy, limiting data access, and having a method for patients to submit complaints; and collecting, integrating, and using data for care management and performance disclosure, focusing on the capture of information in electronic systems and making sure that practitioners can access it.



A trio of new demonstration programs to be launched by the Centers for Medicare and Medicaid Services next year aim to reduce improper Medicare payments. Recovery Audit Contractor audits will be conducted as part of a pilot program in California, Florida, Illinois, Louisiana, Michigan, Missouri, New York, North Carolina, Ohio, Pennsylvania and Texas, reviewing certain types of claims known for high repayment rates -- beginning with inpatient hospital claims for short stays -- before payments are made to ensure that providers followed Medicare rules. Another demonstration program in California, Florida, Illinois, Michigan, New York, North Carolina and Texas will require prior authorization for power mobility devices and other medical equipment. Finally, 380 hospitals across the country are being sought as participants in a Part A to Part B rebilling demonstration program, in which hospitals can rebill for 90 percent of the Part B payment when the Part A inpatient short stay claim has been denied due to billing for the wrong setting.



According to a Harvard University study published in the Journal of Hospital Medicine, hospitals using computerized medical information tools to help doctors make decisions at the point of care have better outcomes than hospitals not using those tools. Researchers examined Medicare beneficiary data for more than 1,000 hospitals between 2004 and 2006 during the adoption of a computerized medical information system, which was then compared with data from more than 2,300 hospitals not using a computerized system. The adoption of the computerized system correlated to a reduction in mortality, shorter hospital stays and better performance on three hospital quality metrics for heart attack, heart failure and pneumonia care.



The ResolutionMD Mobile app is the world's first smartphone radiology product to win regulatory approval for primary diagnostic use. The app runs on the iPhone and iPad and enables physicians to make a diagnosis by viewing patient images and stored medical documents. The Mayo Clinic has been using the original desktop version of ResolutionMD for two years to help stroke victims in rural Arizona. As such Web-enabled technology becomes more widespread, it will allow the pooling of data online, letting physicians access it inexpensively irrespective of their location, according to the Mayo Clinic's Dr. Ross Mitchell, who led the development of ResolutionMD Mobile while at the University of Calgary. "You could bring advanced medicine to rural parts of Africa or Asia," Mitchell says. "It’s not just in the mobility; it’s in the ability to link this up and get a network effect." Ottawa Hospital chief information officer Dale Potter, meanwhile, formed a 70-member software development team to create mobile apps for everything from viewing diagnostic images to assessing pain levels. Potter says mobile devices like the iPad and iPhone help patients feel more engaged because they can see actual images of a fracture, for example. Tablets also foster a more integrated way of practicing medicine, he says.



Dr. Victor J. Marks at Geisinger Health System says physicians must provide service that patients identify as being excellent, especially in a competitive marketplace. He notes that many doctors focus their marketing efforts on diagnostic, technical, or clinical areas, but most patients base their opinions of physicians on their interactions with them and members of their practice. Patients also examine such things as the ease of making appointments, the check-in and check-out processes, the flow in the offices, and accurate and timely billing. Appropriate behaviors are essential as well, Marks says, such as addressing patients correctly, smiling, answering the phone cheerfully, and having nurses introduce themselves to patients. Conversely, "If you roll your eyes at a difficult or demanding patient, your employees will do the same," he warns. Sandra Ellison, president of Ellison Consulting Group, says it is essential for a practice to have a clear and compelling vision, such as being the most in-demand source of services in a particular market or offering the most cutting-edge therapies and compassionate care. The next step is to hold several meetings to ensure that people are aligned around a shared vision and to gather data about four key areas: processes, environment, culture and amenities, she says.



By February 2012, Dr. Reginald McClung plans to slash the number of patients he treats from 1,500 to 600 or fewer, allowing him to spend more time with individual patients. McClung intends to compensate for the reduction in patients by charging each of the remaining 600 a $1,500-per-year membership fee. A company called MDVIP is helping McClung's practice implement the changes. MDVIP has more than 500 member physicians across 35 states to whom it provides legal and marketing services. MDVIP Vice President Mark Murisson says member doctors typically see about a dozen patients a day for at least 30 minutes each, and MDVIP patients undergo an annual two-hour "wellness exam" that features such checks as cholesterol, blood sugar, blood pressure, and mental illness. The company also works with major medical centers like the Cleveland Clinic, the Mayo Clinic, and Johns Hopkins University in order to provide patients with access to specialists for second opinions and consultations, according to Murisson. Patients who join an MDVIP member practice have access to other member doctors while they are traveling. Children between the ages of 16 months to 26 years can join MDVIP for free if one of their parents is a member.



Medical practices will soon face a variety of IT challenges in 2012, so it is important they choose the right technology, says Bob Dean, vice president of technology at ChartLogic. "For practice leaders, the decision is not whether to purchase an EHR, but what type is right for their office," he says. For example, surgeons should seek an EHR system that speeds up the data entry process via dictation or click minimization, he says. Dean adds that practices need to finding skilled, affordable IT personnel to address the rapid growth of the industry. Monitoring payments for ANSI-5010 compliance will be necessary because starting Jan. 1, 2012, all hospitals and physicians must submit bills using the ANSI 5010 transaction standards, he says. Dean further advises that qualifying for meaningful use starts with implementing a certified EHR, which means that the EHR has been tested by an organization designated by ONC-ATCB (Office of National Coordinator, Authorized Testing and Certification Body). Although few physician practices have implemented cloud computing, "this new service holds tremendous potential in terms of expanded services and lower costs," according to Dean. He also says there will be increased enforcement of HIPAA laws, a need to transition to ICD-10 compliance, and an emphasis on sharing data with health information exchanges and accountable care organizations.



Personalized physician practices, which are also known as concierge or retainer-based medicine, are becoming increasingly popular. American Academy of Private Physicians Executive Director Tom Blue says during the last 12 months, the association's membership doubled from approximately 320 practices to 640 that serve nearly 1 million patients. He says personal physicians usually restrict their practice size to an average of 350 patients so that they can spend from 30 minutes to an hour with their roughly 10 to 12 patients scheduled daily. They are also better able to accommodate same- and next-day appointments, he says. Blue says the retainer charged by the practices averages $2000 annually nationwide, and usually features a detailed yearly physical, preventive tests, and screenings. This payment model is dubbed "medical home" because of its focus on long-term relationships between doctors and patients and that it is the opposite of the fee-for-service model, says Andy Reynolds of the National Committee for Quality Assurance, which operates 2,829 "medical homes" nationwide. University of Chicago researcher Elizabeth Hargrave says personal physicians earn about the same as they did in their conventional practice on average but report higher levels of job satisfaction and quality of life.



Dr. Vandna Jerath relies on social media to expand her Optima Women's Healthcare Practice. "There are a lot of people out there who have questions and we can have a broad reach over social media," she explains. Jerath spends an extra hour and a half per week at her computer to reach out to potential patients via Twitter, YouTube, Google Plus, and three Facebook accounts. "As many as a third of my patients are coming from social media," Jerath says. Patients say the social media sites help them feel acquainted with the doctor even before they meet in person. Jerath asserts that social media tools help her demonstrate her transparency and builds credibility with patients. She anticipates that more physicians will turn to these technologies, and says she has been asked by her colleagues to assist them in getting started. All of Jerath's staff members are involved in social media as well and attest to the rising number of patients as a result.



Marc Steen, vice president of development at United Surgical Partners International, says large specialty physician groups need to be involved at the local, state, and national levels to make sure their concerns are heard. "If you're at the table, you have a better chance to navigate the process and have some input into the decision process," he says. Steen also says large physician group must focus on retaining talented physicians in addition to recruiting younger ones who are just entering the workforce. The use of health IT infrastructure is important as well, but electronic medical record vendors need to be chosen carefully because they must be able to adapt to change, says Steen. To curb risks, Steen adds that it is important not to look the other way if a physician poses a significant risk in coding, quality, public relations or aspect. "One physician, caregiver or employee can ruin an entire group's reputation." A large specialty physician group must also market the practice and examine the market's perception of it through outreach with hospital systems, physicians' lounges, social media, and other outlets. And irrespective of whether accountable care organizations are formed or not, Steen advises large specialty physician to hold physicians accountable for quality, compliance, coding, and patient satisfaction and to make sure they are on board with the new initiatives.



Physicians should proactively manage their online presence after creating a Web site. They should know what patients are saying about them, their group, their staff and their practice; and once a month should assess reviews on Yelp and physician-rating Web-sites, correct misconceptions and respond proactively to complaints. Physicians should Google themselves to make sure their telephone number and address is accurate and up-to-date; should have a picture with a warm, smiling face taken by a professional; and should have a profile written in a patient-friendly manner that includes their philosophy, how they treat patients, and even hobbies or interests that would make them more approachable. The Web site should be consistent with their brand with regard to a standard logo, color palette, style of the practice and office materials, but developing a unified brand also has legal ramifications. Joining social networking sites such as Facebook, Twitter, LinkedIn can give physicians a face, but policies and procedures for the use of social media by their staff will be needed. Blogging can give physicians an opportunity to discuss something newsworthy or medical issues, and can offer another way to increase their search ratings. Physicians also should provide links to other medical sites as well as to their profiles on TV or radio, in newspapers and online magazines.