Archive | February 2014

Understanding the Difference Between “Digital” Doctors and “Social Doctors”

According to orthopaedic surgeon Dr. Howard Luks, there is a big difference between a “digital” doctor and a “social” doctor even though many use the words interchangeably. In a recent blog, Luks said the real opportunity is when a doctor uses digital technology to improve communication between clinician and patient. He says that doctors typically use social media for interaction with other doctors. His sentiments concur with the results of the recent JBJS survey mentioned above, where VuMedi was ranked above all other social media sites by orthopaedic surgeons. Dr. Luks concluded that “being a social doctor means you are interested in collaborating, sharing information and lending your expertise.”

ICD 10 Implementation – Are you the 80%

Oct. 1, 2014 is the deadline for ICD-10 conversion. However, according to a survey from the Workgroup for electronic data interchange, 8 out of 10 practices have not begun testing and only half have begun the initial steps of impact assessment. Some attribute these delays to their IT vendors not being ready; 40% of vendors said their products won’t be ready before 2014. There has been discussion about The Centers for Medicare and Medicaid Services (CMS) possibly delaying the deadline again or an “enforcement-free” period of 6 months, but CMS has resisted that idea.

On a more positive ICD-10 note, Sutter Health of California is planning on going live this May, a result of its 3-year planning efforts. The May launch will give Sutter doctors a five-month test period before the deadline. Danielle Reno, Sutter’s ICD-10 program director said, “We won’t be submitting claims to payers in ICD-10, but we will turn it on, and physicians will be able to use it.” Another company testing its ICD-10 plans is North Carolina Healthcare Information & Communications Alliance (NCHICA). Holt Anderson, executive director at NCHICA, ran a test pilot with some of the best coders, and there were still significant concerns about accuracy. Using “dual coders” who coded in both ICD-9 and ICD-10, only 55% of the transition scenarios were accurate in the first wave of testing.

At Your Service – Concierge Style

Concierge medical practices are a growing segment of the healthcare industry. In a concierge practice, patients pay a retainer fee to the practice to assure that they can see their doctor when needed, whether that is the same day or next day. Patients in concierge practices have more time with their physician, and they receive prompt call backs and much more attention — even house-calls. But for a physician considering transition to this type of practice, one of the first things to consider is downsizing the number of patients.

According to Dr. Thomas LaGrelius, a family physician who transitioned from a traditional practice to a concierge practice, “If you’re going to do a comprehensive wellness exam on everyone once a year, it takes an hour or two.” He continues, “That limits you to a membership base of about 600 patients — maybe 800 if they’re younger, healthier people.” Some physicians balk at the idea of downsizing their patient panels, but for Dr. LaGrelius, doing so gave him more time to focus on each patient. But before going concierge, Dr. LaGrelius met with key thought leaders and consultants to help make the transition. The transition to a concierge practice can be most challenging for physicians who don’t have a loyal patient-base.

Top-Rated Orthopaedic App

Ankle & Foot Pro III is one of the highest-rated apps for orthopaedic surgeons, according to TopOrthoApps, a mobile app review site. This app receives outstanding ratings in functionality, coolness, and overall features. Ankle & Foot Pro III gives a visual look at anatomy with high-level, 3-D views into muscles, tendons, nerves, vessels, ligaments and bones. The app features easily manipulated views, a “pen” feature for drawing on the screen, “pins” that identify structures of different layers, and videos demonstrating surgical procedures.

Does Financial Stability Mean Happiness for Orthopaedic Surgeons?

This year’s Medscape’s 2014 Lifestyle Report dives deeply into the lives of physicians outside their practices. The 2014 report, which covers 25 specialties and includes close to 32,000 responses, examines physician health (both physical and spiritual), political beliefs, marital status, and happiness both at work and outside of the office. The report shows that orthopaedists are the most financially stable physicians among the 25 specialties. Family physicians and internists are at the opposite end of the spectrum, with less than 6 out of 10 feeling they have adequate or more than adequate savings. On the happiness scale (login required), 67% of orthopaedists said they are very or extremely happy at home, while 42% of them report being extremely/very happy at work. The least happy physicians at work are family and emergency medicine physicians; only 36% of respondents in those specialties said they were happy at work, with internists and radiologists following closely at their heels.

Bipartisan Step Forward on SGR Repeal

Up against an April 1 deadline that would see Medicare payments to physicians plunge by nearly 24%, a bipartisan group of Congressional negotiators introduced legislation that would repeal Medicare’s sustainable growth rate (SGR) formula and replace it with an annual 0.5% pay increase for five years. The proposed legislation contains additional provisions designed to transition Medicare from a pay-per-procedure system to one that promotes value through alternative payment methods (APMs) and rewards physicians for engaging with APMs. Those provisions include:

  • A consolidation of three existing Medicare quality programs into one
  • Incentives for care coordination
  • Involvement by physicians in developing clinical guidelines, performance measures, and APMs
  • Making provider-specific quality and utilization data more publicly accessible

Before we hail this as the epitome of bipartisan success, it should be noted that the legislation in its current form does not detail how Congress would pay for a permanent SGR repeal, which is estimated to cost between $120 billion and $150 billion. That significant detail will be debated if and when the full membership of both chambers considers the bill. Congress has been at similar SGR crossroads before and ended up passing short-term “patches” without permanently revising what everyone agrees is a failed formula.

Cat Bites to Hand or Wrist Often Lead to Hospitalization

In a study in the February Journal of Hand Surgery, nearly a third of all people who sustained a cat bite to the hand ended up hospitalized for treatment of a serious infection. Among those hospitalized, the average length of stay was 3.2 days, mostly for surgical procedures, including irrigation and debridement, and administration of appropriate antibiotics.

One major risk factor for hospitalization was a bite located over a joint/tendon sheath, rather than one located over soft tissue. Study co-author Brian Carlsen of the Mayo Clinic explained further in an interview with USA Today: “When the cat bites the hand, the joints and tendons are protected with fluid and there is no circulation, so bacteria can grow like crazy.” The most common pathogen isolated in cultures was Pasturella multocida, which the study authors described as “one of the most aggressive pathogens isolated from the saliva of 70% to 90% of cats.”

The authors conclude that “there should be a low threshold for aggressive treatment” in patients who present with a cat bite to the hand along with lymphangitis, erythema, and swelling. Or, as Dr. Carlsen told USA Today (with tongue presumably in cheek): “Rule of thumb–go see a doctor if a cat bites your hand.”

From the AAP: Help Discerning Abuse-Related Pediatric Fractures

Unintentional fractures in kids are much more common than fractures caused by child abuse, but orthopaedists should remain on the lookout for inflicted injuries. To help clinicians assess whether childhood fractures are the result of abuse, the American Academy of Pediatrics (AAP) recently published some guidance.

According to the AAP, classic metaphyseal lesions and rib, scapular, sternal, and spinous-process fractures have a high specificity for child abuse in infants and toddlers. In addition, childhood fractures occurring in the following contexts should raise the suspicion of abuse:

  • The fracture is in a nonambulatory child. (Research suggests that 80% of all child-abuse-caused fractures occur in kids younger than 18 months.)
  • The history provided by the caregiver is implausible relative to the injury sustained.
  • Multiple fractures, fractures of different ages, or other suspicious injuries are present.
  • There was a delay in seeking medical treatment.

The article also provides guidance for conducting medical exams, lab work, imaging, and sibling evaluations to arrive at an accurate diagnosis.