The medical landscape is always changing. With the Affordable Care Act, implementation of ICD-10, and penalties for not participating in the Physician Quality Reporting System (PQRS), practices have a lot of challenges ahead.
To help meet those challenges, orthopaedic surgeon Thomas C. Barber, chair of the AAOS Council on Advocacy, recommends that practices consider expanding ancillary services such as MRI or physical therapy. He also advises that practices should bill for all services rendered and use marketing and enhanced relationships with referring physicians to solidify their business. Finally, astutely observe the trends in your local health care community, such as ACO formation and changes in surgeon/hospital relationships. Barber says that understanding your practice’s economics and local environment will help you see opportunities for merging or collaborating with other practices.
Medical tests have come under close scrutiny in this era of health care cost containment. Test over-ordering is thought to arise largely from the practice of defensive medicine, but Victoria Shaffer, assistant professor of health sciences at the University of Missouri School of Health Professions, has a different hypothesis and has been researching how doctors make test-ordering decisions. In a study published in Health Psychology Shaffer, human factors engineer Adam Probst, and pediatrician Raymond Chan, MD, examined the relationship between how tests are displayed in EMR systems and the number that are ordered.
The study looked at three different ways tests are displayed on electronic health records — one presented tests unchecked by default where the physician had to check the test to be done (opt-in format); one showed tests preselected which had to be unchecked (opt-out tests); and a third showed a few pre-selected tests. The results of this study corroborated Shaffer’s hunch — more tests were ordered when doctors had to opt-out. She thinks the use of opt-in defaults would result in better care for patients and lower costs.
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.”
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.
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.
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.
Most patients with hip osteoarthritis dream of a nutritional supplement that will improve their clinical symptoms. Findings from a new study of a soybean-avocado supplement suggest they’ll have to keep dreaming. However, relative to placebo takers, those taking 300 mg a day of a proprietary soybean-avocado supplement over three years were 20% less likely to experience a loss of joint-space width of 0.5 mm or more. Alas, there were no significant differences between the two groups in important patient-centered outcomes such as pain and the use of analgesics or NSAIDs. The industry-funded study of nearly 400 patients initially set out to determine changes in joint-space narrowing (JSN) between the two groups, but researchers amended the protocol to measure progression because JSN was found not to be a “quantitative linear normally distributed parameter.”
Results from a new JBJS study, Mobile Technology/Social Media Usage Among Orthopaedic Surgeons, show orthopaedic surgeons are frequent users of mobile medical apps, with seven in ten orthopaedic surgeons having downloaded at least one app on their smartphone. Roughly 40% of 320 respondents to a JBJS email survey say they are using medical apps more than they did a year ago, and 41% of the respondents say they have downloaded an app offered by a supplier. The types of information surgeons most desire in an app include drug information, surgical techniques, journal articles, and patient information. The favorite medical app mentioned was Epocrates, an athenahealth app that provides point-of-care medical information to doctors. Other favorite apps include AO Surgery Reference an d Medscape.
The findings also show that orthopaedic surgeons are getting more comfortable using mobile devices for orthopaedic tasks such as referencing drug data, checking formulary schedules, reading journals, communicating with their patients, and seeking information about orthopaedic devices/products. (see charts). Finally, the findings reveal that although many surgeons are not using LinkedIn and Facebook, one in five believe that social media will have a positive impact on orthopaedic care in the future.
New JBJS survey shows that orthopaedic surgeons use medical apps frequently and that they’re getting more comfortable using mobile devices for communicating with patients.
The AO Surgery Reference is a comprehensive portal of surgical knowledge that includes hundreds of surgical procedures and approaches, tools to help make surgical decisions, and access to hundreds of pages of previously published AO material. Developed by the AO Foundation, the reference is now available via iPhone, iPad, and Android apps. This app is a good starting point to access information about the treatment and management of traumatic fractures. According to a recent JBJS survey of orthopaedic surgeons, AO apps were mentioned second to Epocrates as a favorite medical mobile app.