A new report from Accenture estimates that by 2019, two-thirds of US health systems will offer patients the opportunity to digitally self-schedule physician appointments. By reducing the time spent scheduling and rescheduling (an average of 8 minutes per phone appointment versus less than a minute for online self-scheduling), this simple change could save the health care system an estimated $3.2 billion.
Accenture says that nationwide, 11% of health systems currently offer self-scheduling of appointments, but only 2.4% of patients who have the opportunity take advantage of it. That may be partly because retirees—a population that generally prefers conducting business by phone—make up nearly half of the US population. Still, a recent Accenture survey indicated that 77% of patients thought that the ability to book, change, or cancel medical appointments online was important.
Physician assistants and nurse practitioners (often referred to as nonphysician practitioners, or NPPs) can be instrumental in helping physician practices speed reimbursements, increase patient satisfaction, and reduce paperwork burdens for doctors. An article on ORTHOPRENEUR, a digital journal, suggests that practices employ the following tips to ensure optimal utilization of these valuable professionals:
- Create accurate job descriptions.
- Research your payer mix and reimbursement rules.
- Coordinate a pre-employment shadowing day before making a formal offer to an NPP.
- Include professional memberships and CME allowance in the offer.
- Market your new NPP just as you would a new physician.
- Provide one-on-one training with physicians during the NPP’s orientation.
- Create patient scheduling policies and protocols for your staff; train the staff on the type of appointments for which NPPs will be utilized.
- Train your NPP on billing and documentation, including coding.
The accelerometer chip inside almost every smartphone, which helps the device know up from down, could help orthopaedic surgeons remotely analyze the gaits of their patients after joint-replacement surgery. So says Canadian orthopaedist Michael Dunbar, MD, an oft-published JBJS author.
Accelerometers can detect motion in three directions. Dr. Dunbar told Orthopedics This Week that he’s working on an app whereby patients, at the time of postsurgical check-ups, would strap the phone onto their back or hip and go for a walk in their own environs. The app would transmit the accelerometer-captured information to the doctor for gait analysis; the physician would then contact the patient by phone for further discussion about postsurgical progress.
Compared to the traditional follow-up X-ray–which, as Dr. Dunbar noted, “is just a [two-dimensional] picture of the patient lying down and has nothing to do with the patients’ walking”–the accelerometer-enabled remote gait analysis should be more accurate and less expensive and time-consuming.
Magnetic resonance imaging has revolutionized the field of orthopaedic diagnostics, but it has until now been limited by delivering largely static images. Researchers at the University of California, Davis have developed a new MRI technique called “active MRI” that can depict wrist joints in motion at an amazingly fast temporal resolution of 475 milliseconds. The advance could permit a patient to replicate a motion that causes pain while allowing a physician to “see inside” for the cause while the joint is moving.
David Glaser, JD, alerts us to proposed changes in the healthcare reimbursement model that would make employing physicians less appealing for hospitals. MedPAC, the Medicare Payment Advisory Commission, issued a report that details a discrepancy between higher reimbursements for services rendered in hospitals relative to those for the same services provided in clinics. Simply put, more Medicare money is available to compensate physicians when they are in a hospital outpatient setting. This MedPAC report proposes an end to the added “facility fee” that drives the discrepancy by leveling reimbursements across the board in all settings. MedPAC recommendations are not binding, and Congress has the final say about Medicare reimbursements. But in Glaser’s opinion, “the days of additional facility fee payments are numbered.”
On Oct. 28, the American Association of Orthopaedic Surgeons joined other national and state physician organizations in signing a letter to Health and Human Services Secretary Kathleen Sebelius expressing “serious concerns” about a key part of the Physician Payments Sunshine Act. The more than 70 physician-organization signatories argued that medical textbooks, reprints of peer-reviewed scientific journal articles, and abstracts should be excluded from the restrictions because these items directly benefit patients, although they may not be intended for direct use by patients. The Oct. 28 letter, which was spearheaded by the AMA and the Massachusetts Medical Society, says that the decision by the Centers for Medicare & Medicaid Services to not include these educational materials as exclusions in the regulation is “contrary to both the statute and congressional intent and will potentially harm patient care by impeding ongoing efforts to improve the quality of care through timely medical education.” The letter goes on to say that these items are “essential tools” that doctors use to stay informed of the latest developments. The letter further states that including these items in the Sunshine Act reduces the focus on quality patient care.