Practice Management

Dermatologists still can thrive in small private practices - even in this healthcare environment, where bigger is arguably better.

When considering the best way to spend $100,000 on one’s practice, an expert who spoke at the Cosmetic Surgery Forum recommends a pragmatic approach.

Physicians have a lot on their mind these days and, of course, some of it stems from the tenuous concerns about healthcare reform at a time when they are so busy trying to manage their schedules they don’t have time to come up for air.

Smartphones are the newest distracter in the healthcare environment. A study of pediatric housestaff and faculty at a university-affiliated public teaching hospital noted that residents self reported missing a piece of clinical information in 19 percent of their cases and faculty in 12 percent of their cases due to distractions caused by smartphones.

Workplace violence not only compromises employee safety, it also has legal implications. In 1996, OSHA established federal guidelines for businesses implementing violence-prevention programs. The guidelines, although not mandatory, are often cited in workplace violence-related lawsuits.

When it comes to electronic health record (EHR) implementation, dermatology isn’t at the beginning - the naive stage - or at the end - where the technology is doing what it’s supposed to do. Dermatology is in what one might call the teenage years, an awkward, frustrating, but hopeful, time.

Successful social networking requires consistent messaging and a working grasp of how these media interconnect, says an expert who spoke at the Cosmetic Surgery Forum.

Even if a dermatologist has only a few minutes per visit to devote to patient education, taking a practical approach can boost the impact of these efforts, says Judith Hong, M.D., a third-year dermatology resident at the University of California, San Francisco.

To address a medical mistake or unsatisfactory outcome, Neil S. Prose, M.D., has a unique suggestion: “Imagine yourself on the opposite side of the table from the patient, with the problem in the middle. Then imagine what it would take to get on the same side of the table, working together.”

Dermatologists can provide value in the era of healthcare reform by realistically gauging the cost-effectiveness of many treatment strategies, according to an expert who spoke at the 71st annual meeting of the American Academy of Dermatology in Miami Beach, Fla.

A letter comes across your office fax machine indicating that your practice has been scheduled for an audit and site visit from the Centers for Medicare and Medicaid Services, a Medicare administrative contractor, or a zone program integrity contractor the next morning at 8 a.m. Sound far-fetched? This exact scenario is likely if your practice is scheduled for such a visit from the federal government or a government contractor. The timing is intended to give you little chance to prepare.

No matter how long you have been in practice, chances are you have encountered a toxic employee who poisoned the atmosphere of your workplace. If you don’t take action fast, such an employee can threaten your relationships with your patients and your staff, affecting your income in many ways.

E-prescribing has increased dramatically since 2008, according to a recent data brief from the Office of the National Coordinator (ONC) for Health Information Technology.

A patient has melanoma in situ removed from her face and develops sepsis. She sues her doctor, claiming he should have explained that infection could lead to sepsis and death. Was his warning about the risk of infection enough? What is he required to disclose during his informed consent with his patient?

Electronic prescribing (e-prescribing) increases patient safety, experts say. This tool not only eliminates interpretation errors from handwritten prescriptions, it creates a communications bridge between the physician, pharmacist and patient.

Federal regulators are more closely scrutinizing some dermatologic surgery codes, including those that are considered the “bread and butter” for skin cancer repairs. And codes that are deemed misvalued could be cut by as much as one-third by Medicare. Commercial carriers could follow suit.

Many dermatologists are either implementing or considering implementing electronic medical records systems (EMRs) in their practices. Having just done this for my practice, I wanted to share a few thoughts that may be helpful for those who decide to join the “paperless” ranks in the next year or so.

Patients find physicians more approachable when they are wearing “business casual” dress, according to the results of a patient questionnaire. Respondents still prefer the hallmark white coat, however.

In an ethical attempt to limit the numbered of required patient visits, Dr. Smith often will treat 20 to 30 solar keratoses in one visit. Dr. Smith has taken courses on proper coding and codes in a recognized, honest and ethical manner. Unfortunately, several of his carriers inform him that only 15 actinic keratoses can be treated at each visit, and only four such visits are allowed during a year for each patient.

Dermatologists have become extremely reluctant to participate in hospital activities such as evaluating in-patients as consultants, serving on hospital committees, and participating in educational activities in the hospital. the most troubling is our resistance to see patients at the hospital bedside. There are a number of apparently legitimate excuses for the failure of dermatologists to visit the hospital wards.

An online service based in western Pennsylvania aims to get more patient cases in front of dermatologists faster.

Less than 50 percent of dermatologists pursue written informed consent, and procedure type appears to heavily influence the practice, say researchers from Emory University.

Dermatologists can make small changes in their practices to improve the doctor-patient experience, according to Ranella Hirsch, M.D., a Boston dermatologist in private practice. By placing themselves in the position of the patient, physicians can evaluate the user experience and then make adjustments accordingly.

A patient’s experience has been shown to impact treatment adherence and outcome, says Charles Ellis, M.D., William B. Taylor professor and associate chairman, department of dermatology, University of Michigan Health System, Ann Arbor. Therefore, it’s in the patient’s best interest for dermatologists to measure patient satisfaction.

James A. Zalla, M.D., has affected the lives of countless patients during his 43 years of practice as a dermatologist and dermatopathologist. But what many dermatologists might not know is that Dr. Zalla has influenced their practices, too, by working for decades to help ensure fair payment for the specialty’s services.

You can take action to leverage social media in your practice without running afoul of HIPAA and hospital PHI policies.

At first, dermatologists seemed unlikely to be the subject of audits, but that is no longer the case. And it’s not only Medicare and Medicaid trying to recoup funds and find fraud - commercial carriers are as well. It’s a perfect storm for increasing medical audits at all types of physician practices - including dermatology.

Accurately billing for dermatopathology services requires understanding the nuances of current procedural technology (CPT) codes, says David A. Mehregan, M.D. For starters, global pathology charge codes encompass the basic duties of a dermatopathologist, from receiving specimens and processing tissue to making slides and rendering a diagnosis.

As dermatologists face growing pressure to maximize revenues while cutting costs, the appeal of patient loyalty programs and group purchasing organizations (GPOs) is growing, experts say. In both areas, however, they advise choosing carefully.

Documentation of your Evaluation and Management (E/M) service is one of the most challenging parts of the provider's day. It is, after all, one of the bread-and-butter services. Hopefully, many of you reading this are already on a quality electronic medical record (EMR) or getting prepared to transition to one soon.