Wednesday, October 31, 2012

A wonderful article on "Wildly successful medical practices" on Medscape


Why Some Practices Are Wildly Successful?


Here are some helpful tips from a fascinating article, the link to the entire article is provided at the end.

Introduction

Some practices struggle. Some bring in a reasonable income for the partners. And some --even in the current economic climate -- soar. They attract new patients and add new providers, and their revenues outpace those of their peers.
What's their secret? External factors can certainly contribute to a practice's success, and clinical excellence is a must-have foundation. But one of the keys to cultivating a wildly successful practice lies in understanding, accepting, and embracing the fact that a medical office, at its core, is a business.
We asked experts to describe what differentiates wildly successful practices from their peers. Here's their list of must-have qualities:

No Substitute for an Entrepreneurial Spirit

While some physicians focus on the uncertainties of healthcare reform, successful physicians look for opportunities.
"Successful physicians are often impatient," says David Zahaluk, MD, a Dallas, Texas-based family practice physician and author of The Ultimate Practice Building Book (Trafford Publishing, 2007). "They don't want to wait for organic growth, and they're positive."

Have a Strategy and a Plan

For too many practices, the plan for growth consists of little more than "doing the same thing over and over again and hoping to do more of it," says Dr. Zahaluk. "That won't achieve your ends. Seeing one more patient a day just means more energy, more man-hours."
Successful practices plan for long-term growth and have immediate and mid-range action plans that advance their longer-term objectives.

Visibility Is Imperative

Wildly successful practices know how to attract attention.
Some practices tout the expertise or specialized skills of individual physicians, who have name-recognition in their community. Others tap their social and professional networks to attract new patients. Still others differentiate themselves through effective advertising that highlights their unique offerings.

A World of Potential in Reliable Data

Rock-solid practices don't waste their time on guesswork. They depend on data.
They know when diabetic patients need to have their A1c checked. They know their charge volume and payer mix and how long it takes to get paid by a particular payer for a specific procedure. Success depends on "having the right data at the right time and trying to make the right decisions with it," says Scott Andrews. "If you don't, you can't and you won't."
A Patient-Centered Culture Makes a Difference
Of course, few tactics will work effectively if the practice doesn't keep patients happy. Word of mouth is still the strongest weapon in any marketing arsenal. That type of culture doesn't just happen; it's cultivated. Physicians hire with an eye for fit, ensuring that new doctors and staff share their goals and work ethic. 

Strong Leaders and an Outstanding Staff

Great practices have great leaders who set the direction for the practice, says Capko. That said, excellent leaders surround themselves with the right staff. A physician leader needs to have the office manager, support staff, and technological tools in place to effectively handle the day-to-day demands of running the business so that he or she can focus on clinical issues and the overall direction of the practice. Great physicians don't micromanage, because they know they've hired capable staff members and provided them with the training and education they need to help the practice excel. In a perfect scenario, a doctor is spending 95% of his time seeing patients, and the 5% of his time he spends on business is just monitoring and checking the state of the business. 

Willingness to Create Helpful Partners

Successful practices seek expert advice when they need it. 
Efficiency, Productivity, and Discipline
"Top-tier doctors know how to be efficient with their time," says Randy Bauman. "It's not that they're giving patients 2 minutes; it's that they're conscious of their time. They're doing simple things, such as not going in and out of the examination room more than once."
Effective practice management tools are essential to boosting efficiency, Dr. Wilhelm says, and the payoff extends beyond productivity. Because physicians and staff are using their time more efficiently, improved workflow creates a more professional, calm environment, which benefits staff and patients alike.
For the entire article I would recommend logging in to Medscape (free registration) & reading it here





Tuesday, October 30, 2012

Doctors Admit to Unprofessional Behavior in Study at 3 Chicago Hospitals


Working in a real hospital isn’t usually as dramatic as is portrayed in TV shows like Grey’s Anatomy orHouse, MD, but a new study has identified unprofessional behaviors to which hospital-based doctors most frequently admit, including badmouthing fellow doctors and finding medical excuses to get out of having to care for patients.
Two-thirds of doctors surveyed at three Chicago hospitals copped to having personal conversations, such as discussing evening plans, in earshot of patients, and 62 percent said they had mischaracterized a routine test as “urgent” to get it done faster. Four out of 10 said they mocked another physician to colleagues. The same number said they bad-mouthed emergency room doctors for missing part of a patient’s medical problems.
Three out of 10 said they made disparaging comments about a patient on rounds. Twenty-nine percent said they had attended a dinner or social event sponsored by a drug or medical device manufacturer or other business that stood to gain by a doctor’s decision.
The study, published in the Journal of Hospital Medicine, was based on the responses of 77 hospital-based doctors–known as hospitalists–from the University of Chicago Pritzker School of Medicine,Northwestern University Feinberg School of Medicine and NorthShore University HealthSystem.
Some of the unprofessional behaviors involved dumping work on someone else.  According to the study, 9  percent admitted that they had transferred a patient they could have taken care of to another in order to reduce their patient load. This practice is known as turfing, and 12 percent of physicians admitted they had “celebrated” a successful turf. Eight percent of doctors said they had blocked a patient, which means they refused to accept the patient into their unit by claiming the patient should be cared for in another part of the hospital. Twenty-one percent acknowledged celebrating a blocked admission.
The study noted that “participation in egregious behaviors, such as falsifying patient records (6.49%) and performing medical or surgical procedures on a patient beyond self-perceived level of skill (2.60%), was very low.” But more hospitalists reported seeing another doctor act unprofessionally than admitted they did so themselves. For instance, 68 percent said they had witnessed another doctor “blocking” a patient–eight times as many who admitted doing the blocking. And almost 20 percent of doctors said they had observed a patient being discharged before they were ready to go home, while only 2.6 percent admitted to doing that.
Dr.Vineet Arora, one of the authors of the study, said observations of unprofessional behavior can be wrong because doctors don’t “know the full context of the story” or because more than one doctor can report seeing the same incident, inflating the number. She said the study focused on rates of unprofessional actions that doctors admitted participating in, because those are more persuasive to the officials who put together trainings on professionalism for doctors and residents.
“The goal is to figure out what types of behaviors people are not in touch with, that come across as unprofessional,” she said. She said that since doctors may not admit to bad actions even in an anonymous survey, the real rates of some of the unprofessional actions may be somewhere between the number doctors admitted to doing and the number they claim they observed.
Commentary: I found this study fascinating in its definitions of possible "unethical behavior". It showed that most of us doctors are human too, and have our frailties and weaknesses. It also suggests that many a times we may be aware of the 'unethical' nature of our conduct, but may carry on regardless.
Looking at myself, I feel that I have probably done most of the above mentioned stuff at some point of my career, and continue doing some of this, specifically "attended a dinner or social event sponsored by a drug or medical device manufacturer or other business that stood to gain by a doctor’s decision" even now, along with most other private practitioners of our fraternity." I am not sure that I completely agree with this being unethical behavior though, since this is one of the more important ways to learn about new stuff in medicine, especially for doctors from non-academic background in India, and helps us network with other doctors too.

Friday, October 26, 2012

CDC - Prevnar13* and Pneumovax* (PSSV23) Recommendations Update


This message serves to inform you about the new ACIP recommendations to give PCV13 (Prevnar 13) to high-risk adults and includes reviews on existing PPSV23 (Pneumovax) recommendations for adults.
This overview is a must-see for every doctor, nurse, and health care provider who provides medical care to adults.
Healthcare providers should follow these overarching recommendations:
  • Adults 19 years of age or older with immunocompromising conditions, functional or anatomic asplenia, CSF leaks, or cochlear implants, and who have not previously received PCV13 or PPSV23, should receive a dose of PCV13 first followed by a dose of PPSV23 at least 8 weeks later. Subsequent doses of PPSV23 should follow current PPSV23 recommendations for high risk adults.
  • Adults 19 years of age or older with the aforementioned conditions (functional or anatomic asplenia, immunocompromising conditions, or those with CSF leaks or cochlear implants) who have previously received one or more doses of PPSV23 should be given a dose of PCV13 one or more years after the last PPSV23 dose was received. For those who require additional doses of PPSV23, the first such dose should be given no sooner than 8 weeks after PCV13 and at least 5 years since the most recent dose of PPSV23.
  • Those who received one or more doses of PPSV23 before age 65 years for any indication should receive another dose of the vaccine at age 65 years or older if at least 5 years have elapsed since their previous PPSV23 dose. If a dose of PPSV23 was received at age 65 years or later, no additional doses of PPSV23 are recommended.
  • PPSV23 recommendations remain the same for those 65 years and older and those who are immunocompetent with chronic medical conditions, such as diabetes or heart disease.
To learn more about pneumococcal disease and vaccines, visit the resources listed below.
Web Sites