Study: Self-referral for advanced imaging is common

The Center for Studying Health System Change (HSC) of Washington, DC, said its study is unique in focusing broadly on ownership of advanced imaging equipment rather than on specific healthcare services. The data indicate that policymakers may want to reconsider the in-office exemption to the Stark anti-self-referral law, which enables nonradiologist physicians to own and operate imaging equipment in their offices.


HSC researchers asked physicians whether they owned or leased medical equipment as part of its 2008 Health Physician Tracking Survey, a mail survey of U.S. physicians working at least 20 hours per week in direct patient care. The survey sample was limited to 2,750 physicians practicing in community-based, physician-owned settings. Physicians who practiced in hospital-based settings or who were employed by hospitals were excluded.
They reported ownership of medical equipment by the type of devices being used, as well as according to physician practice size and specialty. Among the survey's findings:
Among all physicians, one in six respondents (17.4%) reported that they owned or leased advanced imaging equipment.
For basic x-ray equipment, 22.7% of all physicians reported owning or leasing equipmentOwnership of advanced imaging equipment was highest among surgical specialists: 30.3% reported owning equipment. That compares to 15.7% of procedure-based medical specialists such as cardiologists, 13.5% of nonprocedure-based medical specialists such as neurologists, and 10.6% of adult primary care physicians.
Ownership varied by the size of the physician practice, from a high of 52.9% of groups larger than 51 physicians owning advanced imaging equipment, to a low of 6.7% for solo practitioners.
The report went on to note that Congress and the U.S. Centers for Medicare and Medicaid Services (CMS) have made physician ownership of advanced imaging less attractive by cutting Medicare reimbursement. Also, the healthcare reform law passed earlier in 2010 includes provisions that as of January 1, 2011, will require self-referring physicians to disclose their financial interests to patients and to provide them with a list of alternative service providers.
"Given the growing evidence that physician self-referral contributes to unnecessary and costly care, policymakers might reconsider the broadness of the in-office ancillary service exemption to the Stark law," the report states. "Ultimately, moving away from fee-for-service payment toward payment mechanisms that reimburse physicians for a broader unit of service, such as an episode of care, or putting physicians at least partially at risk for the cost of care will alter the financial incentives that now encourage physician self-referrals."


By : Brian Casey

Physician Time Should Be Considered A Resource

This is especially true for primary care physicians who set as their goal the delivery and coordination of comprehensive care for patients. Achieving such a goal requires availability, a broad spectrum of medical knowledge, effective use of the local health care system, and attention to both the “big picture” and the details of a patient’s life and health. And, above all of this is the management of your daily patient schedule.

The physician’s time has never been looked upon as a resource more so as in the modern times. There has been relatively little study of physician time as a resource. Yet both as a contribution to health care costs and as a key element in patient-doctor relationships, there is reason to believe that it deserves more attention. Furthermore, with an increasing emphasis on value and efficiency in health care delivery, quality time between the physician and patient is an increasingly valuable resource.

Time is relative


The physician must keep in mind that like for everyone else time is finite and they do need to make the best use of it. If the physician wants to utilize the time well, then they must have a set time schedule in place and must follow it to the best of their ability. In between these time schedules they must keep a time gap for buffer of about 5 minutes. This will give them the requisite breathing space and if time overflows for a patient they can still stick to the overall schedule.
I certainly understand how just one event in the office can put a provider behind by a half hour or even an hour.

Your day just became more intense

For example, a patient comes in with a chief complaint of “chest pain”. However slight this may be, there is the usual need to work-up this complaint and decide whether it is cardiac or non cardiac.
This changes the flavor of the visit and can make a regular fifteen minute appointment change into an hour of identifying the problem, getting testing from an ECG to a chest x-ray and even a call to your friendly cardiologist to see if he/she can see the patient to evaluate them.
In some instances you may need to transport the patient to the hospital by ambulance and that will take time to call EMS to come to your office and pick up the patient and take them to the emergency room.
All this takes time and your face-to-face time to care for the patient and an hour slips by fast. When this is all done and you get to start again, you are behind for the whole day trying to get caught up.
.It is quite interesting to note that the amount of time that the patient spends with the doctor varies from country to country. In the US and Sweden it is up to 20 minutes and in the UK it is about 10 minutes.

Try to stay focused

A physician with experience will be able to maintain the schedule far better than one who has a less direct approach to managing the chief complaint, as they will be able to elicit the responses by the patient better by asking pertinent and relevant questions. On the other hand, those physicians who weren’t able to communicate appropriately are the ones who fall behind in the patient schedule.
Therefore, time management and training the ancillary staff to manage patient flow is a crucial component for a physician in order to be able to stick to the time and schedule that has been chalked out beforehand. Multi-tasking many rooms in the office is also a key component if you are to keep the patients flowing and the day running smoother.

 
by : Adam Alper
Medical Biling and Coding For Physicians