Money Woes; Making Good Use of NPPs; Alert Fatigue

Stat: 27

The percentage of U.S. providers who said they have seen ROI with their EHR.

Source: A University of Michigan School of Public Health study of 49 community practices in a large EHR pilot program, published in Health Affairs.

Money Woes

"There are going to be things that the industry expects us to do, that providers and patients will expect us to do, that we simply will not be able to do."

National Coordinator for Health IT Farzad Mostashari, speaking to reporters at the HIMSS13 Conference in New Orleans on the effects of $3 million in sequester-fueled cuts to the ONC budget.

Future Uncertain

"The political, social, and healthcare impacts of the Affordable Care Act have yet to be fully determined because it all depends on how it's implemented."

President Bill Clinton, at the HIMSS13 Conference in New Orleans.

To Charge or Not To Charge?

Enrolling your patients in a patient portal is a win-win for physicians who want to improve efficiencies and patient engagement, and patients who want to easily view and download health information. But should your practice charge patients for using it? Providers are debating that as the adoption of portals grows. Forty-four percent of the nearly 1,300 respondents to our 2013 Technology Survey said their practice uses a patient portal, up from 29 percent one year earlier. While many physicians feel they should be paid for their time associated with portal use, others disagree. "We've never charged for phone calls, and this is just an extension of the phone calls," gynecologist Michael Salesin of Walnut Lake OB/GYN in West Bloomfield, Mich., told Physicians Practice. "We also get letters every day from people who thank us for it, and recommend our practice for it." For more, and to weigh in on the debate, visit http://bit.ly/portal_charge.

Making Good Use of NPPs

Many practices are hiring nurse practitioners and physician assistants. But most aren't quite sure how to optimize their skills and value, Cheryl Toth, a writer, speaker, and tech coach with Chicago-based Karen Zupko & Associates, Inc., recently noted in aPhysicians PracticePEARLS column. One way to maximize their skills: Collaborate with your nonphysician provider to decide on the visit types, conditions, and patients that are most appropriate for her schedule - then check your state's scope-of-practice rules to verify that she can legally deliver these services in your practice. For more tips, please visit http://bit.ly/5NPPtips.

Alert Fatigue

A recent survey of 2,590 primary-care practitioners from the Michael E. DeBakey Veterans Affairs Medical Center in Houston found that a third reported missing EHR alerts for patients' abnormal test results. In the study, appearing in the Journal of the American Medical Association, physicians reported getting an average of 63 alerts a day, which nearly 87 percent said was excessive. "If you're getting 100 e-mails a day, you are bound to miss a few," study author Hardeep Singh, MD, of the DeBakey VA Medical Center told TIME. One suggestion to ease information overload, noted by CBS News: Color code alerts to indicate importance.

Prejudiced Patients

Whether patients should get a choice in who cares for them is at the heart of two lawsuits lodged by two African American nurses at Hurley Medical Center. Their claims are against a Flint, Mich., hospital and a nursing manager for catering to a swastika-tattooed father who demanded only white practitioners care for his newborn, the Associated Press reported. The hospital reportedly posted a note on an assignment clipboard that read, "No African-American nurse to take care of baby." While honoring prejudicial preferences "isn't morally justifiable … there may be times when grudgingly acceding to a patient's strongly held preferences is morally OK," internal medicine physician Susan Goold, a University of Michigan professor of internal medicine and public health told the AP.

Wanted: Proof of Meaningful Use

You've attested for meaningful use. Do you have your supporting documentation ready for CMS to inspect? The agency made it clear during the HIMSS13 Conference in New Orleans that its goal is to make sure every payment to providers and hospitals is appropriate. Therefore, it is pre-auditing a sampling of providers who attested in January 2013, EHR Intelligence reported. These pre-payment audits follow a round of post-payment inquiries started in July of 2012. More than 2,000 post-payment audits are currently underway, some targeted due to flagged data, and others entirely random.

Anger Management

Doctors who feel pushed to the limit are now being advised to attend anger-management courses. While a recent Joint Commission report estimates that just 3 percent to 5 percent of physicians engage in aggressive behavior - such as berating nurses who call them in the middle of the night about a patient, flinging scalpels at trainees who aren't moving fast enough, and demeaning coworkers - "the ripple effect is profound," psychiatrist Charles Samenow, an assistant professor of psychiatry at George Washington University School of Medicine, who evaluates doctors with behavioral problems, told the Washington Post. Programs for anger management counseling, which is sometimes billed as "executive coaching," are flourishing at Vanderbilt, the University of Virginia, the University of California at San Diego, and George Washington University, the Post reported.

Career Influencers

Money and personality are two big factors in choosing the direction doctors take when embarking on their medical careers, but which factors carry the most weight? According to a survey of nearly 14,000 students by the Association of American Medical Colleges, 98 percent said personality fit and the content and fit of a specialty have a "strong" or "moderate" influence. Meanwhile, 47 percent of respondents said income expectations were a factor, and 27 percent listed educational debt as a big factor, American Medical News noted.

Code Cognizant

With the switch to ICD-10 happening in October 2014, how far along is your practice? About one out of three healthcare professionals in a February survey of 260 respondents by Aloft Group, a marketing firm, said their organization has not yet started the process of converting to ICD-10 code sets. Here are some other data points, as noted by iHealthBeat:

• 41 percent of healthcare professionals said their organization has completed about 25 percent of the ICD-10 implementation process;

 • 19 percent said their organization has completed about 50 percent of the ICD-10 implementation process; and

• Only about 1 percent of respondents said their organization has completed 90 percent or more of the ICD-10 implementation process.

This article originally appeared in the May 2013 issue of Physicians Practice.