Practice Management

Maximizing practice efficiency requires analyzing personnel utilization, practice operations, systems and technology and real estate, says Jonathan S. Weiss, M.D.

The recent release of the Centers for Medicare and Medicaid Services Final Rule for Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program gives dermatologists a clear view of where the government initiative is steering you - and your patients. What lies ahead - eventually, even for those not participating in the program - is a new world of electronically connected practices and patients.

These days, dermatologists have a lot to consider. Take, for example, the complexities surrounding implementation of electronic health records, as well as the looming and potentially drastic changes planned for healthcare delivery and reimbursement. So why would any dermatologist want to add learning leadership skills to their list of things to do?

A disgruntled employee went on Facebook and described a salary disagreement with his boss, Dr. Labor. Dr. Labor found out about this and promptly fired the employee for violating an office policy on not discussing office-related issues on social media. The now-former employee filed a lawsuit against him with the National Labor Relations Board (NLRB) alleging that his former boss violated his First Amendment rights.

Dermatologist Joe Psoriasis is known throughout the country as an expert in the treatment of psoriasis. An inherent risk of treating such challenging patients is the higher risk of medical malpractice lawsuits. Dr. Psoriasis has now had five such lawsuits filed against him. He is contemplating discontinuing this portion of his practice. Will the HEALTH Act of 2011 provide him with more protection from such lawsuits?

Barbara Mathes, M.D., started her healthcare career as an emergency room nurse. She remembers answering medical residents' questions, and the residents would tell her she might as well go into medicine. Her reply? "One day I think I will." So started a multifaceted professional life in dermatology, which has included private practice, teaching, industry work, research and more.

For the first time in my life, I had the experience of being on the other side of the doctor-patient relationship. I would not recommend it to anyone, but I learned a lot of valuable lessons about medical care, some of which have direct relevance to the way we all should be practicing medicine.

After the U.S. Supreme Court of the United States upheld the constitutionality of the 2010 Patient Protection and Affordable Care Act (ACA), including the individual mandate requiring all Americans to purchase health insurance, a number of professional medical organizations reiterated concern about potential effects of the law.

When it comes to newer healthcare delivery models, experts say accountable care organizations (ACOs) may impact dermatology only in highly competitive markets. Still, dermatologists worry that ACOs could set primary care physicians (PCPs) and specialists at odds, and that specialists' roles in shared-savings programs remain highly uncertain in today's healthcare arena.

Billing CPT codes that start with "17" - the destruction codes - remain a source of confusion for both billers and providers. Destruction means that you are destroying lesions using one of several methods. The most common methods in dermatology include liquid nitrogen, electrodessication and curettage, laser and the use of chemicals. Below is a snapshot summary of the destruction codes.

Dermatology has a committed ambassador in Capitol Hill, but it's tragic as to why. Rep. Brian Bilbray (R-Calif.) and his youngest daughter, Briana, both have been diagnosed with skin cancer and are speaking out about it to encourage others to prevent and detect skin cancer early. The congressman has co-sponsored the Melanoma Research Act of 2012, which would provide funding for skin cancer research.

A dermatology practice is a hotbed of activity. In addition to the clinical care you provide, there is staff to manage in carrying out your orders, supplies to use, bills to be sent and money to be tracked. The complexity of a practice makes outsourcing - using outside firms to handle work you would normally perform in-house - appear quite appealing.

When working with the media, dermatologists should build their presentations around a key message that helps to focus the audience’s attention, says Patricia K Farris, M.D.

If you're feeling sullen after meeting with your business office staff to mull over the challenges of collecting from patients, maybe it's time to explore opportunities to integrate credit card transactions into your collections process.

Achieving meaningful use and avoiding common mistakes in implementing an electronic health record (EHR) system require careful planning and learning from others' experiences, said Michael Doyle, chairman of Medsphere Systems Corporation, at the 70th annual meeting of the American Academy of Dermatology.

Physicians' relationships with industry have long been an ethical tug of war, yet they remain commonplace. And with government's increasing focus on transparency - augmented with the U.S. Supreme Court upholding of the Patient Protection and Affordable Care Act - consulting, research and other relationships with pharmaceutical and medical device companies will become even more visible.

Recently, Northwestern University Feinberg School of Medicine surveyed their third- and fourth-year residents and found that even though it is not on the official curriculum, the residents are learning defensive medicine. Whether it's an attending mentioning that a particular biopsy isn't necessary or deciding not to offer a patient a particular medication because it of a potential lawsuit, the residents are seeing defensive medicine in practice.

Dermatologists who strongly oppose key provisions of the Patient Protection and Affordable Care Act (ACA), upheld by the U.S. Supreme Court in late June, continue to turn their attention to Congress in the hopes of obtaining some relief.

Social media allow for efficient networking with patients and colleagues, but using these tools successfully with patients requires setting limits and delegating authority.

We medical professionals are confronted with our own assortment of believe-it-or-nots and oddities on a daily basis. Unfortunately, they are often more upsetting or frustrating than astounding. I started keeping a list a few years ago, initially as a coping mechanism. But gradually, the list evolved into a collection.

Dr. Skin hired several people to improve the marketing of his practice. In order to make things simple, he provided them with all of his patients' records to allow them easy access to patient demographic information. Dr. Skin is assured by colleagues that although the involved activity may represent a HIPAA violation, no penalties have been assessed to small practices such as his. Is this true?

Social media consulting firm Maximize Social Media has launched a specialized marketing program that provides support to dermatology practices in need of social media management and local business listing optimization services.

As drug costs and medicolegal scrutiny increase, the future of many drugs appears murky, said Stephen E. Wolverton, M.D., at the 70th annual meeting of the American Academy of Dermatology.

Dermatologists have the highest level of job satisfaction of 25 medical specialties, according to a national survey conducted by Medscape titled Physician Compensation Report 2012. Dermatologists also are among the better compensated, particularly when their more-varied pattern of hours worked are taken into consideration.

I can't tell you how many wonderful things I've heard from medical administrators and non-physician consultants that will result from the adoption of the electronic medical record (EMR). But like most of us, I've been taught to believe that if something sounds too good to be true, it probably is.