Survey: EHR use cuts into patient time, likely reducing revenue in small practices

Researchers studied the impact of EHRs on small physician practices, according to Perspectives in Health Information Management.

Henry Mayo Newhall Hospital's spine education classes prepare patients for surgery: 5 notes

Here are five notes:

1. Henry Mayo Newhall Hospital’s neurosurgeons and spine surgeons require their patients take the classes.

2. A joint and spine clinical nurse navigator teaches the classes, which offer insight into pre-surgery all the way through recovery.

3. Specifically, patients learn about the following topics, among others:

• Surgery details
• Rehabilitation
• Precautions following surgery
• Pain management
• Wound care
• Surgical infection prevention

4. The classes include a Q&A session as well as implant model demonstrations.

5. Upon class completion, patients receive a lesson guidebook, a wash kit for pre-surgery and a spine surgery clinical pathway.

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Creating a digitized patient experience

The healthcare industry boasts a plethora of technology, but are organizations fully integrating it to benefit patients across the care continuum?

John Tiberi, MD, an orthopedic surgeon at Los Angeles-based Kerlan-Jobe Orthopaedic Clinic, believes the industry can find more avenues to incorporate technology.

“If we’re not looking for ways to improve, we’re doing ourselves and our patients a disservice,” says Dr. Tiberi.

Although physicians tend to adopt technology rather slowly, Dr. Tiberi recommends diving headfirst into implementation if a practice vets the technology and believes in it.

“Integration of technology into our practices is something that is helpful and important, but once you decide to do it, you need to be fully invested in it,” he says, or else the practice may lose out on the technology’s key benefits.

A digitized patient experience has the potential to create engaged patients who are more satisfied with their care. Based on Dr. Tiberi’s experience, patients are much more likely to engage with their care via a technological platform as opposed to paper information packets.

“One episode or interaction with the patient is unfortunately a very minimal benefit,” says Dr. Tiberi. “Whereas, if you engage someone on a daily basis, it’s going to go a lot further.”

San Francisco-based PeerWell represents a technology that offers patients manageable bouts of information on a regular basis. In 2016, Dr. Tiberi implemented PeerWell, an electronic system accessed via a smartphone, tablet or computer, designed to engage patients before undergoing surgery.

“I’ve been blown away by how many people have given me unsolicited feedback about how much they liked [PeerWell,],” he says. “I really believe it’s improving satisfaction, which is critical for patient-reported outcomes for these surgeries.”

Patient engagement platforms offer an avenue for patients to share information and build a higher quality of care experience for themselves.

“If a patient shows up to have something done without putting much thought into it, their outcomes can be very different from somebody who has,” Dr. Tiberi says.

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Innovative ideas for orthopedists to consider: Key thoughts from Somerset CPAs' Mike McCaslin

Orthopedic-driven ASCs are thriving and offering surgeons promising futures in private practice.

Indianapolis-based Somerset CPAs Principal Mike McCaslin spoke about exciting developments in ideas related to orthopedics today.

Mr. McCaslin is speaking on a panel titled “The Best Ideas for Orthopedics Now” at the Becker’s 15th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine, June 22 to 24, 2017 in Chicago. Click here to learn more and register.

Q: Which orthopedic developments offer the most promise for today’s surgeons?

Mike McCaslin: There are a number of developments that offer promise for today’s surgeons. Commercial bundled payments offer surgeons the opportunity to manage the care delivery process from beginning to end taking some risk but creating the opportunity for improvements in care at a lower cost of care. The surgeon takes the entire bundled payment and then out of this amount pays for the balance of care required. For those physicians whose groups own most of the care deliver assets required (ASC, PT, MRI, DME, etc.) then the risk in managing the bundle is mitigated substantially. For those who do not own the cadre of assets required they will need to sharpen their negotiating skills with outside entities to arrive at an acceptable rate to pay for the care needed by their patients.

The rapid transition of care from inpatient settings to outpatient settings obviously favors those surgeons and groups who own their own surgery centers. This transition will continue and certainly we all need to keep an eye on CMS to see when they loosen the strings on Medicare patients.

The use of extenders (physician assistants and nurse practitioners) to create more access for patients through walk-in clinics and extended hour/urgent care clinics has enabled the orthopedic surgeon and group to capture more patient volume and using a lower cost setting of care for this patient capture.  The extended-hour/urgent care clinics keep the patient out of the emergency room and have the patient gaining immediate access to orthopedic specialty care so the right test and right diagnosis are received immediately.

Q: How can independent orthopedic surgeons remain in private practice?

MM: I think they need to be able to do the items noted above. In addition good partnerships with the local hospital (two-way partnerships and not one-sided partnerships) for those surgeons who cannot own the assets noted above will be important for both the surgeon and the hospital. An intense focus on the right care by the right provider in the right facility at the right cost is essential for sustainable success.

Q: What are the smartest orthopedic surgeons doing today to set themselves up for success in the future?

MM: In addition to the items noted in No. 1 above (which is the primary focus) many surgeons and groups are discussing destination orthopedic hospitals to manage the volume that will continue to require inpatient settings. Attached to this inpatient facility is the outpatient ASC, the physicians’ medical office building housing the group and the cadre of freestanding services (PT, MRI, DME, skilled nursing) to create the comprehensive campus and destination facilities. In today’s environment, these can only be owned by an existing hospital but there are opportunities available to the surgeon to manage the operations, own the real estate and lease to the hospital and to negotiate a purchase option for the inpatient operations if the prohibition on physician ownership is ever repealed.

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Race & ethnicity's impact on physician income — 5 insights

Here are five things to know:

1. White/Caucasian physicians earn the most annually at $303,000.

2. Asian physicians earned the second most at $283,000.

3. Hispanic/Latino physicians followed with an annual income of $271,000.

4. Black/African American physicians earned the least at $262,000.

5. Specialization choice varies based on race:

  • 80 percent of white/Caucasian physicians opted to specialize
  • 75 percent of Asian physicians opted to specialize
  • 72 percent of Hispanic/Latino physicians opted to specialize
  • 70 percent of black/African American physicians opted to specialize

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Medscape: Self-employed specialists earn 28% more than employed peers

The survey inquired about annual earnings for employed versus self-employed physicians. Of all surveyed physicians, employed physicians earn an average of $269,000 compared to $343,000 for self-employed physicians.

Primary Care

• Employed: $214,000
• Self-employed: $223,000


• Employed: $287,000
• Self-employed: $368,000

While self-employed primary care physicians make 4 percent more than their employed counterparts, self-employed specialists see a significant 28 percent jump in earnings compared to employed specialists.

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Are physicians satisfied with their career choice? 6 AMA survey insights

The American Medical Association conducted a February 2017 survey asking 1,200 physicians, residents and medical students about their experiences, perceptions and challenges in the evolving healthcare space.

Here are six takeaways:

1. Nine out of 10 physicians reported they are satisfied with their career choice.

2. Of the respondents, three-quarters said helping people was their top motivator for going down this career path.

3. Sixty-one percent of those surveyed reported they could encourage other people to pursue medical careers.

4. Of the respondents, 73 percent noted they knew they wanted to become physicians before they turned 20 years old. One-third of respondents knew before they were teenagers.

5. Administrative burden, stress and lack of time ranked as the top three challenges physicians said they faced.

6. Residents noted long hours and on-call schedules ranked among their top challenges.

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5 thoughts on why value based care will survive partisanship over healthcare

While the ACA encouraged the transition toward value-based care, the value movement in healthcare is non-partisan, according to a URAC blog report.

Here are five key notes from the report:

1. Although there is a different administration in Washington and the Republican Congress focused making changes to healthcare, members on both sides of the aisle support value-based care. “Changes will likely be around the margins and underneath will be continued pursuit of care that’s delivered at lower cost at equal or better quality,” said Don Crane, president and CEO of an association representing physician organizations participating in capitated, coordinated care.

2. Hospitals and physicians are moving from fragmented to coordinated care, and that trend is likely to continue.

3. Cost transparency and consumer choice helps define value. “When you come down to actually providing healthcare and the choices the consumer makes and the demands with the system, there’s a cost to it,” said Michael Hunt, MD, CMO/CMIO of St. Vincent’s health Partners in Bridgeport, Conn. “We’ve not really had a very good national conversation on the value of healthcare and what it costs to deliver it.

4. The Medicare Advantage Value-Based Insurance Design Model piloted in several states has reduced costs for enrollees participating in disease management and medication adherence.

5. The movement toward value-based care opens the door for other healthcare provider models, including clinical integration and telehealth.

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Novant Health donates $10k+ to Operation Walk Carolinas — 5 takeaways

Charlotte, N.C.-based Novant Health donated $10,000 in cash and an additional $10,000 in supplies to Charlotte-based Operation Walk Carolinas to help the medical team offer high-quality orthopedic care to people in Cuba.

Here’s what you need to know:

1. Funds from the Novant Health Foundation and Novant Health’s employee giving campaign “Giving. Serving. Together.” make up the $10,000 cash gift.

2. Novant Health employees raised money through four bake sales and individual donations and Novant Health Foundation chipped in, as well. Novant Health then ordered an additional $10,000-worth of supplies and shipped them to Cuba for the May trip.

3. Novant Charlotte Orthopedic Hospital Vice President Jason Bernd said, “Our hospital is excited to be able to partner with this outstanding mission-oriented organization to provide specialty orthopedic care to this underserved population.”

4. Nearly 40 surgeons, internists, physical therapists and other specialists plan to travel to Cuba with Operation Walk Carolinas in May to provide care for Cuban people lacking high-quality orthopedic services.

5. Operation Walk Carolinas was founded by Charlotte, N.C.-based OrthoCarolina orthopedic surgeons Bryan Springer, MD, and Walter Beaver, MD, and is made up of members of OrthoCarolina, Charlotte-based Novant Health and Charlotte-based Carolinas Healthcare System.

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