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2007 Medical Economics Exclusive Survey Exclusive Survey—Malpractice premiums: Starting to level off Rates in many places may have stabilized or even dropped, but no one is celebrating just yet. Exclusive Survey—Expenses: Rising costs hit all physicians Our survey will help you gauge whether your practice expenses are right on target or need a trim. Exclusive Survey—Capitation: Still a factor for some A sizeable minority of primary care physicians still have some prepaid business, and many of them are doing fine. 2007 Survey Methodology Exclusive Survey: Earnings: Group practices pay better Primary care soloists earn less than other doctors, but they're in no hurry to consolidate. Exclusive Survey: Productivity: Sinking reimbursement, harder work Many of your colleagues in primary care are working long hours to keep their incomes up.  MORE ARTICLES Americans with Disabilities Act Q&As Accommodating disabled patients The second-floor office where I'd like to set up my internal medicine practice is not accessible to patients in wheelchairs. However, if I need to see any wheelchair-bound patients, another physician in the building has offered to let me use his office downstairs. Would this arrangement satisfy ADA regulations? Also, what changes will I have to make to the restrooms to accommodate handicapped patients? When a deaf patient demands an interpreter One of my deaf patients is capable of communicating with me in writing or by typing on a computer. However, she insists on having a sign-language interpreter present when she comes to the office. Does the Americans with Disabilities Act oblige me to provide one? Can you fire a staffer on disability leave? My office manager has been on disability for three months. During that time, my other four employees have taken over her tasks, and we're doing quite well without her. Can I eliminate her position?  MORE ARTICLES Antitrust rules Q&As Physician unionization Can physicians who are employed by a hospital to cover the ED form a labor union? Antitrust rules affect mergers My three-doctor cardiology practice is considering a merger with one of the three other cardiology groups in our community. Would this violate antitrust rules?  MORE ARTICLES Business Law: Buy/Sell Agreements Q&As When a medical group practice partner retires A senior partner has announced his plan to retire from our single-specialty group practice. We have a buy-out in place and expect his departure will be amicable. However, we have no experience with managing the details of a doctor's departure. For example, when should he tell his patients and referring doctors that he's leaving? What else do we need to do? A mediator or an attorney? Both my partner-to-be and I agree that the buy-in agreement we signed years ago needs to be renegotiated. But we disagree on some issues. Should we hire a mediator to help us hammer out a new contract, or should we each hire our own attorney? Nailing down the terms of a practice sale I plan to recruit an associate who would buy my practice when I retire in a few years. I'd like to start cutting back my work schedule as soon as he's comfortable. When we draft the buy-sell agreement, what provisions should I include to protect my interests? What happens if a partner dies I'm forming a practice with two other doctors. If one of us dies, does his ownership interest pass to his estate? Should the remaining partners be required to buy his share? What should our contract say about transferring ownership in the event of death? Could a contract clause spoil your retirement plan My younger associate, whom I assumed would succeed me, told me that he intends to resign. He says our buy-sell agreement obligates me to purchase his shares. I plan to retire next year, and this will upset my plans. What should I do? Time to rethink this buy-out agreement According to our small group practice's buy-sell agreement, part of the payout upon termination is return of capital invested. How does the practice provide for the payout without hurting the remaining doctors? Can out-of-state docs bankroll your practice? I want to start my own practice, but I can't get a loan from the bank because I have so much debt already. I have several private investors lined up, though--physicians licensed in another state--who would like to be shareholders in the professional corporation I'd set up. Is this legal?  MORE ARTICLES Business Law: General U.S. Court in Arkansas rejects cardiology practice's antitrust action against hospital, insurer The U.S. District Court for the Eastern District of Arkansas dismissed an antitrust action brought by the Little Rock Cardiology Clinic against Baptist Health and Arkansas Blue Cross and Blue Shield. Collections If a patient receives insurance checks directly, cashes them, and refuses to pay the physician, aside from sending that patient to collection, might criminal charges also apply, and on what grounds? ER Compensation My hospital has recently started paying certain specialists to take ER calls. Other specialists continue to be required to take ER calls as a condition of medical staff privileges. Is this legal to force some physicians to take uncompensated ER coverage while others are being paid by the hospital? Debt collection Is it okay to set up an in-office collection process for past due patient balances using a form letter that looks similar to a collection agencies letter? I have seen other office send these out. The letter usually has a letterhead that indicates something like "The Collection Center," and goes on to advise the patients that they have X number of days to pay their balance or further collection measures will be taken. Charging no-shows a fee I just read the article on no-shows by Dr. Eric Shore (June 6, 2008 issue). I share his concern regarding physicians’ liability when patients neither arrive for their appointment nor cancel. There is an added expense for physicians to follow up on these unreliable patients. What are the legalities of charging no-shows a fee, and what is Medicare’s stance on this? S corp, C corp, LLC, LLP—which is best? Whether you're setting up a new practice or re-evaluating an existing one, here's help in sorting through your options.  MORE ARTICLES Clinical Laboratory Improvement Amendments (CLIA) Adding Ancillaries: Waived lab services This is the ninth in a series of articles on specific ancillary services that can boost your bottom line and keep you and your practice busy in a competitive market. A Physician's Guide to CLIA rules Here's what you need to know to keep your office lab functioning smoothly  MORE ARTICLES Coping with tough markets Viewpoint: Time to consider a financial adviser? Right about now, wealth management feels a lot more like damage control. Coping with tough markets: Doctors battle a health plan monopoly In the Philadelphia area, physicians face the double whammy of high costs and rock-bottom reimbursements. Coping with tough markets: Doctors struggle with staying independent With hospitals in rural North Carolina heavily recruiting, physicians face the hard choice of whether or not to sell their practices.  MORE ARTICLES Debt Management Debt Management: Get out from under If managing your finances is still an uphill climb, read our tips—before it's too late. Debt Management: Will your credit card zap you? Choosing the wrong ones can drive up your borrowing costs. Here's what to watch out for. Debt Management: The right way to shop for a mortgage The wrong loan can burden you for years. Don't contact a lender until you read this guide.  MORE ARTICLES Doctors' Legal Forum Federal court sides with physician in hospital suspension A physician whose clinical privileges at a hospital were suspended without notice or an opportunity to be heard was deprived of constitutional due process, a federal court in Nevada held April 8. Circuit court sides with health insurer in physician reimbursement dispute The Eighth Circuit affirmed March 5 the dismissal of a claim that an insurer violated the Racketeer Influenced and Corrupt Organizations Act by mailing erroneous explanation of benefits forms that improperly denied, reduced, or delayed payments to a physician for the healthcare services he provided to plan members. U.S. Court allows ob/gyn to retaliate against hospital for suspension A federal court in Michigan denied a hospital summary judgment on a physician?s retaliation claim under the Emergency Medical Treatment and Labor Act (EMTALA) that it summarily suspended his privileges after he argued against transferring a patient he believed was in labor. Appeals court faults health insurer for ignoring authorization requests The Florida District Court of Appeal, First District, found February 27 that an insurance carrier forfeits its right under state law to contest the medical necessity of a request for authorization for referral for medical treatment if the carrier fails to respond to the request. Texas high court says liability cap applies to physicians, not insurers A divided Texas Supreme Court found March 6 that an exception to the state's malpractice damages cap that allows further recovery when a liability insurer negligently fails to settle claims, applies only to insurers and does not apply to physicians. U.S. Supreme Court declines to review practice price-fixing case The U.S. Supreme Court declined to review February 23 a Fifth Circuit decision upholding the Federal Trade Commission's finding that North Texas Specialty Physicians illegally fixed prices in its negotiations with payors and its conduct was unrelated to procompetitive efficiencies. Pennsylvania high court rules time-limit unexpired in malpractice claim The Pennsylvania Supreme Court reversed February 19 the grant of summary judgment in favor of a physician who alleged the medical malpractice action against him was time-barred under the two-year statute of limitations. Virginia Supreme Court reverses dismissal of wrongful death suit against pediatrics group The Virginia Supreme Court reversed January 16 a lower court's ruling, finding that a wrongful death plaintiff's medical expert was qualified to testify under the relevant statute. Texas health system settles allegations that it blocked insurers from contracting with competitors Memorial Hermann Healthcare System has settled allegations it engaged in practices that discouraged health insurers from entering into contracts with certain competing hospitals in violation of state antitrust laws, Texas Attorney General Greg Abbott announced January 26.  MORE ARTICLES Employment Law: Contracts Your employment contract As you prepare to start a new job, read your employment contract carefully, make sure you understand all of its provisions, and, if necessary, let a lawyer have a peek. Before you sign... Look out for employment contract snags Be careful, because the terms of this agreement can have a profound impact on your career. When a noncompete isn't ironclad They're tough to break, but two Indiana doctors showed one way to do it. There are other ways that could work, too. The end of restrictive covenants? A state supreme court rules that "noncompete" clauses violate public policy by limiting patient access to medical care. No contract? No good! Leaving things to chance can spell disaster for your practice, the author says. When a salary guarantee expires This "base compensation" model provides built-in incentives for new physicians, and protects the group if they don't produce. Finding a Job Step 4: Weighing offers Before you sign an employment agreement, do your homework, talk with your advisers, then decide which offer you can't refuse. A win-win alternative to noncompete clauses For both groups and their employed doctors, there's now a fair and legal alternative to restrictive covenants.  MORE ARTICLES Employment Law: Discrimination Employed doctors: Know your rights Group practices may unwittingly violate their employees' civil rights. Here's what you need to know to be treated fairly at work. Harassment: When you're the victim Thanks to laws that protect against abuse, there's no need to suffer in silence. Here's how to fight back. A Physician's Guide to antidiscrimination law Federal EEOC requirements—and their local equivalents—govern hiring, firing, and everything in between.  MORE ARTICLES Employment Law: General Before you sign... Employed doctors: Know your rights Group practices may unwittingly violate their employees' civil rights. Here's what you need to know to be treated fairly at work. Personnel files: Documentation is key Whether your practice is large or small, you should follow certain steps to avoid potential trouble. Do doctors need employment practices liability insurance (EPLI)? Does our four-doctor group need employment practices liability insurance to protect us against employment and workplace claims, such as sexual harassment suits? Practice Pointers: What goes into an employee handbook By clearly outlining benefits, duties, and responsibilities, it can improve your staffers' performance and prevent lawsuits. A Physician's Guide to wage-and-hour law Exempt and nonexempt employment status has little to do with job titles, and a great deal to do with workers' level of responsibility. Practice Pointers: Should you give references? Letters of recommendation about former employees can put you in legal hot water—unless you follow these guidelines.  MORE ARTICLES Employment Law: Hiring / firing Before you sign... Practice Pointers: Checking out job applicants Here's how to conduct a thorough background investigation before hiring a new staffer. Clip and Copy: Doing a reference check When you phone a job applicant's former employer, here's what to ask. Practice Pointers: Should you give references? Letters of recommendation about former employees can put you in legal hot water—unless you follow these guidelines. Practice Pointers: When it's time to give an employee the boot Employees who break the rules, won't learn, or spread dissension don't belong in your practice. Here's how to cut them loose.  MORE ARTICLES Health Information Technology: Computers First telehealth provider launches on the Google Health platform Users of Google Health who have scheduled telehealth consultations with physicians or mental health therapists via MDLiveCare will be able to share medical records with their doctors before the appointments and receive records from the doctors after the appointments, thanks to a new collaboration between the two companies. Electronic prescribing increasing in popularity More than 140,000 (23 percent) of all office-based physicians, nurse practitioners, and physician assistants in the U.S. are now using electronic prescribing, according to Surescripts. At the current pace, the company projects, the total number of health care professionals prescribing medication electronically via its network this year will more than double from the 74,000 active electronic prescribers who used it at the end of last year. Study shows medical home model increases quality of care A one-year evaluation study from the Group Health Cooperatives demonstrates that a medical home model in conjunction with health information technology could solve the nation's primary care physician shortage. MGMA calls for EHR data for PQRI The Medical Group Management Association is asking the Centers for Medicare and Medicaid Services to hasten the reporting of electronic health record data for the Physician Quality Reporting Initiative P4P program, according to a letter from the organization. CMS gives guidance on Medicaid incentive payments for EHRs In order to encourage providers to adopt EHR technology, the Centers for Medicare and Medicaid Services has informed state Medicaid directors that the federal government will reimburse states for 100 percent of incentive payments made to healthcare providers showing "meaningful use" of electronic health records. ONC clarifies extension center grant program The Office of the National Coordinator for Health Information Technology has published more information on its $598 million grant program to go towards 70 Health Information Technology Regional Extension Centers. Hospital group opposes 'meaningful use' quality improvement targets The Federation of American Hospitals sent a letter to federal health IT officials asking them to drop "meaningful use" proposals that would require healthcare providers to meet quality improvement targets in order to qualify for federal incentive payments. Federal government sponsors EHR-support offices The U.S. Department of Health and Human Services announced in late August plans to award $598 million in grants to open as many as 70 regional offices next year to help practices adopt electronic health record systems. Survey shows technology, mobility vital to future physicians Medical students view electronic-health-record technology as an important component of their medical education and a critical factor when choosing where they will practice medicine, according to results of a recent survey.  MORE ARTICLES Health Information Technology: E-Prescribing Survey reveals attitudes about health-care information technology Health-care information technology (HIT) has the potential to cut costs, increase access and improve quality in the U.S. health care system, according to results of a Harris Interactive survey of a nationwide sample of 2,200 adults aged at least 18 years commissioned by the Career College Association and TechAmerica. Electronic prescribing increasing in popularity More than 140,000 (23 percent) of all office-based physicians, nurse practitioners, and physician assistants in the U.S. are now using electronic prescribing, according to Surescripts. At the current pace, the company projects, the total number of health care professionals prescribing medication electronically via its network this year will more than double from the 74,000 active electronic prescribers who used it at the end of last year. HHS announces HIT Extension Program funding plan Details of a $694-million program that will create a national extension service to help office-based physicians set up their health information technology have been announced by federal officials. Survey shows technology, mobility vital to future physicians Medical students view electronic-health-record technology as an important component of their medical education and a critical factor when choosing where they will practice medicine, according to results of a recent survey. State privacy laws deter EHR adoption in hospitals EHR adoption has decreased in hospitals in states where privacy laws restrict the ability to disclose patient information, according to a study published in the journal Management Science. Study: Schools' gift policy influences subscriber attitudes Free drug-branded pens, coffee mugs, and note pads may bring about negative feelings in the prescriber, depending on where the doctor went to school. Inconsistent data may lead to medication errors in computerized ordering Inconsistent information in computerized provider order entry systems can lead to a "significant risk" to safety, according to the results of a recent study. E-prescribing on the rise, but still low overall Only 10 percent of total eligible prescriptions are sent electronically to pharmacies, but the number of electronic prescribers and prescriptions has soared during the past two years and continues upward at a fast pace. Problems found with New York drug price comparison website A website created in 2006 by the New York State Department of Health to help New Yorkers comparison shop for prescription drugs is being criticized for failing to live up to that goal.  MORE ARTICLES Health Information Technology: E-mail/secure messaging Patients see benefits of e-mail and web communications -- if free Patients are willing to use e-mail and physicians? websites to communicate with their doctors in an effort to save time, as long as they do not have to pay for the ability. Merck releases iPhone apps for its manuals Merck & Co. has released iPhone applications for the professional and consumer editions of its Merck Manual. First telehealth provider launches on the Google Health platform Users of Google Health who have scheduled telehealth consultations with physicians or mental health therapists via MDLiveCare will be able to share medical records with their doctors before the appointments and receive records from the doctors after the appointments, thanks to a new collaboration between the two companies. Survey shows technology, mobility vital to future physicians Medical students view electronic-health-record technology as an important component of their medical education and a critical factor when choosing where they will practice medicine, according to results of a recent survey. State privacy laws deter EHR adoption in hospitals EHR adoption has decreased in hospitals in states where privacy laws restrict the ability to disclose patient information, according to a study published in the journal Management Science. Telehealth, online appointments could ease healthcare access jam Universal coverage could clog the healthcare system unless new care-delivery models are created, such as telehealth and online doctor appointments, according to a recent survey. Consumer interest in healthcare technology is growing, survey finds Consumer interest in online tools and resources to assist with health improvement is high, according to results of the 2009 Deloitte Survey of Health Care Consumers. More consumers comparing cost, quality of health services A growing number of healthcare consumers are comparing services, quality, and cost in order to meet their health goals, according to a recent survey. Maryland to create health information exchange A group of prominent Maryland healthcare institutions has submitted a plan to create a statewide health information exchange that will allow hospitals to share electronic medical records.  MORE ARTICLES Health Information Technology: Electronic Health Records (EHRs) / Electronic Medical Records (EMRs) NIH grants to fund research using EHRs, informatics Several entities will receive more than $90 million in funds from the National Institutes of Health (NIH) for efforts involving electronic health records (EHRs) or informatics it was recently announced. Survey reveals attitudes about health-care information technology Health-care information technology (HIT) has the potential to cut costs, increase access and improve quality in the U.S. health care system, according to results of a Harris Interactive survey of a nationwide sample of 2,200 adults aged at least 18 years commissioned by the Career College Association and TechAmerica. Electronic alerts do not necessarily ensure timely follow-up Abnormal results on outpatient imaging tests sometimes may not receive timely follow-up even when clinicians receive and read results in an advanced, integrated electronic medical record system, according to a report in the Archives of Internal Medicine. First telehealth provider launches on the Google Health platform Users of Google Health who have scheduled telehealth consultations with physicians or mental health therapists via MDLiveCare will be able to share medical records with their doctors before the appointments and receive records from the doctors after the appointments, thanks to a new collaboration between the two companies. MGMA calls for EHR data for PQRI The Medical Group Management Association is asking the Centers for Medicare and Medicaid Services to hasten the reporting of electronic health record data for the Physician Quality Reporting Initiative P4P program, according to a letter from the organization. CMS gives guidance on Medicaid incentive payments for EHRs In order to encourage providers to adopt EHR technology, the Centers for Medicare and Medicaid Services has informed state Medicaid directors that the federal government will reimburse states for 100 percent of incentive payments made to healthcare providers showing "meaningful use" of electronic health records. Study shows medical home model increases quality of care A one-year evaluation study from the Group Health Cooperatives demonstrates that a medical home model in conjunction with health information technology could solve the nation's primary care physician shortage. Hospital group opposes 'meaningful use' quality improvement targets The Federation of American Hospitals sent a letter to federal health IT officials asking them to drop "meaningful use" proposals that would require healthcare providers to meet quality improvement targets in order to qualify for federal incentive payments. ONC clarifies extension center grant program The Office of the National Coordinator for Health Information Technology has published more information on its $598 million grant program to go towards 70 Health Information Technology Regional Extension Centers.  MORE ARTICLES Health Information Technology: Internet Cash-only patients name their price on doctor fee search website After a successful pilot program in the Seattle area, a website that matches cash-paying patients to healthcare providers is slated to launch nationwide on November 2. Patients see benefits of e-mail and web communications -- if free Patients are willing to use e-mail and physicians? websites to communicate with their doctors in an effort to save time, as long as they do not have to pay for the ability. Online H1N1 self-assessment tool launched Microsoft has launched a new Web site, www.h1n1responsecenter.com, with a self-assessment tool to help individuals with flu-like symptoms determine whether their illness is severe enough to warrant immediate medical attention, and whether they are at risk for developing severe disease. The site also offers practical advice for those with flu-like symptoms. Electronic prescribing increasing in popularity More than 140,000 (23 percent) of all office-based physicians, nurse practitioners, and physician assistants in the U.S. are now using electronic prescribing, according to Surescripts. At the current pace, the company projects, the total number of health care professionals prescribing medication electronically via its network this year will more than double from the 74,000 active electronic prescribers who used it at the end of last year. First telehealth provider launches on the Google Health platform Users of Google Health who have scheduled telehealth consultations with physicians or mental health therapists via MDLiveCare will be able to share medical records with their doctors before the appointments and receive records from the doctors after the appointments, thanks to a new collaboration between the two companies. Web initiative aims to decrease time, expense of office visit paperwork A new Web initiative to be launched in Ohio by several health plans is designed to benefit patients and practices by reducing the time, effort, and expense associated with the paperwork required for office visits. Survey reveals attitudes about health-care information technology Health-care information technology (HIT) has the potential to cut costs, increase access and improve quality in the U.S. health care system, according to results of a Harris Interactive survey of a nationwide sample of 2,200 adults aged at least 18 years commissioned by the Career College Association and TechAmerica. CMS gives guidance on Medicaid incentive payments for EHRs In order to encourage providers to adopt EHR technology, the Centers for Medicare and Medicaid Services has informed state Medicaid directors that the federal government will reimburse states for 100 percent of incentive payments made to healthcare providers showing "meaningful use" of electronic health records. ONC clarifies extension center grant program The Office of the National Coordinator for Health Information Technology has published more information on its $598 million grant program to go towards 70 Health Information Technology Regional Extension Centers.  MORE ARTICLES Health Information Technology: PDAs Merck releases iPhone apps for its manuals Merck & Co. has released iPhone applications for the professional and consumer editions of its Merck Manual. Viewpoint: Why one doctor became his own IT director Many physicians worry that if they install an electronic health record system, they will also have to become computer geeks to keep it operating. I've learned that you don't need to be IT-savvy, but you'll be happier if you are. The best new software for your PDA It wasn't too long ago that many of us toted around a cell phone, pager, PDA, and a laptop—a veritable RadioShack holstered at our waists. Now most of these devices can be consolidated into a single cell phone. Viewpoint: What do patients think about doctors' use of technology? Patients are more satisfied with their doctors' use of technology when doctors took the time to explain what they were doing with it. Prescribing errors can be caught by electronic tools, study finds Most medication errors in primary care practices are prescribing errors--many of which could be prevented by electronic tools, according to a new study by the Agency for Healthcare Research and Quality. Tech firm launches speech recognition for iPhones Speech recognition has come to the iPhone. 10 new tech devices that could improve your practice A wide range of new equipment can help improve your practice — and the quality of patient care. Tools: 25,000 U.S. physicians download free drug info software for iPhone About 25,000 U.S. physicians have downloaded a free drug information software program that runs on Apple's popular iPhone, according to the California company that develops the software. Tools: Tech firm aims to deliver key data to OB's iPhones Obstetricians may soon be able to check key patient data in real time on their iPhones.  MORE ARTICLES InfoTech Bulletin Merck releases iPhone apps for its manuals Merck & Co. has released iPhone applications for the professional and consumer editions of its Merck Manual. Online H1N1 self-assessment tool launched Microsoft has launched a new Web site, www.h1n1responsecenter.com, with a self-assessment tool to help individuals with flu-like symptoms determine whether their illness is severe enough to warrant immediate medical attention, and whether they are at risk for developing severe disease. The site also offers practical advice for those with flu-like symptoms. NIH grants to fund research using EHRs, informatics Several entities will receive more than $90 million in funds from the National Institutes of Health (NIH) for efforts involving electronic health records (EHRs) or informatics it was recently announced. Cash-only patients name their price on doctor fee search website After a successful pilot program in the Seattle area, a website that matches cash-paying patients to healthcare providers is slated to launch nationwide on November 2. Patients see benefits of e-mail and web communications -- if free Patients are willing to use e-mail and physicians? websites to communicate with their doctors in an effort to save time, as long as they do not have to pay for the ability. Electronic alerts do not necessarily ensure timely follow-up Abnormal results on outpatient imaging tests sometimes may not receive timely follow-up even when clinicians receive and read results in an advanced, integrated electronic medical record system, according to a report in the Archives of Internal Medicine. First telehealth provider launches on the Google Health platform Users of Google Health who have scheduled telehealth consultations with physicians or mental health therapists via MDLiveCare will be able to share medical records with their doctors before the appointments and receive records from the doctors after the appointments, thanks to a new collaboration between the two companies. Web initiative aims to decrease time, expense of office visit paperwork A new Web initiative to be launched in Ohio by several health plans is designed to benefit patients and practices by reducing the time, effort, and expense associated with the paperwork required for office visits. Electronic prescribing increasing in popularity More than 140,000 (23 percent) of all office-based physicians, nurse practitioners, and physician assistants in the U.S. are now using electronic prescribing, according to Surescripts. At the current pace, the company projects, the total number of health care professionals prescribing medication electronically via its network this year will more than double from the 74,000 active electronic prescribers who used it at the end of last year.  MORE ARTICLES It Happened To Me Viewpoint: Who cares about free pens? Nothing reveals the seamy underbelly of medicine like an exhibit booth that's run out of freebies. The true final verdict of my malpractice trial A lawsuit left this physician with worries about his reputation, until a surprising patient visit took place. 2007 Doctors' Writing Contest - Young Doctor Award A baseless malpractice suit still cost me Even after being dismissed from a shotgun suit, the author continued to pay the price. 2007 DOCTORS' WRITING CONTEST - HONORABLE MENTION Don't settle if you're right Sued after helping to save a life, this doctor refused to settle the patient's malpractice claim.  MORE ARTICLES Latest Articles Not a first-time homebuyer? You can still save $8,000 The federal stimulus bill offers a tax credit of up to $8,000 for first-time homebuyers, but there are ways to take advantage of this new tax break even if you already own a home. What "mystery patients" can do for you Mystery patients can help solve the problems you didn't even know you had. Rolling out the red carpet If you're looking to increase your patient base, there's a lot you and your staff can do to make first-timers feel welcome and ease their integration into your practice. 2009 federal tax breaks: How your practice can save Lurking within the $787 billion American Recovery and Reinvestment Act are nearly $300 billion in potential tax breaks, and much of it is available to you. Arbitration beats litigation An arbitration agreement signed before the patient seeks or starts treatment is more likely to be upheld than one signed just before treatment. "Loss of chance" doctrine changes malpractice standards The loss-of-chance doctrine provides that even if a patient had less than a 50-50 chance of a full recovery at the time of a physician's negligent act, it is a compensable injury if that negligence deprived the patient of any chance of recovery. Is the time finally right for health reform? While leaders of the AMA, AAFP, and American College of Physicians all support Obama's goals and what he's done so far, no one is underestimating the tremendous political hurdles—or the potential for opposition from segments of the physician community. Viewpoint: Now is the time to invest in stocks The question on many people's lips is whether the stock market has reached bottom or whether there is still a ways to go before we get there. What the "Red Flags Rule" means for you By rule, any medical practice that extends, renews, or continues credit for a patient—i.e., one that bills patients for services rendered—is subject to the "Red Flags Rule."  MORE ARTICLES Legal Update Federal court sides with physician in hospital suspension A physician whose clinical privileges at a hospital were suspended without notice or an opportunity to be heard was deprived of constitutional due process, a federal court in Nevada held April 8. Circuit court sides with health insurer in physician reimbursement dispute The Eighth Circuit affirmed March 5 the dismissal of a claim that an insurer violated the Racketeer Influenced and Corrupt Organizations Act by mailing erroneous explanation of benefits forms that improperly denied, reduced, or delayed payments to a physician for the healthcare services he provided to plan members. U.S. Court allows ob/gyn to retaliate against hospital for suspension A federal court in Michigan denied a hospital summary judgment on a physician?s retaliation claim under the Emergency Medical Treatment and Labor Act (EMTALA) that it summarily suspended his privileges after he argued against transferring a patient he believed was in labor. Appeals court faults health insurer for ignoring authorization requests The Florida District Court of Appeal, First District, found February 27 that an insurance carrier forfeits its right under state law to contest the medical necessity of a request for authorization for referral for medical treatment if the carrier fails to respond to the request. Texas high court says liability cap applies to physicians, not insurers A divided Texas Supreme Court found March 6 that an exception to the state's malpractice damages cap that allows further recovery when a liability insurer negligently fails to settle claims, applies only to insurers and does not apply to physicians. U.S. Supreme Court declines to review practice price-fixing case The U.S. Supreme Court declined to review February 23 a Fifth Circuit decision upholding the Federal Trade Commission's finding that North Texas Specialty Physicians illegally fixed prices in its negotiations with payors and its conduct was unrelated to procompetitive efficiencies. Pennsylvania high court rules time-limit unexpired in malpractice claim The Pennsylvania Supreme Court reversed February 19 the grant of summary judgment in favor of a physician who alleged the medical malpractice action against him was time-barred under the two-year statute of limitations. Texas health system settles allegations that it blocked insurers from contracting with competitors Memorial Hermann Healthcare System has settled allegations it engaged in practices that discouraged health insurers from entering into contracts with certain competing hospitals in violation of state antitrust laws, Texas Attorney General Greg Abbott announced January 26. Virginia Supreme Court reverses dismissal of wrongful death suit against pediatrics group The Virginia Supreme Court reversed January 16 a lower court's ruling, finding that a wrongful death plaintiff's medical expert was qualified to testify under the relevant statute.  MORE ARTICLES Malpractice If a colleague is careless Malpractice Alert Should you sign a "consent to settle"? Malpractice Alert Do you need excess liability coverage? Primary care physicians rarely do the high risk procedures that result in big judgments. Can I pay a patient's bills? Before offering to reimburse the patient's out-of-pocket expenses, report the matter to your liability insurer. 2009 Medical Economics Survey methodology The methodology and numbers behind Medical Economics' 2009 Exclusive Survey Appeals court faults health insurer for ignoring authorization requests The Florida District Court of Appeal, First District, found February 27 that an insurance carrier forfeits its right under state law to contest the medical necessity of a request for authorization for referral for medical treatment if the carrier fails to respond to the request. Texas high court says liability cap applies to physicians, not insurers A divided Texas Supreme Court found March 6 that an exception to the state's malpractice damages cap that allows further recovery when a liability insurer negligently fails to settle claims, applies only to insurers and does not apply to physicians. Pennsylvania high court rules time-limit unexpired in malpractice claim The Pennsylvania Supreme Court reversed February 19 the grant of summary judgment in favor of a physician who alleged the medical malpractice action against him was time-barred under the two-year statute of limitations. Virginia Supreme Court reverses dismissal of wrongful death suit against pediatrics group The Virginia Supreme Court reversed January 16 a lower court's ruling, finding that a wrongful death plaintiff's medical expert was qualified to testify under the relevant statute.  MORE ARTICLES Malpractice risks that you could easily overlook Reduce liability risk when treating elderly patients Experts tell how to avoid accusations of failure to diagnose, failure to follow up, negligence, and abuse.  MORE ARTICLES Medical Career: Finding a Job Finding a job Step 1: What do you want? In this new series, we'll advise you on how to get your career up and running—or get an unsatisfying career back on track somewhere else. Finding a job Step 2: Start looking A physician search firm and the Internet can help you ferret out opportunities. Or you can get by with a little help from your friends, and their friends. Finding a Job Step 3: Selling yourself The way you present yourself—on paper and in person—will determine whether you land that dream job. Finding a Job Step 4: Weighing offers Before you sign an employment agreement, do your homework, talk with your advisers, then decide which offer you can't refuse. Finding a Job Step 5: Settling in Adjusting to a new practice requires finesse, hard work, and patience. Don't be shy about asking for help. Golden Opportunities Physician retirees face unique challenges when looking for volunteer options, but their skills are needed. Finding a Job: Returning to practice This last installment in our series tells you how to get back into medicine if you've been away for some time—or are planning on a hiatus.  MORE ARTICLES Medical Economics CME First seizures Get under the skin Dodging danger Losing sleep over insomnia The amount of training physicians receive regarding sleep disorders is limited and can have a major impact in the recognition and treatment of insomnia. Countering non-compliance Before you sign... Suffering in silence Preparing for an office emergency Diagnosis and treatment of prostate cancer  MORE ARTICLES Medical Malpractice: Asset Protection America's best places to practice With primary care physicians in demand almost everywhere, there's not a region in the nation that wouldn't love to claim you as its own. The question is: Which state is best for your bank account, your career, and your peace of mind? Q&A: Asset protection for young doctors I'm a physician who has just started practicing. How do I protect myself and my assets? 10 years in legal hell This doctor survived a malpractice case and a bitter bankruptcy that threatened to shut down his practice. Asset protection: What to do, how to do it Take all the precautions necessary to safeguard your wealth before it's too late. Could a malpractice mega-verdict wipe you out? In theory, yes. But in reality, doctors rarely lose their personal assets. Malpractice: Is going bare the only option? For a sizable number of Florida physicians, the answer is Yes. See how they're coping. Protect your assets before you're sued The malpractice crisis makes guarding your wealth more important that ever. You can improve your estate planning in the process. Malpractice Consult Protecting your estate if an award exceeds insurance; even frivolous lawsuits go on your record  MORE ARTICLES Medical Malpractice: Awards/Settlements 2009 Medical Economics Survey methodology The methodology and numbers behind Medical Economics' 2009 Exclusive Survey Texas high court says liability cap applies to physicians, not insurers A divided Texas Supreme Court found March 6 that an exception to the state's malpractice damages cap that allows further recovery when a liability insurer negligently fails to settle claims, applies only to insurers and does not apply to physicians. D.C. appeals court upholds $18 million award against malpractice insurer The District of Columbia Court of Appeals upheld October 2 a jury award of over $18 million in a lawsuit brought by a defunct hospital claiming a malpractice insurance company tortiously interfered with the hospital's business relationship with its attending physicians and therefore forced it to close down. Georgia court finds emergency department physician not "grossly negligent" in malpractice lawsuit The Georgia Court of Appeals held September 4 that an emergency room physician was entitled to summary judgment in a medical malpractice action because the plaintiff could not show the physician was "grossly negligent" as required under the relevant statute. Massachusetts Supreme Court recognizes "loss of chance" recoveries in medical malpractice actions The Massachusetts Supreme Judicial Court has held plaintiffs asserting medical malpractice in wrongful death actions could recover for "loss of chance" where defendant physicians' negligence reduced or eliminated their decedents? prospects for achieving a more favorable medical outcome. Tort Reform: A blow to doctors in the Peach State Georgia's $350,000 cap on noneconomic damages in malpractice cases gives doctors special protections that other professions don't enjoy, and is therefore unconstitutional. Who's afraid of the NPDB? If you're not, perhaps you should be. A National Practitioner Data Bank listing can wreak havoc on your career. $200+ million verdict: It started with a midlevel's mistake A huge malpractice verdict in Florida holds lessons for all doctors who use midlevel providers. Malpractice: To settle or fight Even if you think you did everything right, going to trial might not be the wisest course. See how to decide.  MORE ARTICLES Medical Malpractice: Behind the med-mal crisis Behind the med-mal crisis Partisan sniping and Band-aid solutions haven't worked. Perhaps it's time we tried a new approach. Our three-month, six-part, no-axe-to-grind investigation into the causes of the malpractice crisis looks at some that may work. Beyond stopgap: Insurance reforms There are things the industry—and regulators—can do to make rates less volatile. Beyond stopgap: Legal reforms We can make the system more efficient, without sacrificing fairness. The will to be bold Let states test what works—and what doesn't. Beyond stopgap: Medical system reforms Reducing errors, say experts, will reduce doctors' liability. Seeds of the crisis Multiple factors—history shows—have contributed to the current situation.  MORE ARTICLES Medical Malpractice: Communication Repayment of Stark violations can be tricky Exceptions that permit referrals under Stark are complex, therefore determining a violation has happened and the preferred way of managing are also difficult. Electronic alerts do not necessarily ensure timely follow-up Abnormal results on outpatient imaging tests sometimes may not receive timely follow-up even when clinicians receive and read results in an advanced, integrated electronic medical record system, according to a report in the Archives of Internal Medicine. End-of-life care: Who decides when to pull the plug? Efforts to thwart the increasing costs of healthcare cannot succeed without addressing the question of how much care to provide the terminally ill. When to refer a nonadherent patient to a mental health specialist Consider a referral to a mental health provider for patients who remain nonadherent to therapy or lifestyle changes even after extensive patient education efforts. Why every physician should have a migraine Over the many years of my medical practice, it has repeatedly occurred to me that we might be better caregivers if we had a more visceral rather than purely intellectual understanding of what our patients are experiencing. Know when the Stark law applies to you The Stark law is relevant only in situations that involve a specific set of health services and patients who use Medicare. How to avoid malpractice liability in cross-coverage arrangements For a solo practitioner or a small group practice, cross-coverage arrangements are like oxygen: Without them, there is no life—that is, no weekends, no evenings, no vacations, and no holidays. Study: Doctors often fail to inform patients of abnormal test results Primary care doctors or staff neglect to inform patients of at least 1 out of every 14 abnormal test results. PHRs can boost efficiency, but also hold malpractice risk Since personal health records could be the wave of the future, it is important to understand their risks and benefits.  MORE ARTICLES Medical Malpractice: Depositions/Subpoenas/Testimony Dodging danger Virginia Supreme Court reverses dismissal of wrongful death suit against pediatrics group The Virginia Supreme Court reversed January 16 a lower court's ruling, finding that a wrongful death plaintiff's medical expert was qualified to testify under the relevant statute. Ohio Appeals Court requires attending physician to reveal ED colleague conversation in negligence lawsuit The Ohio Court of Appeals affirmed a state trial court's decision to compel treating physician to answer deposition questions about the conversation he had with the head of Akron General Medical Center's emergency department chairman shortly after the death of plaintiff's son. The appeals court found the conversation was not protected by the state peer review privilege. Shouldn't you be getting paid? Malpractice Consult Subpoenaed? Don't panic Malpractice Consult What's a fact witness? A fact witnes testifies to the treatment he provided; he's not an expert witness. Malpractice: A different kind of tort reform This internist uses evidence-based medicine to help lawyers handle malpractice cases. Malpractice: How to survive a deposition Be concise, be cool, be prepared, and don't try to outwit the plaintiff's attorney. Malpractice: Who should judge the experts? Doctors who serve as expert witnesses for malpractice plaintiffs are finding themselves threatened by their state and specialty societies.  MORE ARTICLES Medical Malpractice: Doctor-patient relations Repayment of Stark violations can be tricky Exceptions that permit referrals under Stark are complex, therefore determining a violation has happened and the preferred way of managing are also difficult. Electronic alerts do not necessarily ensure timely follow-up Abnormal results on outpatient imaging tests sometimes may not receive timely follow-up even when clinicians receive and read results in an advanced, integrated electronic medical record system, according to a report in the Archives of Internal Medicine. End-of-life care: Who decides when to pull the plug? Efforts to thwart the increasing costs of healthcare cannot succeed without addressing the question of how much care to provide the terminally ill. Getting reimbursed for patient education Insurers are signing on to support new chronic care patient education delivery systems that incorporate web-based and electronic technologies. Q&A: Can I fire a patient who refuses to pay his account balance? Most states do not outline or limit the reasons a physician can terminate that relationship, which gives the physician considerable discretion to determine the reasons he or she might do so. Cardiometabolic Disorders & Weight: Action for Outcomes For the first time, 17 of Advanstar Communications' Life Sciences publications and its web portal, ModernMedicine.com, are collaborating in a coordinated, interdisciplinary initiative to address a major public health issue: cardiometabolic disorders and weight. Americans spend $34 billion annually on alternative medicine Adults in the United States spent $33.9 billion out-of-pocket on visits to "complementary and alternative medicine" practitioners and purchases of alternative health products in 2007. A complex constellation of interrelated conditions An estimated 47 million Americans have double the average risk of heart disease because they are affected by a complex constellation of interrelated conditions, including obesity, impaired glucose metabolism, hypertension, and lipid disorders. Why every physician should have a migraine Over the many years of my medical practice, it has repeatedly occurred to me that we might be better caregivers if we had a more visceral rather than purely intellectual understanding of what our patients are experiencing.  MORE ARTICLES Medical Malpractice: Documentation Study to make physician notes available to patients online Starting next year, about 25,000 patients will be able to see all the encounter notes from their primary care physicians on an online personal health record for the duration of a 12-month study. Eli Lilly publishes list of payments to physicians Eli Lilly and Co. has launched an online registry detailing recent payments the drugmaker awarded to physicians and other healthcare professionals. Physicians must report changes to National Provider Identifier Physicians need to update the information related to their own NPI numbers. Failure to do so could result in not being paid for some services. FTC issues third delay of "Red Flags" Rule For the third time, the Federal Trade Commission has delayed enforcement of its identity-theft protection system, or "Red Flags" Rule, which applies to physicians' offices. Viewpoint: EHR mandates should be coupled with tort reform There is a middle road wherein standards and expectations of how to practice in a whole new world of real-time data can be established, and it must be addressed so that those who use EHR systems can do their jobs without apprehension and fear. Study: Doctors often fail to inform patients of abnormal test results Primary care doctors or staff neglect to inform patients of at least 1 out of every 14 abnormal test results. Q&A: When patients request "frivolous" letters Generally, the cost of writing letters is not included as a covered service under managed care contracts. Q&A: When patients refuse to provide social security numbers Patients are not required to provide their social security numbers, even if your practice asks them to do so. PHRs can boost efficiency, but also hold malpractice risk Since personal health records could be the wave of the future, it is important to understand their risks and benefits.  MORE ARTICLES Medical Malpractice: Electronic communication Q&As What the "Red Flags Rule" means for you By rule, any medical practice that extends, renews, or continues credit for a patient—i.e., one that bills patients for services rendered—is subject to the "Red Flags Rule." Patient e-mail perils Malpractice Consult  MORE ARTICLES Medical Malpractice: Informed Consent State roundup: Massachusetts physician shortage worsens A look at state legislation affecting primary care doctors. State roundup: Wisconsin court rules on informed-consent law A look at state legislation affecting primary care doctors. End-of-life care: Who decides when to pull the plug? Efforts to thwart the increasing costs of healthcare cannot succeed without addressing the question of how much care to provide the terminally ill. Improve patient communications with voicemail and e-mail E-mail and voicemail are excellent and convenient means of dealing with prescription renewals, appointment reminders, and other standard administrative tasks. Referrals don't let you off the malpractice hook Don't be lulled into the misconception that you have passed off all liability when you refer a patient to a specialist. Sometimes a placebo is the way to go About half of American doctors say they regularly give patients placebo treatments, usually over-the-counter analgesics or vitamins that won't really help their conditions. Washington ushers in era of "Death with Dignity" In November, 57.8 percent of Washington voters said yes to a ballot initiative that permits physicians to offer terminally ill patients prescriptions for a lethal dose of barbiturates, which patients may self-administer to end their own lives. The meaning of 'consent' At trial, informed consent often boils down to a credibility issue. Patient-signed handouts not always a good idea Should ob/gyn physicians use a document for patients to read and sign that describes what the patient can reasonably expect from prenatal care?  MORE ARTICLES Medical Malpractice: Insurance 2009 Medical Economics Survey methodology The methodology and numbers behind Medical Economics' 2009 Exclusive Survey Malpractice insurance rates drop to 30-year low Medical malpractice liability premiums are at a 30-year low and claims have dropped 45 percent since 2000, according to a recent study. Study: Half of younger uninsured are voluntary Almost half of all uninsured U.S. citizens younger than 65 earn enough to afford health insurance but voluntarily don't purchase it, according to research by a Washington, D.C. think tank. American Well to offer online visits nationwide After securing agreements in two states earlier this year, Boston-based physician-visit website American Well has announced plans to expand its services nationwide. PHRs can boost efficiency, but also hold malpractice risk Since personal health records could be the wave of the future, it is important to understand their risks and benefits. Health plans: The questions you should be asking Dedicating the time to conducting thorough research can help you ensure payer relationships that are built upon timely processing of claims, optimal reimbursement, and efficient use of your staff's valuable time. Home sweet medical home? Consider these factors when deciding whether a medical home is right for your practice. Reports clash on costs of public plan Two recent studies paint conflicting pictures of what a public health plan, offered alongside private health insurance, would cost. "Nationalized" medicine lacks national standards To properly design a compliant, multi-state medical practice, physicians must understand the significantly different laws and regulations they may encounter.  MORE ARTICLES Medical Malpractice: Lawyers Contingency fees may be your best protection against frivolous lawsuits Contingency fees are the primary reason for such close scrutiny of extraneous legal issues by plaintiffs' attorneys. Doctors who became lawyers: What they want you to know MD-JDs share provocative lessons they learned from looking at medical practice from an attorney's point of view. If a lawyer calls Malpractice Consult Is your lawyer on your side? Malpractice Consult Malpractice: 3 lessons I learned the hard way After several narrow escapes, the author is eager to share his hard-won lessons with others. Malpractice Consult Don't fill out disability forms If an attorney wants a "friendly chat" A "friendly chat" is certainly preferable to the unwelcome and less flexible demands of a deposition. Last Word Lawyers: To treat or not to treat? Malpractice Consult When to hire your own lawyer  MORE ARTICLES Medical Malpractice: Litigation End-of-life care: Who decides when to pull the plug? Efforts to thwart the increasing costs of healthcare cannot succeed without addressing the question of how much care to provide the terminally ill. Viewpoint: EHR mandates should be coupled with tort reform There is a middle road wherein standards and expectations of how to practice in a whole new world of real-time data can be established, and it must be addressed so that those who use EHR systems can do their jobs without apprehension and fear. Dodging danger Arbitration beats litigation An arbitration agreement signed before the patient seeks or starts treatment is more likely to be upheld than one signed just before treatment. "Loss of chance" doctrine changes malpractice standards The loss-of-chance doctrine provides that even if a patient had less than a 50-50 chance of a full recovery at the time of a physician's negligent act, it is a compensable injury if that negligence deprived the patient of any chance of recovery. Pennsylvania high court rules time-limit unexpired in malpractice claim The Pennsylvania Supreme Court reversed February 19 the grant of summary judgment in favor of a physician who alleged the medical malpractice action against him was time-barred under the two-year statute of limitations. West Virginia high court rules certain malpractice cases will not require precise date of injury The continuous treatment doctrine should be adopted in certain medical malpractice cases where the date of injury is not identifiable due to the nature of the medical treatment received, the West Virginia Supreme Court of Appeals ruled November 19. Q&A: When legal documents include patient records Is it ok to include patient records in legal documents? Contingency fees may be your best protection against frivolous lawsuits Contingency fees are the primary reason for such close scrutiny of extraneous legal issues by plaintiffs' attorneys.  MORE ARTICLES Medical Malpractice: Patient Confidentiality New HIPAA rules on information breaches take effect in September If patient information is stolen, practices must notify the affected patients and, in some cases, the U.S. Department of Health and Human Services and local media, according to new regulations that go into effect on September 23. Q&A: When patients refuse to provide social security numbers Patients are not required to provide their social security numbers, even if your practice asks them to do so. Improve patient communications with voicemail and e-mail E-mail and voicemail are excellent and convenient means of dealing with prescription renewals, appointment reminders, and other standard administrative tasks. New HIPAA rules get tough on security breaches The additional rules obligate physicians to individually notify patients and the local media if there has been a security breach of "protected health information." Q&A: How to avoid HIPAA violations with phone messages Under HIPAA, exactly what information can and can't be left in phone messages? What the "Red Flags Rule" means for you By rule, any medical practice that extends, renews, or continues credit for a patient—i.e., one that bills patients for services rendered—is subject to the "Red Flags Rule." Q&A: Fighting identity theft Do the FTC's "red flags" rules apply to physician practices? Viewpoint: Confidentiality laws bring moral concerns for one doctor A physician shares an experience that tested the bounds of doctor-patient confidentiality. The rules of debt collection Simply because you are in compliance with federal debt collection laws does not mean that you are in compliance with all state laws.  MORE ARTICLES Medical Malpractice: Relations with Colleagues End-of-life care: Who decides when to pull the plug? Efforts to thwart the increasing costs of healthcare cannot succeed without addressing the question of how much care to provide the terminally ill. When to refer a nonadherent patient to a mental health specialist Consider a referral to a mental health provider for patients who remain nonadherent to therapy or lifestyle changes even after extensive patient education efforts. Know when the Stark law applies to you The Stark law is relevant only in situations that involve a specific set of health services and patients who use Medicare. How to avoid malpractice liability in cross-coverage arrangements For a solo practitioner or a small group practice, cross-coverage arrangements are like oxygen: Without them, there is no life—that is, no weekends, no evenings, no vacations, and no holidays. Q&A: Delegating administrative work I'm the youngest physician in the five-doctor group I joined a couple of years ago, and they want me to take on the president position for a year or two. "Nationalized" medicine lacks national standards To properly design a compliant, multi-state medical practice, physicians must understand the significantly different laws and regulations they may encounter. Referrals don't let you off the malpractice hook Don't be lulled into the misconception that you have passed off all liability when you refer a patient to a specialist. Q&A: Following former patients after they enter nursing facilities What can we do to continue caring for our patients after they've entered a nursing facility, and the nursing facility is denying us access? How to avoid malpractice suits The better care you take of yourself legally means the greater your chances of swearing off lawyers forever—the same way that taking care of your body may well mean avoiding costly and intensive medical interventions.  MORE ARTICLES Medical Malpractice: Risk Management Repayment of Stark violations can be tricky Exceptions that permit referrals under Stark are complex, therefore determining a violation has happened and the preferred way of managing are also difficult. End-of-life care: Who decides when to pull the plug? Efforts to thwart the increasing costs of healthcare cannot succeed without addressing the question of how much care to provide the terminally ill. Know when the Stark law applies to you The Stark law is relevant only in situations that involve a specific set of health services and patients who use Medicare. How to avoid malpractice liability in cross-coverage arrangements For a solo practitioner or a small group practice, cross-coverage arrangements are like oxygen: Without them, there is no life—that is, no weekends, no evenings, no vacations, and no holidays. Malpractice insurance rates drop to 30-year low Medical malpractice liability premiums are at a 30-year low and claims have dropped 45 percent since 2000, according to a recent study. PHRs can boost efficiency, but also hold malpractice risk Since personal health records could be the wave of the future, it is important to understand their risks and benefits. "Nationalized" medicine lacks national standards To properly design a compliant, multi-state medical practice, physicians must understand the significantly different laws and regulations they may encounter. Top-down, bottom-up, and medicine in the middle Recent efforts by well-meaning groups have increased concern among my colleagues that the stakeholders in healthcare reform are all aboard different runaway trains, on a collision course toward a muddled huddle of doctors in the middle. Q&A: Offering limited emergency services If you are going to represent yourself as providing emergency care, you should be prepared to handle the full range of emergency care services.  MORE ARTICLES Medical Practice Management: Ancillary Services First telehealth provider launches on the Google Health platform Users of Google Health who have scheduled telehealth consultations with physicians or mental health therapists via MDLiveCare will be able to share medical records with their doctors before the appointments and receive records from the doctors after the appointments, thanks to a new collaboration between the two companies. Exercise stress testing in the primary care office Exercise stress testing is helpful in evaluating chest pain in selected patients and is a cost-effective strategy for triaging patients with chest pain in the primary care setting. Know when the Stark law applies to you The Stark law is relevant only in situations that involve a specific set of health services and patients who use Medicare. Q&A: Offering limited emergency services If you are going to represent yourself as providing emergency care, you should be prepared to handle the full range of emergency care services. The risks of dealing with supplements The overwhelming majority of doctors know little about supplements or the risks, rules, and regulations that may apply when selling them from a medical practice. Q&A: How to get paid for imaging services Is there any way for a solo physician who wants to do imaging services to get the full global fee from Medicare without owning the equipment? Q&A: Steering clear of Stark Several colleagues and I would like to open a diagnostic center with lab, CT, MRI, and X-ray capabilities. We are all independent primary care practitioners in separate offices. How can we do this and avoid Stark Law violations? Physician group may employ part-time physicians for endoscopies A physician group's proposal to employ part-time two physicians to perform endoscopies would not generate prohibited remuneration under the Anti-Kickback Statute, the Department of Health and Human Services Office of Inspector General (OIG) said in an advisory opinion posted December 15. Imaging self-referral proposal would amend Stark laws A Medicare bill introduced in July would require physicians to disclose to patients any self-referral of imaging services such as MRIs and CT scans.  MORE ARTICLES Medical Practice Management: Billing/Collections Coding for the H1N1 virus vaccination Questions and answers dig into preparedness for a potential H1N1 influenza pandemic. Repayment of Stark violations can be tricky Exceptions that permit referrals under Stark are complex, therefore determining a violation has happened and the preferred way of managing are also difficult. Web initiative aims to decrease time, expense of office visit paperwork A new Web initiative to be launched in Ohio by several health plans is designed to benefit patients and practices by reducing the time, effort, and expense associated with the paperwork required for office visits. Coding for vaccinations without counseling Our physicians don't want to report code 90465 when children under 8 years of age are vaccinated, because they do not provide any counseling. Q&A: What to do when your schedule isn't full What statistics do I really need to track in my practice? Q&A: How to tell if going concierge is right for your practice I've had several negative experiences with the insurance reimbursement system and am thinking of going with an all-cash concierge-style practice. Should I? Coding for ring entrapment, removal Unfortunately, even though there are CPT codes for simpler procedures, there is currently no code for ring removal or entrapment. Coding for a primary care preoperative exam Can I bill for a preoperative visit, and if so, what CPT code should be used? CMS releases new ICD-10 fact sheet The Centers for Medicare and Medicaid Services have released a new fact sheet outlining the World Health Organization's International Classification of Diseases, 10th edition.  MORE ARTICLES Medical Practice Management: Business Forms Clip and Copy: How to ask for copays Use scripts to help staffers collect these charges at the time of service. Telephone triage: Can your staff answer the call? Here are some tips that can help improve your staff's skill at fielding patient phone calls. Clip and Copy: Assessing doctors' job satisfaction Use this tool to help determine whether your practice is meeting associates' needs. Clip and Copy: Doing a reference check When you phone a job applicant's former employer, here's what to ask. Clip and Copy: Monitoring exam room wait times Use this tool to keep track of how efficiently your practice is being managed. Clip and Copy: When you refer the patient Use this form to provide information to consulting doctors. Prodding insurers? Use patient power Can't get a health insurer to pay up? It's customers might get better results. Clip and Copy: Enlist employers in claims fights Insurance companies are more likely to pay you after they hear from the folks who pay them. Clip and Copy: A no-show showdown letter Every practice must have a plan to deal with patients who miss appointments. Here's what you need when a patient is regularly absent.  MORE ARTICLES Medical Practice Management: Business Operations Cash-only patients name their price on doctor fee search website After a successful pilot program in the Seattle area, a website that matches cash-paying patients to healthcare providers is slated to launch nationwide on November 2. Q&A: Cure for too much overtime Staff overtime can cost practices thousands of dollars yearly. Learn how to control overtime. Web initiative aims to decrease time, expense of office visit paperwork A new Web initiative to be launched in Ohio by several health plans is designed to benefit patients and practices by reducing the time, effort, and expense associated with the paperwork required for office visits. Q&A: Monitor your practice's economic vital signs What statistics do I really need to track in my practice? Q&A: How to tell if going concierge is right for your practice I've had several negative experiences with the insurance reimbursement system and am thinking of going with an all-cash concierge-style practice. Should I? Why every physician should have a migraine Over the many years of my medical practice, it has repeatedly occurred to me that we might be better caregivers if we had a more visceral rather than purely intellectual understanding of what our patients are experiencing. Physicians must report changes to National Provider Identifier Physicians need to update the information related to their own NPI numbers. Failure to do so could result in not being paid for some services. Q&A: How long to keep explanation of benefits statements? Superbills, encounter forms, and EOBs are not considered primary records and can be destroyed after they are input into the billing system. Telehealth, online appointments could ease healthcare access jam Universal coverage could clog the healthcare system unless new care-delivery models are created, such as telehealth and online doctor appointments, according to a recent survey.  MORE ARTICLES Medical Practice Management: Coding Coding for the H1N1 virus vaccination Questions and answers dig into preparedness for a potential H1N1 influenza pandemic. Coding for vaccinations without counseling Our physicians don't want to report code 90465 when children under 8 years of age are vaccinated, because they do not provide any counseling. Coding for ring entrapment, removal Unfortunately, even though there are CPT codes for simpler procedures, there is currently no code for ring removal or entrapment. Coding for a primary care preoperative exam Can I bill for a preoperative visit, and if so, what CPT code should be used? CMS releases new ICD-10 fact sheet The Centers for Medicare and Medicaid Services have released a new fact sheet outlining the World Health Organization's International Classification of Diseases, 10th edition. Physicians must report changes to National Provider Identifier Physicians need to update the information related to their own NPI numbers. Failure to do so could result in not being paid for some services. Waiting for H1N1 vaccine codes No code has been assigned to report the administration of the upcoming H1N1 vaccine or the vaccine itself. Codes will likely be assigned around October 1. Is there an exemption from the federal EHR mandate? Although Medicare is expected to offer a financial hardship exemption from electronic health records, the agency has offered scant details so far. When Medicare pays for the H1N1 test Medicare will cover an H1N1 test if it is not covered by a state or local health department.  MORE ARTICLES Medical Practice Management: Compensation Cash-only patients name their price on doctor fee search website After a successful pilot program in the Seattle area, a website that matches cash-paying patients to healthcare providers is slated to launch nationwide on November 2. Viewpoint: A tale of three surgeons It may be time in the profession to value quality over quantity. Q&A: Cure for too much overtime Staff overtime can cost practices thousands of dollars yearly. Learn how to control overtime. Viewpoint: Make more money, save U.S. healthcare A better future for primary care is right in front of us if we have the courage to change, and indeed we must change. 2009 earnings survey: How do you compare? A rough year for the U.S. economy had little negative impact on the income of physicians, according to the results of Medical Economics' 2009 Exclusive Survey. Q&A: Monitor your practice's economic vital signs What statistics do I really need to track in my practice? 2009 Medical Economics Survey methodology The methodology and numbers behind Medical Economics' 2009 Exclusive Survey Eli Lilly publishes list of payments to physicians Eli Lilly and Co. has launched an online registry detailing recent payments the drugmaker awarded to physicians and other healthcare professionals. Second Opinions: Family Health Care The challenge: Selling a practice without a broker's help  MORE ARTICLES Medical Practice Management: Group Practice 2009 productivity survey: How do you compare? While primary care physicians, by and large, worked as much in 2008 as they did the previous year, the number of patients seen increased just marginally, according to Medical Economics' annual productivity survey. Q&A: Cure for too much overtime Staff overtime can cost practices thousands of dollars yearly. Learn how to control overtime. 2009 earnings survey: How do you compare? A rough year for the U.S. economy had little negative impact on the income of physicians, according to the results of Medical Economics' 2009 Exclusive Survey. Q&A: What to do when your schedule isn't full What statistics do I really need to track in my practice? Exercise stress testing in the primary care office Exercise stress testing is helpful in evaluating chest pain in selected patients and is a cost-effective strategy for triaging patients with chest pain in the primary care setting. Q&A: Monitor your practice's economic vital signs What statistics do I really need to track in my practice? Doctors prepare for swine flu, await final word from federal officials Now that the H1N1 vaccine has been approved, primary care physicians are waiting to hear whether 1 or 2 shots will be required for adult patients. Cardiometabolic Disorders & Weight: Action for Outcomes For the first time, 17 of Advanstar Communications' Life Sciences publications and its web portal, ModernMedicine.com, are collaborating in a coordinated, interdisciplinary initiative to address a major public health issue: cardiometabolic disorders and weight. A complex constellation of interrelated conditions An estimated 47 million Americans have double the average risk of heart disease because they are affected by a complex constellation of interrelated conditions, including obesity, impaired glucose metabolism, hypertension, and lipid disorders.  MORE ARTICLES Medical Practice Management: HIPAA New HIPAA rules on information breaches take effect in September If patient information is stolen, practices must notify the affected patients and, in some cases, the U.S. Department of Health and Human Services and local media, according to new regulations that go into effect on September 23. State privacy laws deter EHR adoption in hospitals EHR adoption has decreased in hospitals in states where privacy laws restrict the ability to disclose patient information, according to a study published in the journal Management Science. Improve patient communications with voicemail and e-mail E-mail and voicemail are excellent and convenient means of dealing with prescription renewals, appointment reminders, and other standard administrative tasks. PHRs can boost efficiency, but also hold malpractice risk Since personal health records could be the wave of the future, it is important to understand their risks and benefits. Q&A: When your practice's computers get repossessed A few months ago, our practice ran into some financial difficulties, and we tried to renegotiate our lease contract for our computers, but were rebuffed. New HIPAA rules get tough on security breaches The additional rules obligate physicians to individually notify patients and the local media if there has been a security breach of "protected health information." Q&A: How to avoid HIPAA violations with phone messages Under HIPAA, exactly what information can and can't be left in phone messages? Second Opinions: Alta View Internal Medicine The challenge: Accommodating the needs of hearing-impaired patients. Q&A: Can auto dialers violate HIPAA? What is and is not appropriate information to include in phone messages from auto dialers?  MORE ARTICLES Medical Practice Management: Managed Care State roundup: Massachusetts physician shortage worsens A look at state legislation affecting primary care doctors. Your employment contract As you prepare to start a new job, read your employment contract carefully, make sure you understand all of its provisions, and, if necessary, let a lawyer have a peek. Medicare cracks down on false claims Pfizer allegedly promoted four drugs for off-label indications and caused false claims to be submitted to government health care programs for uses that were not medically accepted indications and therefore not covered by those programs. From private practice to hospital medicine Alfred J. Maher, MD, differs from most hospital physicians in that he didn't begin working as a hospitalist soon after residency. Web initiative aims to decrease time, expense of office visit paperwork A new Web initiative to be launched in Ohio by several health plans is designed to benefit patients and practices by reducing the time, effort, and expense associated with the paperwork required for office visits. Health insurers' executive pay faces Congressional scrutiny In a letter sent to executives, two top lawmakers demanded compensation information, for each year from 2003 to 2008, on health insurance company employees earning more than $500,000, including their bonuses, stock options, and other incentives. Coding for ring entrapment, removal Unfortunately, even though there are CPT codes for simpler procedures, there is currently no code for ring removal or entrapment. Q&A: How to tell if going concierge is right for your practice I've had several negative experiences with the insurance reimbursement system and am thinking of going with an all-cash concierge-style practice. Should I? State roundup: Wisconsin court rules on informed-consent law A look at state legislation affecting primary care doctors.  MORE ARTICLES Medical Practice Management: Medicare/Medicaid State roundup: Massachusetts physician shortage worsens A look at state legislation affecting primary care doctors. Coding for the H1N1 virus vaccination Questions and answers dig into preparedness for a potential H1N1 influenza pandemic. CMS gives guidance on Medicaid incentive payments for EHRs In order to encourage providers to adopt EHR technology, the Centers for Medicare and Medicaid Services has informed state Medicaid directors that the federal government will reimburse states for 100 percent of incentive payments made to healthcare providers showing "meaningful use" of electronic health records. Coding for ring entrapment, removal Unfortunately, even though there are CPT codes for simpler procedures, there is currently no code for ring removal or entrapment. Q&A: What to do when your schedule isn't full What statistics do I really need to track in my practice? Coding for vaccinations without counseling Our physicians don't want to report code 90465 when children under 8 years of age are vaccinated, because they do not provide any counseling. Coding for a primary care preoperative exam Can I bill for a preoperative visit, and if so, what CPT code should be used? State roundup: Wisconsin court rules on informed-consent law A look at state legislation affecting primary care doctors. CMS releases new ICD-10 fact sheet The Centers for Medicare and Medicaid Services have released a new fact sheet outlining the World Health Organization's International Classification of Diseases, 10th edition.  MORE ARTICLES Medical Practice Management: Patient Relations Patients see benefits of e-mail and web communications -- if free Patients are willing to use e-mail and physicians? websites to communicate with their doctors in an effort to save time, as long as they do not have to pay for the ability. Cash-only patients name their price on doctor fee search website After a successful pilot program in the Seattle area, a website that matches cash-paying patients to healthcare providers is slated to launch nationwide on November 2. Survey reveals attitudes about health-care information technology Health-care information technology (HIT) has the potential to cut costs, increase access and improve quality in the U.S. health care system, according to results of a Harris Interactive survey of a nationwide sample of 2,200 adults aged at least 18 years commissioned by the Career College Association and TechAmerica. Exercise stress testing in the primary care office Exercise stress testing is helpful in evaluating chest pain in selected patients and is a cost-effective strategy for triaging patients with chest pain in the primary care setting. Q&A: How to tell if going concierge is right for your practice I've had several negative experiences with the insurance reimbursement system and am thinking of going with an all-cash concierge-style practice. Should I? Q&A: What to do when your schedule isn't full What statistics do I really need to track in my practice? A new kind of doctor-rating website? The new program could demonstrate that a low-cost, rigorous survey method can produce ratings and reports on most doctors in the United States. Internet psychotherapy for depression in primary care shows effectiveness Patients suffering from depression who participated in online cognitive-behavioral therapy sessions were nearly 2.5 times more likely to recover from depression than their standard care counterparts. Why every physician should have a migraine Over the many years of my medical practice, it has repeatedly occurred to me that we might be better caregivers if we had a more visceral rather than purely intellectual understanding of what our patients are experiencing.  MORE ARTICLES Medical Practice Management: Practice Pointers First steps in your job search Whether just done with residency, an experienced hospitalist seeking new work, or a private practice physician transitioning to hospitalist work, a job hunt, at the outset, is an exercise in information-gathering. Q&A: Cure for too much overtime Staff overtime can cost practices thousands of dollars yearly. Learn how to control overtime. Health plan proposal has downside A rule proposed in the health reform legislation would allow health insurers to sell plans across state lines. Survey: Physicians confused about off-label drug use Nearly half of physicians believe that various off-label uses of prescription drugs are approved by the Food and Drug Administration, according to a national survey. Q&A: Monitor your practice's economic vital signs What statistics do I really need to track in my practice? Improve your management of cardiometabolic disorders The art of medicine can be as pivotal as the science of medicine when it comes to managing the treatment regimens of patients with cardiometabolic disorders. Viewpoint: Help your patients make a difference in their own lives Beginning this issue and continuing through November, Medical Economics will deliver "Cardiometabolic Disorders & Weight: Action for Outcomes," a series of in-depth coverage designed to help you manage your patients' disorders more effectively. Cardiometabolic Disorders & Weight: Action for Outcomes For the first time, 17 of Advanstar Communications' Life Sciences publications and its web portal, ModernMedicine.com, are collaborating in a coordinated, interdisciplinary initiative to address a major public health issue: cardiometabolic disorders and weight. A complex constellation of interrelated conditions An estimated 47 million Americans have double the average risk of heart disease because they are affected by a complex constellation of interrelated conditions, including obesity, impaired glucose metabolism, hypertension, and lipid disorders.  MORE ARTICLES Medical Practice Management: Productivity Q&A: Cure for too much overtime Staff overtime can cost practices thousands of dollars yearly. Learn how to control overtime. 2009 productivity survey: How do you compare? While primary care physicians, by and large, worked as much in 2008 as they did the previous year, the number of patients seen increased just marginally, according to Medical Economics' annual productivity survey. Q&A: Monitor your practice's economic vital signs What statistics do I really need to track in my practice? 2009 Medical Economics Survey methodology The methodology and numbers behind Medical Economics' 2009 Exclusive Survey Improve your management of cardiometabolic disorders The art of medicine can be as pivotal as the science of medicine when it comes to managing the treatment regimens of patients with cardiometabolic disorders. Telehealth, online appointments could ease healthcare access jam Universal coverage could clog the healthcare system unless new care-delivery models are created, such as telehealth and online doctor appointments, according to a recent survey. EHRs remain a top challenge for group practices Choosing and implementing an electronic health record is among the top concerns for medical group practices, according to a study from the Medical Group Management Association. Study finds no link between stress and physician errors Primary care physicians report job stress and a chaotic work environment, but researchers found no link between their feelings and an increase in medical errors, according to a recent study. Q&A: What to consider before you cut staff Staffing is my biggest expense. How can I cut back?  MORE ARTICLES Medical Practice Management: Re-engineering Your Practice Viewpoint: A tale of three surgeons It may be time in the profession to value quality over quantity. Exercise stress testing in the primary care office Exercise stress testing is helpful in evaluating chest pain in selected patients and is a cost-effective strategy for triaging patients with chest pain in the primary care setting. Viewpoint: Make more money, save U.S. healthcare A better future for primary care is right in front of us if we have the courage to change, and indeed we must change. Q&A: How to tell if going concierge is right for your practice I've had several negative experiences with the insurance reimbursement system and am thinking of going with an all-cash concierge-style practice. Should I? Federal bill would provide deferred-payment loans for EHRs A deferred-payment loan of up to $315,000 for solo physicians to purchase electronic health record systems may soon be available from the Small Business Administration. Viewpoint: Why one doctor became his own IT director Many physicians worry that if they install an electronic health record system, they will also have to become computer geeks to keep it operating. I've learned that you don't need to be IT-savvy, but you'll be happier if you are. Is becoming a medical home worth the trouble? Although most of the programs promise increased reimbursement or lump-sum payments, conversion to a medical home requires a level of transformation that can be prohibitive to many practices. Home sweet medical home? Consider these factors when deciding whether a medical home is right for your practice. Medical homes across America Details of several health-plan-sponsored medical home projects around the country  MORE ARTICLES Medical Practice Management: Records New HIPAA rules on information breaches take effect in September If patient information is stolen, practices must notify the affected patients and, in some cases, the U.S. Department of Health and Human Services and local media, according to new regulations that go into effect on September 23. Federal bill would provide deferred-payment loans for EHRs A deferred-payment loan of up to $315,000 for solo physicians to purchase electronic health record systems may soon be available from the Small Business Administration. Is there an exemption from the federal EHR mandate? Although Medicare is expected to offer a financial hardship exemption from electronic health records, the agency has offered scant details so far. Study to make physician notes available to patients online Starting next year, about 25,000 patients will be able to see all the encounter notes from their primary care physicians on an online personal health record for the duration of a 12-month study. State privacy laws deter EHR adoption in hospitals EHR adoption has decreased in hospitals in states where privacy laws restrict the ability to disclose patient information, according to a study published in the journal Management Science. Pen-and-paper workarounds plus EHR may boost efficiency The use of pen-and-paper workarounds in conjunction with electronic health records could boost overall efficiency, according to a new study. Viewpoint: EHR mandates should be coupled with tort reform There is a middle road wherein standards and expectations of how to practice in a whole new world of real-time data can be established, and it must be addressed so that those who use EHR systems can do their jobs without apprehension and fear. Q&A: When patients request "frivolous" letters Generally, the cost of writing letters is not included as a covered service under managed care contracts. Vaccination codes: Medicare vs. third-party payers Medicare has established G codes only for administration of the influenza vaccine, pneumococcal vaccine, and hepatitis B vaccine.  MORE ARTICLES Medical Practice Management: Relations with colleagues U.S. Supreme Court declines to review practice price-fixing case The U.S. Supreme Court declined to review February 23 a Fifth Circuit decision upholding the Federal Trade Commission's finding that North Texas Specialty Physicians illegally fixed prices in its negotiations with payors and its conduct was unrelated to procompetitive efficiencies. Best ways to communicate with specialists This doctor learned that reading others' chart notes is not enough. AAFP Primary Care News: Communications critical to developing clinical teams "Team" is the latest buzzword in redesigning medical practice to provide more effective and more satisfying care. But what is a team? Communication tips: Helping specialists help you Coordinating a patient's care across multiple providers and settings isn't easy. Here's how to keep the lines open. The risk of hospitalist hand-offs Communication gaps between co-treating physicians are a major source of patient injuries. Hospitalists: Communication is key They can do a much better job keeping you informed, but they need your help.  MORE ARTICLES Medical Practice Management: Solo Practice 2009 productivity survey: How do you compare? While primary care physicians, by and large, worked as much in 2008 as they did the previous year, the number of patients seen increased just marginally, according to Medical Economics' annual productivity survey. Q&A: Cure for too much overtime Staff overtime can cost practices thousands of dollars yearly. Learn how to control overtime. 2009 earnings survey: How do you compare? A rough year for the U.S. economy had little negative impact on the income of physicians, according to the results of Medical Economics' 2009 Exclusive Survey. Q&A: What to do when your schedule isn't full What statistics do I really need to track in my practice? Exercise stress testing in the primary care office Exercise stress testing is helpful in evaluating chest pain in selected patients and is a cost-effective strategy for triaging patients with chest pain in the primary care setting. Q&A: Monitor your practice's economic vital signs What statistics do I really need to track in my practice? Doctors prepare for swine flu, await final word from federal officials Now that the H1N1 vaccine has been approved, primary care physicians are waiting to hear whether 1 or 2 shots will be required for adult patients. Know when the Stark law applies to you The Stark law is relevant only in situations that involve a specific set of health services and patients who use Medicare. Cardiometabolic Disorders & Weight: Action for Outcomes For the first time, 17 of Advanstar Communications' Life Sciences publications and its web portal, ModernMedicine.com, are collaborating in a coordinated, interdisciplinary initiative to address a major public health issue: cardiometabolic disorders and weight.  MORE ARTICLES Medical Practice Management: Staffing Q&A: Cure for too much overtime Staff overtime can cost practices thousands of dollars yearly. Learn how to control overtime. Q&A: Monitor your practice's economic vital signs What statistics do I really need to track in my practice? High-tech handwashing system could help reduce hospital infections Testing of a hand hygiene program using infrared and radio frequency identification technology to capture and time-stamp hand washings is underway at a Miami hospital. Q&A: What to consider before you cut staff Staffing is my biggest expense. How can I cut back? Revamping your practice's retirement plan Now may be the time to review your original goals for having a retirement plan, then evaluate whether your plan is meeting those goals. Q&A: Dividing overhead costs between full- and part-time doctors When part-time and full-time doctors work out of the same office, friction over expense allocation is common. Q&A: Substituting for another physician Is it legal for another practice to bill my services under its own tax identification number? Study: Even with IT, billing and admin costly for physicians Billing and administration costs remain high even when a practice has implemented health information technology, according to a recent study. Q&A: How to pay an employed physician Paying based strictly on RVUs often results in a physician who is far more concerned about production than about quality or effectiveness of patient care.  MORE ARTICLES Medical Practice Management: Starting A Practice Starting a practice: The first steps, one year out Here's the first installment of our nuts-and-bolts guide to getting a medical office up and running. Starting a Practice 9-10 months out: Loans, leases, and credentialing This second article in our series gives you guidelines for financing your new practice, finding office space, and making certain that you'll get paid.