Document Reminders, Reduce Risk
Medical Economics (04/21/06) Vol. 83 , No. 8 , P. 60(1) ; Karp, David

In response to a question on whether a medical practice is obligated to remind a patient to return for follow-up care, risk management and loss prevention consultant David Karp writes that depends on the specific circumstances. A medical practice would be responsible for providing a patient with their test results in an appropriate amount of time, and advising the individual to return for additional tests or follow-up care, says Karp of Cloverdale, Calif. Patients with chronic conditions and who need close follow-up care should be advised in a similar manner. Doctor's offices can help patients protect their health by reminding them to make and keep appointments for recommended follow-up tests or care. Reminding patients to make and keep their appointments can also reduce the risk of a practice if a medical problem develops following a missed appointment. Karp recommends that medical practices document that they have asked a patient to return, and that they gave the individual an opportunity to make an appointment before they left the office. Progress notes that fail to document instructions to return to the office have been used as evidence in court that the doctor did not advise the patient to make a follow-up visit, says Karp. Medical practices should also set up a reminder system, which can consist of mailed notices, e-mail messages, and phone calls.
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Clearly Define Nonphysicians' Status, Role
American Medical News (04/03/06) Harris, Steven M.

Physicians who move into ancillary services often do so by signing a professional services contract with nonphysician staffers to help them do so. These professionals can include physician assistants, advanced practice nurses, and physical therapists. Before signing such a contract, there are four general matters that need to be taken into account. The first is taking care of liability issues, which generally involves identifying the professional as an independent contractor whose provision of services does not create a joint venture, partnership, or other affiliation with the practice. Any outside contractor should have professional liability insurance that covers the services provided at the practice. The next matter to take into account is scope of practice, including confirming that all the contractors have the appropriate credentials, licensure, and insurance coverage and that the situation is in compliance with all applicable regulations. The third matter is supervision, as most states regulate the amount of supervision that nonphysicians need to have when they provide medical services. Finally, the fourth matter to take into account has to do with documentation and billing, making sure that the documentation is concise, complete, and timely.
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Electronic Records a Must for New Practice
Health Data Management (05/06) Goedert, Joseph

Upon its creation early last year from the merger of three group practices and a solo practitioner, the 12-physician practice Surgical Specialists of Spokane immediately went live with new electronic medical record (EMR), practice management, and dictation/transcription software. Though this was the first EMR for all of the practice's physicians, practice administrator Kristy Fresh says that "it was never an option not to do an EMR." Fresh explains, "Physicians frequently would be on call for unfamiliar patients. Regardless of where the patient was seen or when, we needed access to the available information." The business logic of using Nuance Communications' Dragon speech recognition technology--which cost $900 for each of the 12 licenses, compared to the cost of three or four transcriptionists at $45,000 to $55,000 a year--helped convince the physicians to go along with the new technology. Fresh put together a pair of budgets, one of which showed what it would cost to keep using paper technology and one of which showed what it would cost to rely more on IT, and the obvious contrast meant that "my business case to them was actually very easy," she says. The practice's physicians were seeing patients at hospitals on the first day of business, rather than seeing patients in the office, which meant office staff had the chance to take refresher courses in the new software and workflow. Staffers were offered cash incentives to acquire proficiency with the systems quickly: $100 if they met the proficiency standards within three weeks, and $50 if they met them within four weeks. Fresh chose the technology for the practice, which consisted of EMR and practice management software from NexGen Healthcare Information Systems along with the Dragon speech recognition software, with input from other practice administrators in online user communities.
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Secrets for a Successful Malpractice Defense
Medical Economics (03/17/06) Reynard, Michael

Physicians have several ways to improve their outcome in court if they are sued for malpractice. This includes being knowledgeable about the documents used by both their attorney and the plaintiff's attorney, as such information is typically left on display for the judge and jury. They would be wise to assist their attorney in creating a display, and they should point out any errors in the information presented by the plaintiff's attorney. Rather than provide only yes or no answers under cross-examination, physicians should insist on being allowed to tell the whole truth, offering detailed answers if allowed. Additionally, they should formulate strategies for handling weak links that are exposed by the plaintiff's attorney and underscore their values, expertise, and concern for their patients when faced with personal attacks. They should make eye contact with the jury only when making important statements in order to avoid distractions, speak in laymen's terms, and carefully consider each question before answering. Physicians should not be afraid to ask the plaintiff's attorney to rephrase questions that do not make sense or ask about the relevance of a particular question, and they should be respectful of the jury by dressing appropriately and arriving on time.
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Malpractice Rate Hikes Paint Ugly Picture: Causes More Than Skin Deep
Dermatology Times (04/06) Vol. 27 , No. 4 , P. 92 ; Nash, Karen

Emergency physician and lawyer Hugh F. Hill, III, M.D., and dermatologist Sandra I. Read, M.D., say dermatologists need to keep better record of what conditions and procedures are leading to malpractice lawsuits in order to keep increases in malpractice premiums under control. The husband and wife team has compiled statistics on malpractice claims, and they share the information at American Academy of Dermatology meetings. Hill has obtained data from legal databases, while Read has gained access to information on dermatology claims from 1985 to 2001 from the Physician Insurers Association of America (PIAA) while working on risk management for the National Capital Reciprocal Insurance Co. Insurance companies keep such records as proprietary information and use them when they set rates, and the information gives them an advantage over doctors. Hill and Read say doctors need to collect and collate data on the circumstances of lawsuits, the process of suits, when a claim was or was not settled, where it occurred, what expert witnesses said about malpractice, and why they said it. "One thing we hope dermatologists will take away from this talk is that dermatology can lead in gathering data, cooperation and information-sharing, in an attempt to share the information that will allow dermatologists to risk-manage rationally," says Hill. "I don't want to sound like a broken record, but we need the information to make rational risk-management decisions--otherwise, we're just guessing."
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Writing Your Employee Handbook
Cosmetic Surgery Times (05/06) Vol. 9 , No. 4 , P. 54 ; Berkeley, Rice

Medical practices must have a handbook for conveying what is and is not acceptable at the office to safeguard practices from potential lawsuits. Separate versions of handbooks are usually created for supervisors and employees, and it is crucial to keep employee manuals easy-to-understand to avoid legal terms. The practice might seek help from a practice management consultant or an office manager, and a reliable healthcare lawyer must review the final draft, according to Barbara Fick, a professor of labor law at Notre Dame Law School in Indiana. From the outset, the handbook should state that it does not go over every possible incident or problem and that the practice has the right to insert or modify formation in the guidebook at any time without earlier notice. Furthermore, the guidebook should state that it does not represent a guarantee of ongoing employment or a contract. New workers should be given the guidebook as part of their introduction and should also sign a document stating they have read, understood, and accepted the policies expressed in the handbook. The different areas that should be covered in the manual include a welcome message, work schedule, absences, vacation, salaries and benefits, job descriptions, performance evaluations, career development, patient confidentiality, termination, discrimination, harassment, and personal conduct.
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