Wednesday, March 20, 2013

What's The Big Deal About A 2% Cut?

                              What is the big deal about a 2% cut in Medicare spending?

Actually, this is the question on the minds of a lot of people today. Two percent doesn't sound like much, but in an economy of rising unemployment, foreclosures, and rising fuel prices it means a lot! The results can be far reaching and devastating causing the financial situation in this country to worsen for several reasons. Let's take a look at some ways that it will affect your practice or business. 

According to an article written by Mark Crane on medscape.com, this 2% cut could lead to job losses in the healthcare industry.


"Earlier this week, American College of Physicians President David Bronson, MD, told Medscape Medical News he 
worries about the deleterious effects of budget cuts for agencies such as the Centers for Disease Control 
and Prevention, the US Food and Drug Administration, and the National Institutes of Health. A report released 
jointly by the American Medical Association, the American Hospital Association, and the American Nurses Association 
found that:




"766,000 healthcare and related jobs could be lost by 2021 just
because of a 2% cut in Medicare payments."



It is a steep and vicious cycle downward both for the physician, healthcare workers, support staff and patients.

"Overall, the cut will mean $11 billion less for doctors, hospitals and other providers in 2013. "One in five Medicare patients already is facing difficulties in finding a doctor to take them. If you cut their pay, this access problem will only get worse."
The threat of payment cuts isn't new for doctors who treat the nation's 47 million Medicare patients." 


  • If you cut the physician's pay, they are going to look at alternative ways to make up the difference so that they can stay in business. 
  • The doctor may be faced with the decision of staff cuts. Who would be let go? 
  • The work load will increase on his already overwhelmed staff. 
  •  Up-coding or bill fraudulently for services not rendered are a greater temptation.

 Possible Solutions:

  • Outsource medical billing to a reputable medical billing company. Research proves that this is a viable option because you would be saving money on office space, utilities, professional fees, insurance premiums, vacation pay, etc. This option could save thousands of dollars annually.
  • Maximize income by minimizing lost revenue through re-submission of unpaid claims, rejected claims, etc. There is huge loss of revenue from simple errors that may be time consuming, but worth the effort in reimbursement.
  • Refuse to treat Medicare/Medicaid patients. That is a trend across the nation, but it will not help in the long run. Yes, their payments may be much smaller than the commercial insurers, but it still is a source of income! Small amounts do add up in time.
That brings us to another effect of the Medicare cuts... the elderly patients on fixed incomes who come into your office. Many of them are facing financial strain already because of added responsibilities of raising grandchildren or helping their children who lost jobs and homes because of the downturn in the economy. They are paying more for their medicine to sustain their quality of life and they trust you as their doctor to provide the care that they need. When you turn them away because it does not seem financially feasible to continue their care, you are turning away some little grandchild's future with their grandmother or grandfather. They are forced to make tough decisions that may be ultimately detrimental to their health. 
  • If you do not treat them, they may be forced to find a doctor with much less expertise than you have. They lack the patient rapport that you have.
  • The patients are less likely to tell a new doctor everything because they do not trust him or her fully. This can be medically devastating!
  • They are not as likely to seek healthcare for early prevention of diseases such as cancer, heart disease, and other silent killers. 
  • They may not purchase the needed medications because they can't afford them, thus causing  preventable illness or death.
By eliminating the Medicare and Medicaid patients, that leaves you with self-pay customers, commercial insurance beneficiaries and military or worker's compensation patients. Here is the problem. 
  • The self-pay are un-insured and may be slow pay so you end up writing their bills off unless you have a very good medical billing specialist and collections agency.
  • The commercial insurer beneficiaries still have co-payments and co-insurance payments. If their policy is at 70/30 or 80/20, you still need to collect those percentages.  
So, you can see that the 2% cut does make a big difference overall. There are a lot of tough decisions that physicians must make, but the right ones could lead to better quality of life for your patients, financial health for your practice, and overall peace of mind.

Thanks for reading.

Donna McHugh, CMRS





Resources:

1.  http://money.cnn.com/2013/03/02/smallbusiness/medicare-doctors-spending-cuts/index.html

2.  The Daily Buzz, Larry Weston AMBA,  Article: CMS describes how sequester will be applied to Medicare payments

3. .http://www.huffingtonpost.com/robert-kuttner/us-budget-cuts_b_2850554.html

4.  http://www.medscape.com/viewarticle/780133  CMS Now Says Sequester Medicare Pay Cut to Kick in April 1
by Mark Crane






Friday, March 15, 2013

Why Are Patients Dishonest With Providers?

Last time, I wrote an article about doctor honesty with patients. However, since there are two sides to every coin, I wanted to address patient honesty this time.

Why would a patient lie to their healthcare provider?

My research indicates that there are a number of reasons why a patient would be dishonest with the provider.

1. The doctor does not take the time to really listen to what they are saying. Face it, the doctors have to see so many patients per day in order to pay their bills and stay in business. When a patient feels that the doctor is not listening, they will not give the whole story, sometimes to their own detriment.

2. They feel intimidated by the doctor. The patient-physician trust relationship has to be maintained if the patient is to be properly cared for. The physician's body language and bedside manners are key to maintaining the relationship, but the patient's willingness to listen to their doctor goes a long ways to keeping their end of the bargain. 

3. The patient does not want to feel foolish because some of the information is embarrassing to share with the doctor. However, withholding that information could be life-threatening to them in certain circumstances. It is better to take the risk and tell the whole truth than to lose your life over something that could have been prevented. 

If the patient-doctor relationship is not healthy, then the patient does have options. They do not have to just ignore the problem and hope it goes away. They sought medical care for a reason and they need to know what is going on with their body.

The Patient Options:


1.  Get a second opinion when you are diagnosed with something that requires any sort of ongoing care ie. surgery, chemo, etc.  

2.  Even if your diagnosis isn't life threatening, you can research. The internet has a wealth of information at your fingertips. The doctor may not have time to give all of the information that you need to know, but that is no excuse for being uninformed.

3. Do not agree to an option for your healthcare unless you thoroughly research the best option for you. Sometimes the doctors recommend a procedure because they will get paid more to do that procedure than a less invasive and less expensive procedure. You do have a right to say NO.

4. Ask around for a recommendation of a different doctor. If there are personality conflicts,  find another doctor who will be better suited for you. Since complete honesty is vital to the patient-physician relationship, you need to feel comfortable with your physician so that you can be totally honest and he needs to listen to what you are saying.

5.  Trust your own judgment. You know your body better than the doctor does. If you are not comfortable with his answer, then research to confirm or deny it.

The provider can help maintain the healthy relationship and cash flow into his practice by doing his part as well.

Doctors Advice:

1. Take time to really listen to your patients.

2. Be totally honest when giving patient information about their condition. They need to make informed decisions based on the information that you give them. Don't purposely mislead your clients. It will come back to haunt you in lost business!

3. If the patient is unable to emotionally cope with the results of their diagnosis, ask them to bring a friend or mate with them to discuss the results. 

4. The patients may not appreciate what you have to say, but at least you did your part to maintain honesty and your reputation will grow as a good and honest physician ultimately paying off in your cash drawer.

Patients that are happy with their physicians are more likely to pay their co-payments, co-insurances and patient balances!

Thanks for reading.

Donna McHugh, CMRS





Resources:

1.Stewart Segal is a family physician who blogs at Livewellthy.org.


2. http://www.philly.com/philly/blogs/fieldclinic/Successful-doctor-patient-relationships-require-honesty.html

3. Is Your Doctor One of the Dishonest Ones? By Trisha Torrey, About.com GuideFebruary 13, 2012





Thursday, March 7, 2013

Do Healthcare Providers Practice Total Honesty?

A personal experience with a healthcare provider's dishonesty-- not once, but twice, in one visit and caused a lot of unnecessary suffering.  I will think twice before returning for medical care from her. She broke the provider-patient relationship. This prompted me to research the topic and post the results. Sadly, dishonesty in healthcare is a  negative trend for more than one reason. Lying to patients can lead to serious results for them as well as for the physicians and other healthcare providers in the long run.



In the healthcare setting, the patient-provider relationship is key. When trust is broken, the patient will find another doctor who will tell the truth.  In the end the provider loses income because patient satisfaction is a great way to advertise, but distrust will also spread through word of mouth. Negative advertising affects your practice more than you may think!


A survey published this week in the journal "Health Affairs" reflects this complex relationship. Lisa Iezzoni and her colleagues surveyed 1,891 physicians nationwide about how honest they are with their patients regarding medical mistakes and a patient's prognosis. 

Results:

  • Although two-thirds of doctors agree they should share serious medical errors with their patients, one-third did not completely agree. Nearly two-fifths of the respondents said they did not disclose their financial relationships with drug and device companies.
  •  And more than 55% of physicians said they often or sometimes described a patient's prognosis in a more positive manner than the facts might support. 
That is a lot of dishonesty going on! Why would they do it?

  • Medical errors can be due to negligence, but they are more often a failure to analyze data properly. They are forced to see so many patients back to back with little down time to research properly and study cases as they should. They are performance driven. The more patients they see in a day, the better the finances at the end of the day. This is a false security because if their office staff is not filing claims properly, collecting on old claims and sending patient statements in a timely fashion, they are making less money than they think they are.
  • Fear of litigation. In this society of suit happy clients, providers are less likely to admit to their mistakes. Nobody wants sued!
  • Discomfort of admitting mistakes is more commonly the reason for not coming forward. They want to be perceived as having all of the answers because patients want answers that they may not know, so in the time crunch of trying to race to the  next client, they would rather be dishonest or make something up than follow through with the correct answer.
  • Sometimes the truth is not good news and they hesitate to tell the truth because the patient may not be able to emotionally handle the news that they have to tell.
"Not telling the truth in the doctor-patient relationship requires special attention because patients today, more than ever, experience serious harm if they are lied to."

So, let's sum this up. If a provider lies to a patient, they will eventually lose:
  • clients
  • income
  • credibility
  • patient-doctor trust
Tell the truth and you will gain all of these mentioned above and more. Your reputation as a healthcare provider will stand out in the marketplace.

Thanks for reading.
Donna McHugh, CMRS


Resources:
1. http://www.uchile.cl/portal/investigacion/centro-interdisciplinario-de-estudios-en-bioetica/publicaciones/76983/honesty-in-medicine-should-doctors-tell-the-truth

2.http://www.kevinmd.com/blog/2012/04/medical-care-honesty-essential.html

3.http://www.cnn.com/2012/02/11/health/dishonest-doctors-survey-brawley