Practice Management

After 4 years of negotiations with trial lawyers and physicians,Washington Gov. Christine Gregoire has brokered a liability tortreform package acceptable to both parties.

How do you get the best terms on an HMO or PPO contract? Should you merge with another practice to gain more negotiating clout? Do you need a specialty lawyer or consultant? These are just a few of the questions answered in Part 2 of our series.

Practicing medicine in post-Katrina New Orleans is not always easy. There are no 15-minute appointments.

New Jersey is now the 24th state to pass a law providing contraceptive insurance equity. The new law, A.B. 292, requires most insurers in the state to provide coverage of prescription contraceptive drugs and devices. The law provides an exemption for qualifying religious employers if contraceptive coverage conflicts with the employer's "bona fide religious beliefs and practices," according to the American College of Obstetricians and Gynecologists (Government Relations Newsletter, 1/13/2006).

President Bush used his State of the Union address to once again urge Congress to pass medical liability reform, specifically citing the crisis in obstetrics and gynecology. He said, "And because lawsuits are driving many good doctors out of practice?leaving women in nearly 1,500 American counties without a single ob/gyn?I ask the Congress to pass medical liability this year."

New Jersey is now the 24th state to pass a law providing contraceptive insurance equity. The new law, A.B. 292, requires most insurers in the state to provide coverage of prescription contraceptive drugs and devices. The law provides an exemption for qualifying religious employers if contraceptive coverage conflicts with the employer's "bona fide religious beliefs and practices," according to the American College of Obstetricians and Gynecologists (Government Relations Newsletter, 1/13/2006).

You may not have been trained as a CEO, but unless you sharpen your business skills, your clinical skills may be all for naught. In the first of our 3-part series, a seasoned physician executive outlines the tools needed to manage people, profits, and policies.

More and more health plans are taking up the onus of getting information technology into physicians' practices. They are offering free or subsidized e-prescribing or electronic medical record (EMR) systems to physicians in the hopes that the effort will ultimately save money and improve quality of care.

If so, you are not alone. More than 50% of doctors younger than 35 in developed countries use a personal digital assistant, according to a review in The Lancet (10/1/05). The review stated that physicians used PDAs in daily clinical practice most often for drug reference (80%). They also used it for scheduling (67%), medical calculations (61%), prescription writing (8%), and billing (4%).

Malpractice rates continue to be a hot topic across the nation. Here's a look at recent developments in three states, as reported by the electronic newsletter American Health Line (9/16/05):

There is no secret to finding, hiring, and keeping great office staff. Prepare before you need to hire, hire correctly, and be the best boss in town.

We have the technology to enhance patient safety and care. Now we have to use it.

Sen. Olympia Snowe (R-Maine) introduced a bill that would require all health plans that cover prescription drugs to include coverage of FDA-approved forms of contraception.

A recent study on closed malpractice claims in Texas found that "insurance market dynamics"—not increasing payouts in lawsuits—were to blame for rising insurance premiums, according to Medical Liability Monitor (April 2005). The study, authored by three law professors, was promptly criticized by medical groups and insurers.

Tort reform measures in three states seem to be improving the environment in which to practice medicine, according to American Medical News (3/28/05).

In a previous article, we reviewed coding changes for vaginal colpopexy. This article looks at a related code introduced in CPT 2005 and how to report multiple services provided during the same surgery.

As I write this I am post-call, which may account for the tone of my meandering discourse. At my age, the problem is not so much taking call but surviving the next day. While tackling clinical challenges can be exciting, what I find most stimulating is the chance to teach and learn from my residents.

Senate Majority Leader Bill Frist, R-Tenn., wants to put politics aside and get momentum behind stalled medical malpractice reform in Congress.

A coalition of patients, attorneys, physicians, and hospital administrators is promoting an alternative way to control medical liability costs, in lieu of tort reform. And all it requires is an apology and an offer of fair compensation to the patient if a medical error occurred.

Each year CPT introduces new codes and makes revisions to existingcodes to better reflect current medical practices. CPT 2005 is nodifferent. This month, we'll look at changes in coding for vaginalcolpopexy. The 2005 CPT codes reflect the expansion and improvementof surgical techniques in the area of female reconstructive surgery

When is OVD indicated? When do the risks outweigh the potential advantages? What should your pre-op assessment include? To answer these and related questions, two experts take an in-depth look at the research data.

President Bush has kicked off his second term in office by asking Congress to impose limits this year on medical malpractice litigation, according to The New York Times (1/5/05).

Venous thromboembolism (VTE), a leading cause of death and disability in women, principally manifests as deep vein thrombosis (DVT) and acute pulmonary embolism (PE). Every year, as many as 600,000 patients develop a PE in the United States, resulting in up to 200,000 deaths.

Last May, it was my privilege to address fellows of the American College of Obstetricians and Gynecologists and guests at the annual ACOG convocation in Philadelphia. I proposed a Women's Health Bill of Rights. Most of these 10 "rights" related to equity and equality in access to, coverage of, and treatment in our health-care system. The tenth item on my list was quite different and reflects thoughts on a paradigm shift in health care.

Last night you were on call and delivered three babies, managed a patient with severe preeclampsia, treated a case of uterine atony, and readmitted a woman with a post-hysterectomy wound infection. Yesterday you covered the hospital's Women's Health Clinic; it's a twice-monthly pro bono service you provide to the community. And this morning, you're facing a waiting room full of patients and two assistant U.S. attorneys. The grave-looking men in dark suits say they are investigating you for up-coding of Medicare and Medicaid claims and private insurance reimbursement. You're facing possible federal criminal prosecution, but you're not alone because the hospital also is being investigated.

PMS has been a legitimate diagnosis for several decades, but there are no FDA-approved therapies for it. Off-label use of medications that are FDA-approved for PMDD is common in clinical practice. For patients taking daily SSRIs for anxiety or mood symptoms, premenstrual dose adjustment offers a novel management strategy.