Practice Management

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.

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.

Imagine practicing gynecology and performing the most challenging surgeries day and night without worrying about malpractice suits, managed-care pre-authorization, or CPT and ICD-9 codes. Wouldn't it be wonderful to have no concerns about being paid and patients who are grateful for care even when the outcome isn't perfect? That would never happen in this country but it's a scenario experienced by health-care professionals affiliated with PRN Relief International. These dedicated individuals minister to some of the planet's most needy-and grateful-patients. I was fortunate to be able to serve with them recently in Jamaica and it's an experience I'll never forget.

As described in the first half of this roundtable (see Contemporary OB/GYN, November 2004), the professional liability insurance crisis has had a broad and pernicious impact on the country's obstetrician/ gynecologists. As they conclude the discussion, the panelists move from reflecting on how the crisis came about to speculating about the prospects for reforming--or even completely replacing--the current tort system.

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.

These experts offer a common sense approach to reduce pregnancy-linked deaths.

We may have seen the first glimmer of light in the otherwise dark tunnel of the professional liability insurance crisis. On July 12, during a speech at the National Press Club, U.S. Senate Majority Leader Bill Frist proposed "an expert medical court system with transparent decisions, limits on punitive damages, and scheduled compensatory damages to provide rapid relief to truly injured patients (instead of trial lawyers)" while holding negligent doctors accountable.