Practice Management

Looming reimbursement cuts from government and commercial payers worry many dermatologists, all of whom fear a decline in practice profitability. Before you take dramatic cost-cutting measures, make a careful review of your practice's efficiency.

Defending one's online honor begins long before someone posts a cyber-slam, according to several experts who spoke at Cosmetic Surgery Forum 2010 in Las Vegas in December.

The 2011 Medicare physician fee schedule published Nov. 29 by the Centers for Medicare & Medicaid Services (CMS) offers valuable insight into reimbursement for 2011. The final rule adjusts work relative value units downward for many services, but dermatology emerges as one of winners, getting a 4 percent increase overall.

One part of the healthcare reform package mandated under the Patient Protection and Affordable Care Act includes a measure to give physicians a financial incentive for developing "meaningful use" of their certified electronic health record technology. As I learn more and more about the meaningful use provision, I realize it involves a great deal more than just digitalizing patients' medical records.

Reducing patients' time to wait is certainly a noble goal and one that you should always strive to achieve. Eliminating wait time, however, is impossible for most dermatology practices. Steps you take to improve the quality of waiting time can do more than reduce frustration; they may turn the experience into a positive impression for patients.

Dr. Buttox travels to Europe to learn about a new botulinum toxin that is popular there. He understands he can't use the product in his office without FDA approval, but his marketing department gets him to discuss the product with the national press. Does the FDA have jurisdiction over Dr. Buttox in this instance, and if so, to what extent?

As the nation - and your patients - struggle with healthcare costs, building patient loyalty will be an important success factor for all dermatology practices. Outside of your own skills as a dermatologist, nothing builds patient loyalty as effectively as knowing how to manage the "moment of truth." The "moment of truth" occurs when a patient has the opportunity to make a snap judgment about the quality of your practice's services.

New dermatology criteria from the Certification Commission for Health Information Technology (CCHIT) can simplify electronic health record (EHR) purchasing decisions, sources say. But, so far, these criteria are driving few dermatologists to implement EHRs who weren't already planning to do so, these experts add.

Learning curves aside, current users of electronic health record (EHR) systems appear satisfied with them.

Dr. Derm spends 10 percent of his annual gross earnings on marketing, much of which is Internet-based. He often finds himself telling his peers how wonderful Internet marketing is, until one day he finds out that a disgruntled patient has damaged his reputation on the Web. Dr. Derm is concerned that this malicious act may ruin his career. What can he do?

There is a battle brewing in Washington by men and women who wear white coats to work. It's a battle over the manner in which non-physicians, such as nurses and nurse practitioners, can market or promote their level of service and expertise, and it has resulted in legislation being introduced in the U. S. House of Representatives.

The adoption of electronic health records (EHRs) among dermatologists is hitting a stumbling block - namely, the onerousness of final "meaningful use" rules recently released by the federal government. The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) recently released guidelines for earning government incentives for implementing the paperless systems.

Mid-level caregivers are taking on an ever-larger role in dermatologic care. According to professional organizations, about 11,500 board-certified dermatologists practice in the United States. In addition, there are about 3,000 dermatology physician assistants and 1,650 nurse practitioners working in dermatology offices - or the equivalent of about one mid-level dermatologic caregiver for every 2.5 dermatologists.

Implementation of the Red Flags Rule by the Federal Trade Commission (FTC), which would require doctors and other businesses to take specific steps to minimize identity theft, has been delayed until a federal appeals court rules on a lawsuit by the American Bar Association (ABA).

Experts say a few clear rules will help physicians effectively engage patients via social media. They advise making a plan and writing a policy that delineates privacy and other requirements. Avoid postings that sound like sales pitches, and don't "friend" your patients.

Two years ago, Dr. Reputation noticed a slowdown in his practice, which he attributed to the poor national economy. Recently, however, other dermatologists have reported an upturn in their schedules. One day, a loyal patient tells Dr. Reputation that a popular physician grade website gives Dr. Reputation a failing grade. Can Dr. Reputation sue to find out the methods used by the website?

Dermatologists may be able to breathe a sigh of relief over the final rules for the government's electronic health record (EHR) incentive program released July 13 - but only a small sigh. Although the rules are hardly light reading, understanding them and putting them into operation is essential to successful participation in the government's bonus payment program for EHRs.

One of the most difficult lessons that I have had to learn since entering private practice four years ago is that patients want to have their say. In fact, sometimes this is the main reason for the office visit. If we do not understand the full motivation of the person seeking our care, we may fail that patient in a very profound way.

Although setting up a cosmetic practice requires commitment and creativity, such practices can help insulate dermatologists against the impact of a sluggish economy, an expert says.

Although many dermatologists have not yet embraced social media - such as the wildly popular Facebook - for their practices, others are finding that these tools can provide a targeted, cost-efficient and increasingly useful channel for connecting with patients, experts say.

Dr. Bill's practice sees more than 1,000 patients a week, most covered by some version of medical insurance. The practice outsourced its billing to a billing company, which takes a small percentage of each paid patient bill as its method of payment. Recently, a disgruntled patient sued Dr. Bill, alleging illegal fee splitting.

All physicians are familiar with the concept of the Hippocratic Oath, a 2,500-year-old promise to uphold professional ethical standards. I have not reviewed the oath since I recited it at my graduation from medical school in 1985, but it came to mind as I faced a monthly red budget statement despite a full-capacity schedule with limited staff support, and low Press Ganey satisfaction scores about lengthy waits for appointments and service.

As teledermatology gains acceptance throughout the healthcare field, dermatologists must ensure that they and their residents are comfortable with this technology, according to one expert.

Dermatology practices across the country report a higher percentage of missed appointments than in the past. You may consider appointment no-shows a nuisance, but patients missing appointments may have a greater impact than you or your staff realize. Every appointment no-show is a revenue drain and a missed opportunity to contribute to your bottom line.

There is little doubt that every physician in the U.S. has an opinion on the recent healthcare legislation and its impact on medical care in this country. What is less clear is whether or not most physicians understand the tax ramifications of the new law.

If you've been on the fence about purchasing an electronic health record (EHR) for your dermatology practice, it's time to make your move. The federal government has pledged billions of dollars to finance the automation of medical practices. Also working in your favor now are the advances in the technology behind these sytems; today's systems are much better than what you could find just 12 or 18 months ago.

The newly passed federal healthcare legislation mandates changes that will impact dermatology practices to greater or lesser degrees, depending on practice size, patient base and other factors. But dermatologists say they're most concerned about what the legislation omits: an explanation of how the new Medicare Independent Payment Advisory Board will function, and a fix for Medicare's sustainable growth rate formula.

A six-month plan to forestall Medicare reimbursement cuts yet again - a proposal pending in the Senate at press time - is the latest in a series of delays that continues to leave dermatologists and other physicians frustrated.

One of the main rallying cries for passage of healthcare reform legislation was to improve access to healthcare for the 47 million (or 32 million, depending on which source you happen to read) Americans who previously didn't have health insurance. Legislation that corrects this obvious shortcoming of our healthcare system is certainly welcomed. However, does this law accomplish that goal?

Dr. Eczema has a very large dermatology practice and performs studies on new treatments for a variety of dermatoses. Recently, one of the pharmaceutical companies with which Dr. Eczema works contacted his research nurse to ask her to provide a copy of all of this electronic data, which she does. A former research patient finds out and has an attorney inform Dr. Eczema he will sue for a HIPAA violation unless he settles with his client for $100,000.