Financial Management

Should Hospitalists Unionize?

  If you have given any thought to corporatized medicine and its impact on medical practice, I advise you to read this extended New York Times piece:           The story concerns the contentious relationship between a hospitalist group and their employer, PeaceHealth Sacred Heart Medical Center in Springfield, Oregon.  The group alleges the hospital made advances to replace them on account of their suboptimal performance--both financial and professional.  Sacred Heart put out bids to national companies to outsource their inpatient line of business.  However, their plan did not move forward due to significant physician backlash. Feeling vulnerable, the docs chose to join a union and hitched with the American Federation of Teachers, which already represented nurses at Sacred Heart.  (more…)

Money back Guarantee!

We’ve all seen hundreds of commercials of companies advertising products and services with a money back guarantee. The Men’s Warehouse, for example, has been guaranteeing to men across the globe for over a decade, “You’re going to like the way you look; I guarantee it!” But to date, no one has made such a “guarantee” in the healthcare industry. Buying a suit is not exactly like getting your gallbladder removed. Geisinger Health System President and CEO, Dr. David Feinberg, is doing just that. Their health care system has developed an application, called the Geisinger ProvenExperience, which can be downloaded onto a smartphone. After a procedure, a patient is given a code for the condition that was treated. With that code, they can enter any feedback they have on the services provided; and then they can request a refund if they are not fully satisfied. Most remarkably, the request for a…

If you were paying you, when would you time your bonus and how?

  We all walk into the supermarket and see an abundance of goods. Every item has a place under alluring lighting and come-hither ads. The displays move you and your wagon, despite your beliefs, through the aisles in a deliberate way. The Walmart Supercenter manager wishes to steer your senses so as to induce the transfer of maximal amounts of merchandise from the shelf to your basket (and money out of your wallet). You don't think Whole Foods places huge reams of flowers at the entrance to their stores just to remind you of Mother's Day, do you? (more…)

CMS Just Paid for Advance Care Planning. But You’ll Still Make More Giving Injections.

I know the following may convey a lack of gratitude.  CMS funds a code, and by doing so, validates an activity for so long many in medicine have overlooked or dismissed.  Many specialists probably viewed end of life counseling as "stuff" those docs in the offices without the cherry finished cabinets dealt with.  You know. Trivial stuff.  Well, at least we can put that little contrivance to bed.  Amen. Cash is hard to come by these days and introducing a newly funded service risks cost overruns from overuse.  But if I had to guess how often practitioners will utilize these new E/Ms (99497 and 99498), my bet would be less than expected--and CMS can ease their fears that providers will back their Brink's truck in. (more…)

You Can Learn A Lot From Billing Data.

Because hospitalists lack a specialty code for billing (probably forthcoming), and we do not have formal board certification (I would bet it's in our future), anyone interested in identifying hospitalists beyond their hospital walls has a tough slog.  You can call several thousand hospitals and speak with the appropriate department and question; you can call every internist, pediatrician or family practitioner in the AMA database and ask them, "Are you a hospitalist?"; or you can find an alternate method---because the latter two will keep you busy until the next solar eclipse. Knowing adult inpatient practitioners bill just a small cluster of codes--observation, critical care, or inpatient--having access to a national database with physician billing data (Part B submissions) would provide a route to determine which docs practice in acute care settings.   (more…)