MediPro Insider – March 2016
The Art of Handling ‘Difficult’ Patients
You know who they are: patients who are angry, disrespectful, and rude; patients who demand specific drugs or tests, even when they’re not indicated; and patients who growl at everyone, act suggestively to the nurses, or ask you to submit a fraudulent bill so the insurer will cover the cost of treatment.
In a recent Medscape article, physicians discussed how they deal with the types of patients doctors dread. One suggestion, for example, is to draw boundaries with angry patients, clarifying behavior that’s unacceptable and demanding respect. Many patients are unaware of how they appear to others. If this doesn’t work, such patients are sometimes asked to leave the practice.
Another tack is learning how to say “no” without being negative. Apologies can also win over difficult patients. One doctor readily apologizes for things that aren’t her fault: an overlong waiting room stay, a specialist referral whom the patient didn’t like. “Patients are forgiving if you are seen as genuinely sorry for what happened to them, regardless of how it happened,” the article pointed out.
Their strategies inspired commenters to share some pearls of wisdom.
“Rude, abusive patients need to be dealt with,” an emergency physician agreed. “Professional, well-paid front office staff know how to deal with them. When you pay minimum wage for receptionist personnel, you are getting what you paid for. Patients don’t come into the office because they have nothing better to do. They have a concern. If we aren’t running on time, they get impatient and may pull an attitude. It’s having your staff prepared to deal with attitudes that makes for a successful environment.”
“My hospital department head used to make this observation,” an ob/gyn recalled: “‘5% of your patients cause 95% of your patient problems! Get rid of them!'”
“I handle this always in the same manner,” a pulmonologist explained. “I inform the patient calmly and politely, in the presence of my office manager (sometimes I do this in writing to avoid a confrontation), that the basic ingredient in the patient/doctor relationship is trust, and that their behavior implies that they do not have trust in me as a doctor or in the practice in general. This makes it impossible for me to be their physician. I advise them to find another doctor and discharge them from the practice. I refer them to the doctor referral service at the local hospital or to their primary care physician for a referral to another physician in my specialty. Finally, I advise them that I will be available for emergencies only for 1 month after the date of my letter. I document any behavioral issues, of course. Bingo—no more bad patients and a nice and quiet practice.”
“The whole notion of ‘firing’ a patient is an absurdity,” another emergency physician contended. “In over 40 years of practice, I haven’t run into a patient who isn’t manageable. I make believe that every patient is wearing an invisible sign that says, ‘I want to feel important.’ Patient’s don’t want to feel as if they received the crumbs of your attention. In assembly-line medicine, docs tend to lose sight of the art of listening and encouraging communication with their patients.”
“I keep seeing this advice: ‘Letting the patient tell their story without interruption doesn’t take that long,'” a family physician notes. “Must be from doctors who see a very different kind of patient than I do. I work on an Indian reservation. There is a very low level of medical knowledge, and it is a story-telling culture. Telling about elbow pain may eventually involve every part of the body; unrelated accidents going back to 1942; and what every cousin, doctor, nurse, and others have said to the patient in the past 6 months. I think I will continue to interrupt and guide the conversation as needed.”
“Very few people are not trainable,” a psychiatrist observed. “Our own dynamics tend to trip us up more than our patients do. We are usually pressured for time. We try to make things run smoothly so that our staff aren’t taking the heat for our delays, but it’s hard—hard not to show impatience and inadvertently inflame the situation, hard to feel compassion for someone acting like a jerk, and hard not to take a day of frustrating encounters out on the people in our lives. We fear harming a patient by missing a diagnosis, not recognizing an important drug/drug interaction, forgetting to check a lab, missing a call-back, etc, and this problematic patient causing uncomfortable delays rapidly erodes the very slim margins we deal with. But we have to do it. It is part of our roles as physician and leader to handle the situation and find an appropriate path through. That involves having clear boundaries for both patients and staff, good training for staff, and learning how to identify and manage what pushes our own buttons.” Continue Reading
Source: Medscape | Neil Chesanow | 2/23/15
Why MACRA matters for your practice
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) eliminated the notorious sustainable growth rate (SGR) formula last year, but what will the new MACRA payment policies mean for your practice? Three experts offered answers to this question and detailed what physicians can do now to shape these changes themselves.
Payment changes coming under MACRA
“While we are thrilled that Congress finally did away with SGR, it is very important that we take a closer look at what was adopted in its place,” said Barbara L. McAneny, MD, immediate past-chair of the AMA Board of Trustees and an oncologist in New Mexico.
MACRA creates a new framework that was designed to offer physicians a choice between a modified approach to fee-for-service and transitioning to alternative payment models (APM), and physicians can offer their insights on these choices as they are being developed. Those who choose to stay with the fee-for-service model will see their payments increased or decreased under the new Merit-Based Incentive Payment System (MIPS).
“MIPS is going to adjust the fee-for-service payments based on a number of factors including, clinical practice improvement, quality, judicious use of resources and use of electronic [health] records (EHR),”Dr. McAneny said.
“Performance measures are not new,” said Richard Hellman, MD, a clinical endocrinologist in Kansas City, Mo., and a past-president of the American Association of Clinical Endocrinologists. “But what you use these performance measures for is to improve your practices … and work together as a team.”
“One of the things that the outside world doesn’t know,” Dr. Hellman said, “is the fact that ours is a very dynamic profession. There’s science coming in, there are new concepts coming in—things change.” Performance measures need to reflect that, he said.
Physicians are able to elect to participate in alternative payment models (APM) as an alternative to the MIPS, Dr. McAneny said. “Well-designed APMs can allow physicians to provide better care to their patients, lower health care costs in general and improve the financial bottom line for the practices.”
“I have seen the potential for APMs first hand,” Dr. McAneny said. “I led the design and implementation of an oncology medical home model, which received a health care innovation award from CMS. The grant allowed me to show that physicians have the ability to prove that we can provide better care at a lower cost if we are given the tools to do so.”
What physicians can do to make the system work for them
The Centers for Medicare & Medicaid Services (CMS) announced three changes it is making to ensure these new systems are better for both physicians and their patients. It is important that physicians get involved right now in the development of performance measures and APMs that work as they need them to rather than leaving it to the government to design these tools.
Harold D. Miller, president and CEO of the Center for Healthcare Quality and Payment Reform and one of the 11 members of the federal Physician-focused Payment Model Technical Advisory Committee (PTAC) created by Congress to advise the Department of Health and Human Services on the creation of APMs under MACRA, spoke to physicians on how to create a physician-led health care future.
“SGR is dead, and we need to keep the sword sharpened,” Miller said. “If [we] continue to [let] happen what is happening today … we’re going to continue to get what we’re getting today,” Miller said, “which is small physician practices and hospitals being forced out of business, high prices from those who are left, shifts in care to higher cost settings, overuse of expensive procedures, loss of innovation, large increases in insurance premiums and patients who can’t afford their care.”
“If we have a physician-led future, that could change,” he said.
“I think the most efficient health care delivery entities in the entire world are small physician practices,” Miller said to applause. “If we let them go, we will regret it.”
“Alternative payment models, if they’re designed well, can be win-win-wins,” Miller said. “They can be wins for the payer because of lower spending; they can be wins for the patient because they’re getting better care without unnecessary services; and they can be wins for the physicians because they’re getting paid adequately to deliver high-value services.”
Now it is up to physicians to work closely with their medical specialty societies to design APMs that will work for their practice, improve their patients’ care and meet the MACRA standards that are soon to be set by CMS. Find out how you can work with your specialties to design APMs that are broadly applicable.
The 6 Skills Every Successful Physician Leader Needs
The need for physicians to be engaged in these roles must be part of the discussion around evidence-based management.
Delivering care in this new environment will call for skills that are generally not prioritized. Changing the paradigm will require focused and intentional effort during training.
The skills that have been identified as paramount are:
- Interdisciplinary Collaboration
- Effective Communication
- Adaptability (Understanding and quickly integrating adapting roles into the delivery team)
- Ability to Identify and Understand Metrics for Physician Impact and Output
- Emotional Intelligence
In addition, physician leaders need the ability to tangibly grasp an organization’s behavior and be able to strategically manage in roles that generally ask the leader to wear multiple hats in addition to the many already donned.
To further this end of developing and understanding evidence-based management, Dr. Nancy Borkowski of the University of Alabama at Birmingham, has called for more research into resilience and collaborative leadership. The challenge: In such an unstable environment, how do we define resilience and adequately measure it, so as to be better able to gauge those team members with adequate levels of resilience and those who still need to further develop it?
It is also important to develop one’s leadership framework and style. As there will be often a need for different types of leadership in uncertain environments. The shift to more value-based care rooted in the coordination of multiple stakeholders will require collaborative leaders.
Collaborative Leadership Means:
- Leaders who can gain and maintain the trust of groups that they may not have control or oversight over, and have the ability to bring various organizations together in order to focus on solve problems.
- Leaders who have the ability to focus on authentic leadership and steer clear of passive aggressiveness.
- Leaders who intensely pursue transparency at all levels of decision-making.
- Leaders who view the resources within their arsenal as instruments of action and not possessions.
- Leaders who can effectively manage the relationship between decision rights, accountability, and rewards.
Source: Joseph Chiweshe, MD | Physician’s Money Digest | 3/3/16
ICD-10 claims denial rate at 1.6 percent, RelayHealth reports
Out of about 262 million claims processed between Oct. 1, 2015, and Feb. 15, 2016, which totaled $810 billion, 1.6 percent were denied, according to an announcement from the revenue cycle management solutions organization.
The numbers show there has not been a “marked increase” in rates for claim denials, Marcy Tatsch, RelayHealth Financial’s vice president and general manager of reimbursement solutions, says in the announcement.
However, she adds that “as many as 1 in 5 claims is still denied or delayed–which can mean a dip of as much as 3 percent in a hospital or health system’s revenue stream.”
The Centers for Medicaid & Medicare Services, in a recent blog post by Acting Administrator Andy Slavitt, posted 2015 ICD-10 claims rejections, based on estimates from testing. CMS found that an average of 9.9 percent of claims were denied; the RelayHealth Financial’s reported rate of 1.6 percent shows actual rates may be lower than those averages.
Slavitt says in the post that while CMS is continually improving and won’t “declare victory,” the fears surrounding implementation of ICD-10 never materialized.
To learn more:
– here’s the announcement
Source: FierceHealth IT | Katie Dvorak
**A special note from MediPro, Inc.: The RelayHealth Clearinghouse is one of our preferred products for Eligibility, Claims, ERA and Financial Analytics performance. With a market proven reputation and additional tools for Billers to utilize, we encourage you to explore RelayHealth especially if your practice has a relatively updated version of the Lytec Practice Management software.