ProNex Inc. Enables Family Physicians to Maintain Their Autonomy June 7, 2010
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“The front line of medical care—primary-care doctors—is crumbling as med-school grads opt for better pay and a more predictable life.” This is a quote taken directly from a recent article in the June issue of Connecticut Magazine. There is a growing trend in healthcare away from the practice of family medicine. Increased costs and decreased revenue are in part to blame. Small family practices, ones that are viable, consider themselves small businesses in addition to the foundation of family health. This ideology and mind-set is not unique to Connecticut as there is a growing trend across the country toward physician autonomy. This is no small feat, with autonomy comes cost and time management issues. In many ways you, the family practitioner, are the hub or gateway of the healthcare system. Your responsibilities for delegating care for your patients are at the fabric of a functional connected physician/patient/physician relationship. Changes within the family practice are essential in order for physicians to remain in family care where they are sorely needed.
We at ProNex Inc. have created a communications platform for the family practice which decreases administrative costs, increases efficiencies, increases ease of connectivity and offers an alternative source of revenue for the family practitioner. In theory the time you spend caring for your patients is bundled and you are compensated duly and fully for care administered. In reality, your administrative workload is taking away from the reason you went into medicine. Whether it be solely for the altruistic vision of creating a better life for your patients through the practice of medicine, or combined with your entrepreneurial spirit to run a business of your own. ProNex’s My ProConnect Platform was created with you in mind. The vision to see the landscape of tomorrow will prepare you to succeed in your professional endeavors today. We appreciate the opportunity to share our vision and demonstrate how it will benefit you, your practice and your patients for years to come. I will leave you with one final thought:
Various studies show that in areas where there are high ratios of primary-care physicians, patients are the winners. They have fewer hospitalizations. They have fewer complications. The data is overwhelming that the more primary-care docs you have taking care of a given population, the better the outcomes and the less expensive the care.
You, the family practitioner, are essential!
Vincent Brown / Regional Manager ProNex Inc. vincentbrown@pronexinc.com
Medicare Denying Payment For Readmissions May 5, 2010
Posted by treatinghealthcare in Ray Bianchi MD.1 comment so far
Medicare, with one sweeping stroke of a pen, is planning to deny payment for our most vulnerable patients. As of January 2010, based on the recommendations of PPACA (Patient Protection and Affordable Care Act) Medicare is threatening financial penalty levied on hospitals for readmissions of Medicare patients within 30 days of their last discharge. Medicare Payment Advisory Commission (MedPAC) is suggesting denying any payment to hospitals towards the second admission for readmissions within a 30 day period. This act, if carried out by Medicare, will expect our hospital systems to absorb the ensuing cost on the false premise that the hospital is responsible for the patient’s failure to respond to their initial treatment or the development of new medical complications requiring hospitalization. This places an immense financial burden on the hospital system as nearly 20% of all Medicare admissions are readmissions within 30 days. This is an obvious denial of the fact that frail patients, with multiple system abnormalities, are at high risk of readmissions into the health system. To deny payment for their medical care is a gross injustice for these patients as it is discriminatory for the elderly, mentally ill, and handicapped. Such a gross injustice will ultimately lead to them having difficulty in obtaining quality access for their medical needs. The government has no right to arbitrarily deny payment for the weakest of our patients for whom we have devoted our lives to serve while in the same measure threaten our hospital system with either financial penalty or litigation if they don’t meet the health care needs of a patient even if they can’t be reimbursed.
Our nation and our profession have always taken great pride in serving the needs of the weak and never should we stand silent as our governmental leadership denies payment for our most ailing patients. The AMA must stand tall together with the American Hospital Association to ensure that our Medicare recipients always be allowed access for medical care and should not be discriminated against simply because they are more ill than other patients.
WHEREAS: Medicare recipients should always be able to rely on payment for medical care which is not discriminatory against them because of need,
WHEREAS: hospitals should not be forced to absorb the cost of care when it is the responsibility of the payer, Medicare,
WHEREAS: when Medicare denies payment for readmissions it will lead the path for other third party payers to follow suit as well,
WHEREAS: denying payment to a hospital system by Medicare simply for the reason of readmission within 30 days on the premise that the hospital and or physicians did not provide the best of care is a blatant denial that most of these patients are frail and in need of recurrent medical intervention,
WHEREAS: such denial of payment for the above premise will give a false sense of responsibility to the hospital and medical staff for a good outcome which will only make hospitals and physicians unfairly liable if they care for such frail patients,
BE IT RESOLVED: that our AMA publicly protest any payer system, i.e. Medicare, that will deny payment to hospitals and physicians based primarily on readmission within a certain period of time,
BE IT RESOLVED: that the AMA, in its commitment to serve our most fragile patients, never tolerate any denial of payment from Medicare which discriminates against the most vulnerable of our patients and partner with the American Hospital Association and AARP to establish legislative action with congress to reverse this ruling.
AND BE IT FURTHER RESOLVED: that the AMA/OMSS introduce this resolution at the AMA June 2010 meeting once approved by the OMSS assembly.
Ray Bianchi MD
Sponsored by ProNex Inc. www.pronexinc.com
The Suffering of Alzheimer’s Dementia March 23, 2010
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Alzheimer’s Dementia is a disease state of progressive cognitive decline which can be a very frightening diagnosis for all those involved. What can feel worse than suffering from a disease in which you will lose the ability to recognize those you love? In a similar way, the loved ones of the patients with Alzheimer’s suffer as well when they are confronted with the reality that those they love no longer recognizes them. I believe this can be the most important time that God calls us to be with our loved ones and to be present with them in their solitude and despair. We should not be tempted to run from this struggle but rather we need to pray for the courage and perseverance to embrace this cross with our loved one. I believe that this is a special time in which God calls us just to be there in their suffering and to place on the cross the pain that we endure when our loved one doesn’t recognize us anymore.
It can also be painful when patient’s say some terrible things to their loved ones or yell out in frustration or fear. When this occurs, I will often remind them that is the dementia talking, not the soul of their loved one. Our objective must be in trying to comfort the patient and remove their fears. Dementia for these individuals will create a distorted sense of reality which will prevent them from seeing their environment and their loved ones as they really are. When we feel that we are being verbally abused by a demented loved one we must keep in mind the above and do our best not to take it personally.
Alzheimer’s Dementia is a terminal diagnosis but as a society we must continued to dignify their human nature. They continue to deserve the best of care to treat reversible medical conditions if that is what the patient desires. Examples of such care would include the treatment of infections such as pneumonia and bladder infections, bed sores, broken bones, and chest pain all of which are potentially reversible. We must never abandon them in their medical struggles and always bestow upon them the dignity that they deserve.
Unfortunately, many patients of Alzheimer’s will steadily lose weight around 10 years after diagnosis. They will progress to a failure to thrive state which can lead to their demise. Initially, patients can be given drugs to stimulate their appetite in an attempt to improve their weight gain. Unfortunately, this is only a temporary solution because as the diseased brain progressively declines, patients eventually don’t eat enough to sustain life. When you force feed patients in this state with a feeding tube, they are at risk of suffering more from bed sores or aspiration of feeding contents into their lungs leading to recurrent pneumonia and hospitalization. For this reason, I have often advised the loved one’s of these patients that such measures could be considered heroic, comparable to sustaining patients on ventilator support who otherwise could not breathe on their own. As critical as oxygen is to sustaining life, so are calories, and thus I will ask them to take the same pause in reflection before forcing nutrition thru a feeding tube. I remind them that if their loved one informed them that they would not want to be placed on a ventilator when they are approaching death, they probably would not want you to force feed them as well for the same reasons. Of course, patients should be allowed to eat and drink as they would desire to do and not be deprived. But if they are of near death we should not force feed them to just simply prolong their suffering in delaying their death unless it is the patient’s desire to do so.
Dr. Ray Bianchi Will Be A Featured Guest On Relevant Radio 3/31/10 March 13, 2010
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Dr Ray Bianchi to be featured on Relevant Radio !
Topic: Dr. Bianchi will be discussing Alzheimers Dementia and end of life issues.
When: Wednesday March 31st
Time: 1:00pm
Tune In: Either 950am, 930am or listen via the internet www.relevantradio.com
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Sponsored by ProNex, Inc. www.pronexinc.com |
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Medical Malpractice – Let’s Look at The Whole Picture February 22, 2010
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One of the biggest drains on our health care dollar is medical malpractice. High medical malpractice rates have forced many physicians to leave many states including Illinois in favor of states with caps. This has limited access for many specialities including neurosurgery and obstetrics in these states. Just 2 weeks ago the Illinois Supreme Court ruled malpractice caps unconstitutional which has the potential to cause medical malpractice premium rates to soar through the roof.
In addition, with the looming threat of litigation that every physician must contend with, physicians often feel compelled to practice defensive medicine. This increases the cost of delivery of health care which makes it very inefficient. For our administration to project that they intend to make health care more efficient is disingenuous if they choose to ignore tort reform which is an obvious drain on our health care dollar. The analogy I make on this matter is the purchase of Chrysler by our administration with the intent to make Chrysler cars more gas efficient from 22 mpg to 28 mpg. But would this be a waste if our administration ignored a hole in the gas tanks. Not addressing tort reform while insisting on making health care more efficient is similar to allowing our health care dollar to be spilled onto the pavement. A wasteful cost we cannot afford any longer.
Ray Bianchi MD www.amcfamilymedicine.com
Sponsored by ProNex, Inc. www.pronexinc.com
Give The Power Back to The People February 19, 2010
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We the people should have the power over our health care delivery which is why we should own our health care plan and not our employer. This would permit us to have the portability to take our health care plan from job to job and not feel threaten to lose our health care should we lose our employment. Our employer should be allowed to get tax credit for contributing in part or in total for the health care plan that the employee chooses to purchase. When purchasing our health plan we should be risk stratified by our health history and by the communities in which we reside and not as individuals. We should require health insurance companies to compete for our business in a similar way auto insurance is done in our communities. Furthermore, if health insurance companies were allowed to compete for the business across state lines, competition will lower the premium rates which is similar to the competitive market of the auto insurance industry. If we are not happy in the way our health care plan is managing our claim, we would have the option to seek another carrier. Presently we are locked in to our health care plan with our employer which is why many of us feel powerless to get the service we deserve from our health insurance. Sadly, because we personally purchased our auto insurance, we are in a better position to get better service for our auto than we can get for our health when our health insurance policy is owned by our employer. The power for health care delivery must be restored to the patient at which time you will see the value for each health care dollar improve.
Ray Bianchi MD www.amcfamilymedicine.com
Sponsored by ProNex, Inc. www.pronexinc.com
A Peek Behind The Health Insurance Curtain February 18, 2010
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We have to be careful not to relinquish the control of our health care destiny to the government who in recent history has not respected the dignity of life. For that reason we have to be assured that decisions relating to our health care remains in the domain of the patients and their physicians. The more power we give to the patient, the better health care reform will be. First we need to insist on insurance reform that does away with antitrust exemption that health care insurance industry currently possesses. The government gave the health insurance industry exemption from antitrust in return for them agreeing to pay 30% surcharge to in part subsidize Medicare and Medicaid. In this way many of us were being taxed through our premiums to help support the Medicare and Medicaid programs instead of being directly taxed through our payroll tax which would have been an unpopular political move.
Ray Bianchi MD www.amcfamilymedicine.com
Sponsored by ProNex, Inc. www.pronexinc.com
Physician Wellness Services targets burned-out docs February 11, 2010
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If Dr. Gregory House, played by actor Hugh Laurie in the hit FOX drama “House,” was real, he’d be a prime customer for Physician Wellness Services (PWS). The company, a recently formed division of Workplace Behavioral Solutions Inc., designs counseling and intervention programs for hospital and medical organizations to treat problem doctors struggling with stress, substance abuse and depression. Founded in early 2009, PWS now boasts 30 customers in 10 cities.
House may be fictitious but disruptive physician behavior is very much a real and serious problem, said Dr. Alan Rosenstein, medical director for PWS. A growing body of scientific literature suggests problem docs not only threaten patient safety but expose hospitals to malpractice lawsuits and staff shortages, especially nurses bullied out of their jobs by intimidating physicians.
According to a 2003 survey of 2,000 nurses, pharmacists and other staff by the Institute for Safe Medication Practices, nearly half of the respondents reported intimidating behavior, mostly from doctors, such as strong verbal abuse and threatening body language. Four percent even reported physical abuse.
While hospitals have traditionally tolerated the problem, such behavior has drawn increasing attention in recent years, Dr. Rosenstein said, thanks to a strong focus on physician accountability by outside groups like insurance companies and government officials who demand lower costs and better medical outcomes.
In 2008, The Joint Commission, an independent, nonprofit organization that accredits and certifies more than 17,000 health care organizations, established new standards that require hospitals to develop “a code of conduct that defines acceptable and disruptive and inappropriate behaviors” and “create and implement a process for managing” such behaviors.
The problem with problem docs stems from a unique, unforgiving culture, said Dr. Rosenstein, a national expert on disruptive physician behavior who has published several articles on the issue. Medical school graduates starting their careers are first “broken down” and told they know nothing, which produces low self esteem and confidence, he said. Then the docs are thrust into a situation where “they work autonomously and autocratically,” Dr. Rosenstein said.
“That’s the way you are trained in medical school,” he said.
The physicians develop big egos that defy any scrutiny of their performance or competence. Throw in long hours, the emotional toll of treating patients and doctors start to suffer from stress and depression, failed marriages and even alcohol and drug abuse. They start to lash out at nurses and other staff, which jeopardizes patient safety because the two groups either won’t or can’t communicate with each other, Dr. Rosenstein said.
According to the 2003 survey, which included 1,565 nurses, 88 percent of respondents encountered condescending language or voice intonation (21 percent often), 87 percent experienced impatience with questions (19 percent often), and 79 percent encountered a reluctance or refusal to answer questions or phone calls (14 percent often). In fact, some experts blame the acute shortage of nurses on disruptive physicians.
“Intimidation clearly impacts patient safety,” the report concluded, citing the 49 percent of respondents who say their past experiences with intimidation altered the way they handled questions over medication orders.
The Joint Commission’s new standards proved to be a watershed moment in spotlighting disruptive physician behavior because the organization carries real weight with hospitals. Whether or not a hospital receives Medicare payments often depends on receiving accreditation from the body.
“The presence of intimidating and disruptive behaviors in an organization erodes professional behavior and creates an unhealthy or even hostile work environment — one that is readily recognized by patients and their families,” The Joint Commission said. “Health care organizations that ignore these behaviors also expose themselves to litigation from both employees and patients.”
Workplace Behavioral Solutions decided to form a unit specifically focused on physicians because they work in such a unique culture, said Lori Brostrom, PWS director of marketing. PWS offers three services: an employee assistance program that provides voluntary counseling to doctors by specially recruited and trained peer doctors, an intervention program for the most serious cases of physician misbehavior, including substance abuse and severe depression, and training, workshops and consulting services.
Dr. Daniel Whitlock, vice president of medical affairs at St. Cloud Hospital, which employs 412 doctors, said he wants to “turn the organization into a caring organization instead of a disciplinary organization.” He recently renewed the hospital’s contract with PWS, which provides an employee assistance program.
Normally, by the time a disruptive doctor demands his attention, Dr. Whitlock takes punitive action. Instead, he prefers to nip the problem in the bud.
“There’s not a lot of leeway when it gets to my desk,” Dr. Whitlock said. “If the only thing you have is the death sentence, then your hands are tied. We would like to ratchet it down, intervene before it boils over into something serious or harmful. Over the years, we found that [doctors'] private lives affects us greatly in how they perform their professional duties. It really cries for help but doctors are not particularly good at asking for help.”
Dr. Whitlock also sees his doctors as investments that need fine-tuning. Just as the hospital will spend money to purchase and maintain expensive equipment like CT scanners, the hospital needs to devote similar time and resources to maintain the emotional welfare of doctors, he said.
“We’re facing a physician shortage,” Dr. Whitlock said. “We have a real difficult time attracting primary care doctors. When we bring a doctor into our community, we make a big investment in that person.”
PWS hopes to expand into 10 more major cities and eventually medical schools. Such institutions tend to emphasize technical skill over emotional competence, Dr. Rosenstein said. Helping students cope with the rigors of their profession in medical school would help prevent disruptive behavior long after they graduate, he said.
A 2005 study published in the New England Journal of Medicine concluded “disciplinary action among practicing physicians by medical boards was strongly associated with unprofessional behavior in medical school. … Professionalism should have a central role in medical academies and throughout one’s medical career.”
Among the behaviors the study identified in problematic medical students were irresponsibility — poor attendance and follow-up patient care — and diminished capacity for self improvement — failure to accept constructive criticism, argumentativeness and a poor attitude. The study also blamed bad behavior on anxiety, nervousness and insecurity.
Comments will be replied to by a member of the Physician Wellness Services team.
Blog posts sponsored by ProNex, Inc.
Obesity Surgery Technology Partnership to Improve Patient Access and Care February 2, 2010
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Fred Pira, CEO of ProNex, Inc. said:’ProNex has work extremely hard on developing the most comprehensive bariatric practice management tool on the markets. Our goal is to deliver a tool that answers all the technology and administration needs a bariatric surgery practice faces daily. With the addition of Info-Surge and BSCI to our pool of services we have achieved a new level of service that is going to change the bariatric world.’
Info-Surge online patient education platform helps physicians educate patients before and after medical procedures. Info-Surge’s online education products bridge communication gaps and increase practice productivity. To learn more, visit http:// www.info-surge.com or call (888) 203-0465.
Bariatric Support Centers International (BSCI) a Utah based company, has been a leader in the bariatric support community, assuring optimal outcomes since 2000. BSCI is also home of the International Bariatric Support Group Registry and The Success Habits of Weight Loss Surgery Patients. To learn more visit http:// www.bsciresourcecenter.com/ or call (801)-327-6500.
Pronex, Inc. developed My ProConnect EMR platform which brings medical practices enhanced individual care, patient relationship management, improved clinician productivity, decreased costs and increased revenue. To learn more visit http:www.pronexinc.com or call (847) 726-7718.
Sponsored by ProNex, Inc.
Medicare Denies Re-admission Payments to Hospitals. January 26, 2010
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2010 brings new personal resolutions for some of us but it also brings adverse changes to Medicare and their constituents. As of January of 2010, Medicare will be denying payments to hospitals for the health care of patients who have been readmitted to the hospitals if they have been previously admitted to the hospital within a 30 day period. Medicare substantiates this injustice by claiming that had the hospital and physicians provided proper care, the patient would not have needed to be readmitted within a 30 day period from discharge. Although their observation may have a glimmer of merit, the vast majority of readmissions will occur second to the obvious reality that elderly patients often posses multiple disease processes which can be exacerbated when under medical stress – leading to complications with readmission to hospitals.
Allow me to describe a patient case example which underscores the error in judgment for the above policy. A patient is admitted to the hospital for a broken hip. The hip is surgically repaired and the patient is discharged in five days. Two days later the patient is readmitted to the hospital for pneumonia. On the surface government administrators would assume that the patient was infected with pneumonia during his previous hospital stay and thus the hospital should be fiscally responsible for the patient’s subsequent hospital care for his pneumonia. But as is so often the case, we cannot concur with such a simplistic assessment of medical care delivery.
The patient mentioned above is a nursing home patient with osteoporosis and severe Alzheimer’s dementia. He was admitted to repair his hip but also suffers with severe dysphagia from his Alzheimer’s making it difficult for him to swallow. As a result, he had been on a puree diet in an attempt to limit his potential for aspirating his food even prior to his hip fracture. When he was discharged, his dysphagia may have worsened in light of his further compromised state during the immediate post operative period. On the second day after his discharge back to his nursing home, he aspirated his food in his lung which brought him back to the hospital. This caused him to develop a severe pneumonia requiring him to have ventilator support in the medical ICU for 2 weeks. This clearly is not the fault of the health care institution as it is the unfortunate consequence of many of the elderly with multiple co morbidities.
This is where the main difference occurs – Medicare recognizes that most elderly individuals will spend half of their health care dollar within the last year of their life. This is really a manipulative attempt to limit the financial appropriation deemed necessary for end of life care. Hospitals cannot afford to deliver this care without compensation and keep their doors open. This could ultimately lead to a medical culture that will resist the delivery of health care to the elderly, a responsibility we as a society have been entrusted to honor. Those whose lives are diminished or weakened deserve medical attention and should not be denied only because of the cost that would accrue to deliver their care. If society allows this we will be allowing the continued degradation for the dignity of life. Society has the responsibility to deliver care to the elderly otherwise we run the risk that we will deny care for other disadvantage populations such as the poor, mentally ill, or the handicap.
I believe we must all be in opposition to a government policy that would deny care to the disadvantaged and our elderly. It remains our duty to make ourselves a neighbor to others and to actively serve them which becomes even more urgent when it involves the disadvantaged, in whatever area this may be. “As you did it to one of the least of these my brethren, you did it to me.” Mt 25:40
Ray Bianchi MD www.advmedicalcareltd.com
Sponsored by ProNex, Inc.
