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Instead of roaring through stoplights, an ambulance transporting an elderly woman with pneumonia recently pulled off the road in St. Louis. Emergency rooms at six nearby hospitals had just told [...]

Patient education is increasingly being sought by patients and managed care firms to give patients in-depth information that doctors cannot give due to their hectic schedules. Patient education classes are categorized into three. These are disease management courses, maternity classes and lifestyle classes. Disease management courses are geared for patients suffering from asthma, diabetes and hypertension. In maternity classes, pregnant women are taught pointers on diet, exercise, childbirth and breast-feeding. Stress reduction and weight loss are taught in lifestyle classes., A "Health Care U"can improve outcomes, reduce utilization, and save time. But filling the classroom takes hard work and physician buy-in. Every month, approximately 125 patients visit Camino Medical Group [...]

Physicians should be sharp in noting the first signs of a downward turn in contracts with health plans to minimize the damage that would be inflicted to them. A simple test that doctors should ask themselves is if their present contract pays enough to cover their expenses and provide them with enough income. The quantification of the answer to the question will be greatly aided by the use of appropriate software. Another crucial factor that should not be overlooked is comparing the payment schedules of the present health plan with other plans by means of a spreadsheet software., Wrestling With the Managed Care Octopus Part 5 Sweet managed care deals often sour. Here's how to detect and reject those that aren't in your best interests. In cities such [...]

HubSouth Medical Group is one of the few group practice institutions which saw their business wane due to mismanagement and lack of member cooperation. Founded in July 1997 with an initial investment fund worth $5,000, HubSouth's growth was undermined by massive financial constraints. In less than 14 months of operation, 39% of the company's account receivables was delayed, as top officials tussle over professional disputes. Efforts by Pendulum Practice Management to salvage the firm proved too late, as member doctors were compelled to disband due to unmanageable debt., Thrown together to meet a perceived managed care threat, a 90-doctor group dissolved in chaos 14 months later. Looking back, the doctors have learned a bitter lesson in how not [...]

Medical partnerships should have professional executives on their corporate boards. The medical training received by physicians do not equip them with the skills required in managing businesses and professional managers can always advise doctors on management issues. Medical groups should revise their bylaws to give the board of directors a significant role in governance. The bylaws should reflect the interest of the whole organization rather than that of respective specialty groups. Designating board seats lead to fragmentation which may be destructive to the organization., Physician directors are traditionally far less sophisticated than their corporate counterparts - and that's something you can no longer afford. How do you grow a group practice? For starters, talk [...]

This practice made the transition slowly, systematically - and, for the most part, successfully. Physician 'superusers' eased the way for everyone else. Whenever Little Rock FP David Nelsen Jr. sees [...]

The emergence of various non-formulary medications in the US has changed the outlook of patient-doctor relationships in the country. In fact, statistics show that direct-to-consumer drug advertising has considerably increased the health consciousness of patients. Records, however, revealed that doctors tend to generate a negative feedback for these types of drugs. Experts believe that doctors should always observe patience, empathy and consideration when giving advice to their patients about such drugs. Aside from cost differences, doctors must be able to provide patients with adequate information on a drug's indications and effectivity., ". . . and I want it." Learn how to deal with this request, because you'll be hearing a lot more like it. Admit it. Those television, radio, and magazine [...]

The need to provide innovative health care services to patients has prompted medical institutions to adopt online information processing. Computer technology does not only allow medical practitioners to obtain access to various data files from video and audio sources real-time, but convert these information on screen as well. One of the most interesting electronic medical record systems available in the market is 'EncounterPRO,' a program that allows users to enter data and create medical charts by merely touching the screen., Physicians make a lot of excuses for not computerizing, most of which no longer apply. Meanwhile, the list of reasons to go electronic is growing fast. A hospital in Sarasota, [...]

An interview of physicians shows that they identify with comic-strip character Dilbert. They point to predatory insurance contracts, burdensome government regulations, health maintenance organization cost pressures, malpractice case threats and the inability to make decisions in group practices as their major source of disillusionment. A primary cure to Dilbertitis is to assume the role of a leader to avoid being victims of office politics., It's the compromisers rather than the individualists who tend to thrive amid the absurdities of corporate medicine. Here's how to adapt. Who ever thought that doctors would come to identify [...]

Large physician group practices can find doctors who will stay with them through careful screening and interviewing. The key is to determine whether the practice needs a doctor and develop a hiring strategy based on the results of this evaluation. During the screening process, it is important to look at the personality traits of the candidates to find out whether they are compatible with the company in many ways. Another smart strategy is to carefully examine the background of the doctor to uncover any bad records., Finding new doctors for large group practices has gotten as complex as gene therapy. Professional headhunters increasingly turn to sophisticated tools such as computer databases and Internet advertising to fish [...]

The coming of a child in the family requires certain financial moves. Rearing one child, on the average, costs approximately $437,881 not including college tuition. Expecting a child thus mean expecting more expenses. The decision to continue or become a two-income family should be made with careful consideration because this decision has great financial impact. Health insurance coverage should be made sure to include maternity benefits and policies should be thoroughly checked to know what they do and do not cover. Tax angles of child care should also be considered., Children are priceless. Raising them is another matter. The US Department of Agriculture estimates that a baby born in 1997 will cost its parents $353,130 to rear through age 17 [...]

FPA Medical Management made big promises, failed to deliver, then hightailed it to bankruptcy court. Now these doctors are struggling out of the rubble. Keith Gladstien, a pediatrician in Santa [...]

Newly wed couples should incorporate financial planning into their lives to avoid domestic problems associated with money. Making a list of assets and debts is needed to determine how income will be managed. Individual assets that were brought into the marriage do not automatically become conjugal property. Keeping track of purchases and payments should also be shared by a couple. Bearing these in mind, the value of communication should not be overlooked for the continued harmony of the marriage., "I, Sue, take thee, John . . . for richer, for poorer." As the traditional marriage vow suggests, money plays a major role in the union of husband and wife. [...]

Physician groups have to devise ways of dealing with older doctors who may either want to lessen their call duties or reduce their working hours. Some physician groups have solved the problem by offering doctors aged 62 and above with fewer working hours and call duties. Others offer a minimum of 20 working hours in exchange for a lesser share of the group's earnings. Others deal with doctors who refuse to retire despite physical or cognitive regression by negotiating a new employment contract that is renewed annually., Senior physicians - both those who want to slow down and those who refuse to - may need help in getting off the fast track. Outfitted in scrubs and hunched [...]

Medical education has gone beyond the days when medical students could see patients only on their third year. Courtney Apple, a second-year student at Case Western Reserve University School of Medicine, had already participated in a birth delivery on her first year. Prior to that, she analyzed the mother's urine sample and rubbed an ultrasound wand on her stomach to listen to the baby's heartbeat. Caring for a patient early is just one of the innovations in her medical education. She is also learning why certain therapies cure patients and how much they cost., Medical education has changed dramatically, but today's students and residents share one thing with their predecessors: the desire to heal. For decades, first-year medical students have dozed during lectures on [...]

Medical bills until the 1940s were paid directly by patients to their doctors. However, doctors were paid farm produce by poor patients who do not have the money to pay their bills. A 1939 cartoon in 'Medical Economics' shows a doctor being paid in blueberries. The establishment of Blue Shield plans for auto workers during the period signaled the arrival of affordable medical care for the US' working class. Although many doctors initially resisted the idea, health insurance enabled them to collect fees they otherwise would not have been able to do so. The same thing happened with the passage of Medicare but as internist Michael Karl admits Medicare made a lot of doctors rich., Once, patients paid their doctors directly; sometimes in berries. Then third parties came along, and physician income increased - but at a price. In the early 1940s, Michigan doctors faced [...]

Doctors who have attitude problems need to be disciplined and rehabilitated by the profession since they do not only make themselves easy targets for lawsuits but also the medical group to which they belong. Clinic and hospital employees as well as nurses are no longer docile to accept any abuse from doctors and they have become more assertive of their rights. Medical groups should create a complaints committee which will serve as an alternate forum for aggrieved parties who would otherwise resort to legal means.

Uncollected accounts receivables can eventually pile up and lead to bankruptcy for medical practitioners. Doctors are advised to keep tabs on their practice's financial reports which can be easily managed with the use of software packages such as Medical Manager or Medic. Proactive steps such as review of monthly financial summaries, tracking adjustments to gross income, assessment of overdue unpaid bills, and utilizing collection agency reports are also recommended., A few simple reports can keep you in the know about your accounts receivable. Insist on seeing them. At many groups, a gnawing uncertainty lurks in the backs of most [...]

The waiting room of a medical office or clinic must convey an atmosphere that is comfortable for patients. Physicians must create waiting rooms whose features, including art and light, remind patients of their own living rooms. Effective waiting rooms allow patients not only to pick up interesting information but also to know the background of the doctor who will attend to them. Proper use of colors also enhances the overall ambiance of waiting rooms., If you're backed up or overbooked, give your patients sometime to do other than look at their watches, leaf through old magazines, and fume. Do you enter your office through [...]

Unhappy physicians are turning to labor unions to reclaim their profession. But first they must confront employers, antagonistic laws, federal investigators, and their own biases. Like millions of other workers, [...]

Cost-cutting measures can be employed by group medical practitioners who are in a financial quagmire. Instead of laying off partners or clerical staff, a group may consider shifting their employees' working hours to prevent the problem of overstaffing and understaffing. Employees must be assessed for their abilities to perform part-time and full-time work. Moreover, reducing unnecessary services such as cleaning and eliminating excesses in inventory can be effective cost-cutting measures., A sudden drop in revenue requires emergency measures. Here how to trim outlays without hurting your recovery chances. Your group has just lost a key managed-care contract. Suddenly, one out [...]

Midlevel providers (MLPs) such as physician assistants, nurse practitioners and nurse midwives can be used by group medical practices to improve their productivity, enhance patient satisfaction and reduce expenses. MLPs can be relied on to take care of routine health problems and may even deliver babies in the case of nurse midwives and physician assistants. The only problem seen is that the patients who are easy to treat are taken away from the doctors., Physician assistants, nurse practitioners, and nurse midwives can boost productivity, improve patient satisfaction, and even save you money. The parents thought their fussing 10-month-old girl had an earache, but pediatric [...]

The Internet provides several practical benefits for medical practitioners. Physicians who have their own Web sites can educate their Netsurfer patients on health-care informations by posting health-related articles and answering patients' E-mail queries. They can also become efficient in related trends such as having access with electronic medical records and telemedicine. Moreover, Web sites can also help them retain current patients and attract new ones with their improved services., Your own site on the World Wide Web can help you attract new patients, retain current ones, and increase office efficiency. And it doesn't cost a fortune. An ad in [...]

The Physicians Aid Association and Physicians' Home provide financial assistance to doctors and their families. These groups are funded by donations from other physicians. Physicians Aid spent $95,000 in financial support for applicants in 1996, while Physicians' Home spent $335,000 to help about 60 families. Applicants range from widows to recovering addicts., Careless retirement planning, bad investments, failing health, or a bout with drug addiction can wipe out a physician's finances. These organizations lend a hand. If you liken wealth to health, [...]

Proper design of a medical facility is dependent on the selection of an experienced architect. They are more likely to consider issues such as positioning of nurses' stations and avoiding recirculation of contaminated air. Collaboration between architects and physicians also prevents design flaws that may prevent safe, efficient patient service., Stick to the pros, ask the right questions, and avoid easy solutions. After all, you're going to work there for a long time. How's this for a new surgeon general's [...]

A group of physicians in Rockford Health System has organized a union that would serve as their grievance representative. The Rockford Physicians' Council vowed never to jeopardize patient care by striking. Its goal is mainly to sit with the health system to come up with a possible collective bargaining agreement. Once the table is set, the council's task is to see to it that they would be granted more democratic management structure., Are they extremists? Or simply desperate? In either case, a doctors' union illustrates the sour side of practice acquisitions. In 1994, when Rockford Health System acquired the 80-doctor Rockford Clinic [...]

Business meetings held within group medical practice are part of each partner's legitimate work. It can be productive and significant if proper strategies are applied before, during and after the meetings. Meetings must have the proper agenda and specific objectives to avoid confusion and waste of time. The length of time for the meeting must be strictly followed to prevent unnecessary delays. Objections and approvals to a specific topic must be noted to avoid unnecessary and repetitive discussion., Which would you prefer: root-canal work, or sitting through another meeting? If you chose the root canal, read on. These tips can make your meetings shorter and more productive. Monday, [...]

Financial management of group medical practice can be improved by applying strategies acceptable to all associates. Drawbacks related to extreme frugality and austerity must be emphasized and explained as counter-productive factors in the practice. Performance of cost-benefit analysis and presenting it as an effective way to improve the practice can lead the way for the acquisition of much-needed equipment and hiring of the best qualified staff. Persuading a senior associate on the benefits of intelligent business spending is an additional advantage., Too few phone lines? Not enough staff? Penny-pinching management? Here's how to make the case for fiscal sanity. It's bad enough that HMOs cut costs to the point of degrading [...]

Time management serves an important function in helping physicians meet the requirements of their jobs. With the increasing focus on managed care, physicians need to budget their time properly for their personal and professional activities. Time management begins by identifying top priorities which should be translated into an organized daily plan. This will help physicians be constantly reminded of the things that requires immediate attention., In this age of too many things to do, time-management gurus teach not only how to be more efficient, but how to focus your energy on the truly important. Seven [...]

Problems arise in the division of overhead costs within multispecialty organizations when some specialists usually receive fewer expenses than primary-care physicians while grossing much more. Several suggestions to divide overhead properly for the benefit of all are presented, such as, the use of single-specialty practices which utilize the simplest expense and income arrangements due to physicians' similar practice patterns, and the introduction of cost accounting as a method to increase the category of direct expenses to include as much overhead as possible., The 23-doctor San Luis Valley Medical Clinics in Alamosa, Colo., has sliced the overhead pie almost every way imaginable. And fingers have been nicked in the process. In the late [...]

The Hopedale Medical Complex in Illinois boasts of a family of doctors dedicated to serving people and bringing 21st-century health care within the reach of the rural community. Anesthesiologist Lawrence Rossi Sr. was responsible for the medical center's establishment in 1955. His children carried on his legacy, with most of them rendering their services at the medical center. Training became an important tool for the Rossi children in pursuing their medical careers and serving their rural community., The scene was a bilateral renal artery bypass, but it resembled a family reunion. Actually, it was just business as usual for the Rossi clan of tiny Hopedale, Ill. Anesthesiologist [...]

Group practice has its downsides as seen from the experience of Generations Health Care, a group of Ob/Gyns in St. Louis, MO. The group was formed to improve the doctors' prospects of increasing their revenues. However, it failed to realize its financial objectives, thus resulting in an exodus of doctors to seek better opportunities elsewhere. Ex-members consider mismanagement as a major reason why they decided to leave group practice. With operations now in the hands of HealthLine Management Inc, the group aims to improve its growth potentials., Generations Health Care, a group of St. Louis Ob/Gyns once 30 strong, was barely a year old in April 1996 when five doctors exited as if fleeing from a burning [...]

Giant automobile manufacturer General Motors Corp. (GM) is emerging as one of the leaders in educating physicians on quality data and health care costs. Physicians are divided over their reaction to the innovative move by the company whose revenues reached $164 billion for 1996. Some physicians have accepted GM's efforts to help them provide quality care at minimal costs while some accuse GM of trying to reduce its employees' health care expenses which totaled $4.8 billion in 1996., The carmarker hopes to apply to medicine the lessons it so painfully learned from its Japanese competitors. There's a giant organization aiming to lower the cost of health care while [...]

Learning from their predecessors' missteps, these IPA s are determined to avoid dominance by hospitals and specialists. They're making primary care their top priority - and beating insurers at their [...]

The issue of informed consent takes on a new perspective based on the lawsuit filed by patient Donna Johnson against neurosurgeon Richard Kokemoor for the latter's failure to properly disclose his aneurysm surgery experience's complication rate, which caused serious damages to the patient. Furthermore, it was revealed that Kokemoor's previous aneurysm surgeries entail lower risks compared to what was required for Johnson. Since he did not consider the risks involved and should have instead referred the patient to a more experienced surgeon, his liability was further strengthened., That will happen if this important verdict sets a precedent. The case also has implications for referrals and physician training. Donna Johnson was in a preoperative room at Sacred Heart [...]

A research done on medical malpractice emphasizes that honesty and admitting a mistake are still the most effective way of avoiding malpractice litigation. Other cases have proven that hiding a blunder or not telling the truth to patients often encourages them to sue in order to know what really happened. Laying out the facts and explaining in detail what really occurred would increase the probability for patients to understand while still preserving the solidness of the physician-patient relationship., Clamming up only increases the odds a patient will sue. But there are good ways and bad ways to say you're sorry. You're a good doctor. But you're also human. [...]

Physicians sometimes find themselves in hostile situations where their managed-care patients accuse them of holding back required care for financial gains. To avoid such occurrences, doctors should learn how to empathize with their patients and develop a trusting relationship right from the first meeting. They should also uphold their professional values, spend time to educate their patients and listen carefully. These guidelines result in a friendlier atmosphere in the age of managed-care., He thinks you're withholding necessary care for financial reasons. How do you tell him the truth? Here's a lot of good suggestions. It was a fairly routine case, Seattle FP [...]

Physician groups that want to raise capital but do not savor the idea of giving up control to hospitals through physician-hospital partnerships should consider a direct public offering (DPO). This practice is a financial tool that enables a company to issue stock without incurring costs usually attached to going public. Doctor groups that intend to make a DPO should actively market the stock because failure to do so may makes the initiative unsuccessful., Using a Wall Street firm to issue stock will cost your group a bundle. Here's an economical alternative. While some doctors have successfully raised money from their hospital without giving [...]

Carle Clinic Assn. in Urbana, IL, has drastically reduced the volume of telephone inquiries received by its 300 member-doctors through its Patient Advisory Nurse Service. Under this system, doctors take only about 5% of patients' calls while the rest is handled by telephone-triage nurses. These nurses serve callers by referring them to the right doctors, sending to the urgent-care center when necessary, suggesting home remedies or making clinic appointments. The nurses do not make medical diagnoses, write prescriptions or interpret test results. The system gives doctors more free time., A time-tested triage system at this Illinois clinic relieves the physicians of dealing with thousands of inquiries. "I've had this headache and sore throat for a week." Joel McCrary (not [...]

A new breed of patients is showing up in doctors' offices, elbowing aside those who quote from medical books and magazine articles. These new set of patients claim to have been educated on the Internet through health-care sites offering a wealth of medical information. Patients with Internet access can easily get hold of peer-reviewed articles that doctors read in medical journals or medical knowledge from sites of health-care groups such as the National Cancer Institute and the American Academy of Child and Adolescent Psychiatry. This information revolution allows patients to take responsibility for their well-being and reduces the burden on physicians., The Internet has put a wealth of medical information at patients' fingertips. That's both good and bad. When Tom Ferguson was a medical student at Yale in the mid-1970s, he [...]

The size of a medical group affects its internal culture. A medical practice group composed of not more than seven doctors can easily gather and make decisions together. On the other hand, a group composed of more than seven doctors is difficult to gather for meetings and management issues are handled by executive committees. The 'intentional' group is the ideal group because it stresses teamwork, shared leadership and open communication., Just as in the corporate world, your workplace likely has its own distinct culture. Here's a look at how that colors your practice and your life. Internist C. Raymond Fernandez, [...]

Physicians may consider hiring professional business brokers once they have decided to sell off their practice. These brokers may help identify the right hospital, insurer and practice management company to buy the medical practice. Moreover, they can provide many other services that doctors may find useful in selling their businesses. However, these physicians should be careful in choosing a broker because business brokerage is largely unregulated and attracts incompetent people., Possibly, but seller beware. Business brokerage is largely an unregulated field, and the big money attracts new people who aren't necessarily competent. Meet A.T. "Fred" Zirkle, a business broker in [...]

Call schedules in a medical group practice need to be managed well to avoid giving doctors additional stress. Participating doctors should be apportioned an equitable share of patient calls to ensure fair financial opportunities. With salaried doctors, this problem has been partly solved. Scheduling, nevertheless, should be flexible so as not to unduly burden doctors who may be unfortunate to be assigned midnight calls., Call duty can impose a heavy, unequal burden. These groups use flexible scheduling and other ways to make it more palatable. One of the lures of group practice is being [...]