pediatrician

This just in from the NICHQ folks:

Finding successes and highlighting them gives hope and promotes new thinking--two major reasons that pediatricians and family physicians, nurses, public health professionals, managers, and parents attend the Annual Forum of the National Initiative for Children's Healthcare Quality. In my presentations at the NICHQ Forum I would like to highlight important, successful improvements (programs/activities/events/policy changes/institutional commitments) in the performance of the children's health care system or innovative ideas with great potential that have come to light over this past year...if you know of any, or have been involved in any, please tell me about them, and I will follow up with you to get more information!

Please send me an e mail (title: Top 10 Improvements) with your improvement story (or lead) at hidden@email-address. If you could let me know by February 1st, 2008, that would give me a little time to follow up and get more information.

Thanks so much!

Charlie Homer

Charles Homer, MD, MPH, CEO
National Initiative for Children's Healthcare Quality
20 University Road, 7th Floor
Cambridge, MA 02138

You can reach him at hidden@email-address

I was 3/4 of the way through a follow up piece on the Physician's Practice Reimbursement Survey when I realized that some of the data is so goofy that I ought not really say much about it. That is, I can't really reach a conclusion about Pediatric Surgeons averaging $5 for 99212s through 99215s.  Is that actually possible?  I don't think so.

I hope to have time to post a good RVU calculation message this afternoon but, before I do, I wanted to share an excerpt from a PedTalk message this AM.  It comes from Dr. Lessin, with whom I often enjoy disagreeing particularly because we often actually share similar viewpoints.

I think the message below captures a growing vision of pediatrics-to-come, the dismay at the direction of the practice of medicine.  It's like [censored]ens' Christmas Story: this is the Ghost of Pediatrics Future.  Everyone whines about the "good ol' days" in just about any context ("When I was in school..." or "In 1956, the New York Yankees..." or "They call that music?"), but I really think we are heading towards a nadir of satisfaction in this profession unless there are some significant changes.
Anyway, here it is.

Unfortunately, with the emphasis on consumer driven health care, we are  becoming even more focused on what people want as opposed to what they  need.  Hospitals design their systems to appeal to the customer.  That is  good, except when it impedes the doctor's work flow and ability to provide  good care.  Patients come in demanding things that they have read about on the internet.  Sometimes, they are right.  Often they are wrong.  But since we are now a volume dependent business, we are terrified that they will go to someone who will give them what they want.  It is coming down to the fact that we might prescribe that useless antibiotic because the guy down  the street will do it and the patient will flame us on the net if we do not., and complain to the insurer about what an awful doctor we are.  It is a sad state of affairs.  I never thought that this profession would devolve  to the decision between paper or plastic.

Herschel Lessin MD

I don't agree with him 100%, but boy that's an excellent summary of the corner into which pediatricians have painted themselves.  Sure, it's easy to pick on the position he takes here (I think of that awesome scene from Malice with Alec Baldwin), but that would miss the point.

Need proof that this is the best pediatric practice management resource on the planet? Check it out.

Oh, first: major drama at PCC's office last night. Let's hope this post is the closest I come to being a war correspondent. I don't like the proximity of the event to yesterday's message about flooding.

I am feeling a little like the Winooski River, when it freezes over and then dams up, causing the water to overflow the banks and wreak havoc locally.

Today's missive has no practice management value.  It is pediatric related, though.

I travel a fair amount for work (how else would most of you know me?).  Which means I spend times in planes, airports, and hotel rooms.  As a result, in addition to my predisposition, I read a lot.

Most of the time, I try to read something of substance.  That is, I try to avoid the schlock...but sometimes, in between flights, you reach for the best seller lists and see what happens.  [Plus, I will admit, some of the schlock is a good break.]

I was coming back from El Paso two weeks ago and I picked up "Tell No One" by Harlan Coben.  It's not one of his Bolitar series, but a one-off about a widower who is suddenly struck with information that his wife may actually be alive.  Typical page-turning, made-for-movie material.  But not bad.  Turns out that it is a well-received French movie, now, too.

The interesting part, however, is that the protagonist is a pediatrician!  He practices at a clinic in "upper Manhattan."  Don't know if he's a pediatrician in the movie, but I have obviously read the "pediatric" moments of the book closely.  You won't be disappointed!

First one to ask me for my copy gets it.

I was on the phone yesterday with a client from Rhode Island who was taking the time to tell me about his practice's search for an EHR. To my surprise, they had flown down to visit another customer of ours in Tennessee to see what they thought of an installation with one of our EHR partners. They gave him some interesting advice: take your time. Even though the TN practice is happy and up-and-running with the EHR, they realized that it has taken them a year or more to figure out what, exactly, they want and expect from it. And that has cost them time and money. [Note: the EHR company in question has served them well; this is a classic practice management issue.]

Which makes me feel that I know what I'm talking about sometimes.

You see, a few weeks ago, I was honored to give a presentation at the VT AAP fall meeting. My discussion was entitled "Choosing a Pediatric Electronic Health Record". Perhaps it was "Preparing for..." In fact, I think I can use Wordpress to post the presentation. In any event, the fundamental point from the entire presentation is:

The single biggest and most common mistake practices make when choosing an EHR is to learn what they need after they purchase the system.

Look at that!

Now, many of you read this blog have heard me speak, but there are plenty of you who haven't. Although common sense and not false modesty tells me that I'm far from the world's greatest speaker, I think I'm often better in person than I am in writing. My brain seems to enjoy the challenge of making things up on-the-fly, which means I sometimes end up saying things in a presentation that I would have never thought to communicate in writing. So, there, in the middle of my talk, I blurted out:

Purchasing an EHR before organizing your practice and knowing exactly what to expect is like having kids to save a marriage. Sometimes it works, but it usually doesn't. And it's always more expensive.

Now, maybe that doesn't ring as true in the middle of a blog as it did 45 minutes into a lecture about the subject, but I saw the lightbulbs turn on in the eyes all around the room, so I thought I'd record that analogy before I forget it. And extend it poorly with some comment about birth control.

So, if you're shopping for an EHR - take your time and prepare. Want some suggestions? Just ask.

First, I have to be clear: my knowledge of the arcane RBRVS system, the RUC committees, CMS, etc., is all driven by my work for pediatricians. Thus, I have a very skewed view of how it works. Almost all of the changes to the CMS budget affect my clients indirectly and I have very little understanding of the big picture/politics of it all. Often, when I read through the RVU content, I gloss over big sections of important-looking information because it doesn't seem to apply to pediatrics. I don't know why I'm offering this caveat today, perhaps it's the GI bug I picked up from my kids speaking.

Anyway, the interesting news.

• There is language on the table to remove the scheduled 10.1% reduction and replace it with a .5% increase. However, there may be a related relationship to an expansion of the physician quality reporting system. No idea yet.
• There will be an extension of the 1.0 floor to the work geographic adjustment (the effects of the loss of which were heroically outlined par moi).
• Both of these changes last only until June, 2008, at which point the original proposals will be enacted. I think. We don't know, yet.

You can seem some other reactions to this news in obvious places, such as the WSJ. One thing I find interesting is that it looks like the language to make the changes above may be knowingly vetoed by GWB, but there are enough votes to override the veto. [This is a good example of what I talked about above.]

As the world turns!

We've been working on it for a long time (toooo long), but we are just about to officially release our Practice Vitals Dashboard service to PCC customers.

"Dashboard?" you ask. "What's a dashboard?"

You'll know them as soon as you see them. In fact, here's a quick sample of a piece of one:

This is a quick snapshot of just the initial graphical display of one of six benchmarks we hope to display to them at first (Revenue-per-Visit, E&M Distribution, RVU-Per-Visit, Pricing, Sick-to-Well ratio, A/R Days). The example above shows that the E&M distribution for this sample customer is 18.7%, putting them at the lower end of the "Good" scale.

Each of the benchmarks, like the one above, is "clickable" for more detail. Thus, you could log into pcc.com using your special login and would be immediately presented with your most important management measurements, complete with detailed explanations of the benchmarks, comparisons to other pediatricians around the country and in your region, and an historical view. It's really cool to click on a PCC customer and watch their Revenue/Visit rise every year. Actually, here's what it looks like!

Pretty cool, eh?

I mention all this for a couple reasons:

• We are going to make some very simplified versions of these benchmarks public as part of our new pediatric resources WWW site (more about that later). You won't be able to find this information anywhere else.
• P CC customers will have access to more than I am describing here - super cool.
• PCC customers who are also part of our "Practice Advancement Plan" will receive the Advanced Practice Vitals Dashboard, which will include many more benchmarks as well as the ability to drill down like crazy. You want to know your RVU-Per-Visit for Doctor X in 1999? Click it!

Obviously, all of these reports are available in our system and our clients can run them at any time on their. This service exists for the majority of physicians who don't have the time or inclination, however, to do that. We think it will go over pretty well!

Any suggestions for benchmarks welcome!

I've always appreciated the effort some of our clients to participate in medical missions. Dr. Stoller did a presentation at our Users' Conference last summer about her experience and people were blown away. So, when I came across this request for pediatricians, I wrote to Dr. Braico and asked her to give me a quick message to post. Pass the word.

The Glens Falls Medical Mission (www.gfmmf.org), serves people in the same community, Nueva Santa Rosa, Guatemala, twice each year for a week. We will see over 2000 (sometimes nearly 3000) patients in 5 days, and provide medical, dental, gyn, and pediatric care. We bring our own pharmacy with us, we provide dental prophylaxis for children, we partner with Gautemalan NGO's, we provide education for local Public Health MD's and RN's as well as the fire-rescue personnel and midwives. We will be working with Rotary to bring clean water to the surrounding villages.

All volunteers pay their own way, $550 covers room, meals, ground transportation and security costs. Airfare is up to the individual (although we work with a travel agent for those who wish). We like to have about 4 pediatricians if possible. We will work together in one room. We give the providers a book we have written, called Syndromic
Management, which helps you to learn what kind of diseases you will see, and how to treat them.

Our spring mission will be April 18-26, 2008. We are looking for doctors and mid level providers in pediatrics, general medicine, gyn, and dentists. We also need pharmacists, nurses, Spanish translators, podiatrists, dental hygienists. We take a limited number of people who are general volunteers, we call them ATV's (all terrain volunteers!).
They do crowd control, team hydration, fluoride varnish on teeth, etc. Applications can be downloaded from the web site, and the deadline for April is Jan. 15, 2008. There will also be another mission in late October, 2008 (exact dates will be posted by the summer.)

Questions can be addressed to me, Kathy Braico, MD at hidden@email-address.
Hope some of you are interested!
Happy Holidays, and thanks for posting this!
Kathy