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Reimbursement Rates: Don’t Settle for Less

As with anything in the healthcare industry, reimbursement rates are constantly in flux. New providers are often caught between the urgency of signing contracts in order to expand their patient base and the time it takes to negotiate fees(1) that accurately reflect their experience and talent.

Lack of experience can definitely be a liability when it comes to negotiating power. Results are what providers need to prove their value to insurance networks. However, providers can’t get results without being part of a network. Lacking results, a provider’s next best asset is data. Do some homework on your available network options, also taking into consideration providers in both similar and parallel specialties. A strong medical network works just as a strong social network does: it’s who/what you know and who/what they know.

Reimbursement rates are influenced by more than a single physician’s skill. The entire office staff is a reflection of what the physician is worth, including any advance practice providers (APPs), such as PAs and APRNs(3), that support the registered physician. The office’s reputation, clinical quality, professionalism, and patient satisfaction are all measurable components that can help you make an argument for increasing your reimbursement rates every time your contract is up for renegotiation. Keep in mind that insurance companies have their own competition to ward off, and every provider that they can depend on in their provider counts is an asset in their marketing arsenal too.

Our partner, SE Healthcare, has published an insightful piece, titled “Positioning Your Practice to Negotiate the Reimbursement You Deserve from Payers.(2)” This ebook explains strategies to uncover missed opportunities and grow your revenue by maximizing reimbursement rates.

Contact us(4) today so you can take advantage of the benefits of your CARE membership to utilize the expertise of our partner, SE Healthcare. They will help you assess your current reimbursement rates and formulate a strategy to maximize your current reimbursement contracts.

Footnotes

  • https://blog.evisit.com/how-to-negotiate-higher-physician-reimbursement-rates
  • https://www.sehealthcarequalityconsulting.com/download-ebook-positioning-your-practice-to-negotiate-the-reimbursement-you-deserve-from-payers/
  • https://www.physicianspractice.com/article/pas-deserve-direct-reimbursement-their-services
  • https://care-ins.com/contact/

The Fine Line Between Supervision and Accountability

In an earlier blog, we discussed the Swiss cheese model as it relates to risk management in healthcare. Today’s article takes a deeper dive into the element of supervision in that model, especially as it relates to Advanced Practice Providers (APPs). These APPs are generally defined(1) as professionals with advanced training, such as Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs). A practice itself might employ APPs or managing physicians may simply have supervisory responsibilities due to contractual arrangements directly with APPs or with facilities that use APPs. In either case, APPs are able to practice independently of physicians(2).

As this video explains, APPs are essential to professional practices in that they assist with provider workload and help keep costs down. Any office that is inundated enough to outsource some of its workload to APPs runs the risk of miscommunication, inadequate care, adverse events, and subsequent litigation. This resulting litigation could potentially involve both the supervising physician and the APP. That is why it is immensely important to outline the scope of the APP’s responsibilities, taking in to account their experience and ability to make judgement calls in the absence of the supervising provider.

The RiskFit helpline, managed by OmniSure, serves as a vital resource to CARE Professional Liability Association members. The professionals that operate this helpline can answer questions about the following:

  • Developing a collaborative provider/APP agreement
  • State-specific laws regarding APP scope of responsibilities
  • Hiring protocols
  • Proper risk reduction audit procedures
  • Capturing patient satisfaction metrics

All of these aspects of APP employment need to be carefully planned and documented to avoid potential litigation issues. The partnership between CARE and OmniSure puts a wealth of expertise at your fingertips to help you fill the holes in your risk management plan so that it does not turn into a block of Swiss cheese.

Contact us today if you have questions about whether your plan provides coverage for the APPs in your practice. Laws vary based on the state where you practice(2), and are constantly changing. Put our expertise to work for you in designing a coverage plan that perfectly suits your business.

Footnotes

  1. https://www.forbes.com/sites/realspin/2017/03/16/advanced-practice-providers-are-key-to-americas-healthcare-future/#2c8596759985
  2. https://www.studergroup.com/resources/articles-and-industry-updates/insights/august-2016/optimizing-the-value-of-advanced-practice-provider
  3. https://www.healthleadersmedia.com/clinical-care/aprn-and-pa-scope-practice-rules-draw-fire

Losing a Provider: Ensure Proper Recordkeeping

Providers change practices every day, so it’s important to have a policy in place to provide guidance for patient care and records retention. A formal policy could include the following elements(1):

  • Notify patients of provider’s departure (state laws vary as to whom the responsible party is for this notification, as do details of what to include in the notice; check with your legal counsel for specifics of your situs state)
  • Instructions for contacting departing physician (if still practicing medicine)
  • Contact information at existing practice for reassignment to another provider
  • Instructions for requesting medical records

Most importantly, the policy needs to be communicated to existing staff so that there is no disruption in continuity of care.

Managing the affected patients is only one aspect of provider departures. When it comes to medical records(2), a policy should specifically outline these elements:

  • Exact end date of departing provider
  • Specific party responsible for transferring and archiving records
  • Which party is responsible for contacting affected patients
  • Updating new provider with relevant medical history of patients

Don’t rely too heavily on electronic recordkeeping, though. Nothing beats the trained eye of a professional. Electronic health record (EHR) systems(3) are only as thorough as the data that a person has entered into the system. Mistakes and oversights are just as likely to happen on a computer screen as they are to happen on paper. While EHRs save time, space, and headaches, they might also be managed with great care upon a provider’s departure from one practice to another. Fastidious record keeping is even more important in the event of retirement or death.

If you would like additional guidance in developing these types of policies for your practice, look to other sources, such as HIPAA guidelines, payer contracts, and federal programs such as the Centers for Medicare & Medicaid Services (CMS) (4).

Contact us today. We can help you formulate these types of policies to ensure that they mitigate your risk from future litigation.

Footnotes

  1. ECRI.org
  2. ama-assn.org
  3. physicianspractice.com
  4. cms.gov

CARE partners with SE Healthcare

At CARE Professional Liability Association, we partner with companies that not only help our members, but also understand the healthcare industry and its specific challenges. Our latest partnership with

SE Healthcare provides additional resources to help our members improve operational performance.

SE Healthcare’s Physician Empowerment™ Suite, a set of high-impact data analytics tools, leverages key performance metrics to help practices increase revenue. This is accomplished through enhanced reimbursement negotiations, coupled with an improved industry reputation, once providers have the power of analytics backing their performance.

Other tools provided by SE Healthcare include:

  • Patient Experience Platform
  • Five-Star Reputation Tool
  • Clinical Effectiveness Platform
  • Long-Term Care Assessment
  • Reimbursement Effectiveness™ Platform
  • Physician Burnout Prevention Program
  • Performance Improvement Tools

Both CARE and SE Healthcare understand the intricacies and inherent risks involved for healthcare providers because both companies were built by people with intimate knowledge of the industry. This not only includes physicians, but also top minds from the legal and compliance fields, as well as professionals who continue to shape the future of healthcare. You get the benefits that the years of experience this collaboration creates, including what we have learned from past mistakes, and best practices we’ve developed.

In future partnership blog articles, we’ll discuss the multitude of benefits that providers can gain from SE Healthcare’s analytics tools, including:

  • Getting fair reimbursements from payers
  • Making your practice more attractive to networks
  • Improving your reputation and transparency to convert website visitors into new patients
  • Retaining current patients by creating a better patient experience
  • Enhancing the workplace culture for physicians
  • Enhancing patient engagement and satisfaction
  • Addressing critical issues like physician burnout, quality, and safety

Contact us today for more information about how this CARE/SE Healthcare alliance can benefit your practice.

Is Technology Helping or Hurting Your Litigation Chances?

The advent of electronic health records (EHRs) can only be a positive thing for patient care, correct? Maybe not. And EHRs would certainly prevent a number of malpractice suits, right? Guess again. While vast improvements in healthcare technology, including EHR adoption, create synchronicity among providers and streamline care delivery, errors within these systems create the potential for risk. In fact, medical liability claims with an EHR as a contributing factor are on the rise(1).

The risks with any new technology are twofold:

  • The potential for user error increases: Proper training is paramount to avoiding mistakes and issues
  • New software applications are rarely without technical glitches: Stay abreast of upgrades and patches, and have an experienced technical team (either in-house or through an external vendor)

Another common factor with increased electronic solutions is user burnout(2) – wherein healthcare staff tire of spending more time inputting data than they do actually caring for patients. Any system, no matter how sophisticated it is, can only be as good as the data it captures. It can’t think, and it can’t do a healthcare provider’s thinking for them.

One way to ensure that EHRs are accurate is to institute an official audit schedule. While this includes confirmation of edits/additions to records, it should also include an audit of the application itself to ensure the latest updates are downloaded and running properly. The best way to instill a sense of importance around any EHR audit is to garner involvement at every level of the practice. This includes proper training, proper audit authority, and proper incentives for successful EHR implementation.

Even seemingly foolproof technology can fail. If (when) it does, be sure that your practice is prepared to mitigate the potential damage. One important piece of the plan is having proper medical malpractice insurance in place(3). It’s important to understand what your policy covers before you need it. Your agent can educate you about the different policies available(4) and the best risk management plan for you.

Contact us today if you have questions about the risks associated with electronic health records and other technology in the healthcare industry. Our years of experience can help you decide which professional liability plan works for you.

Footnotes:

  • https://www.medicaleconomics.com/news/your-ehr-malpractice-risk
  • https://www.the-hospitalist.org/hospitalist/article/121825/potential-dangers-using-technology-healthcare
  • https://www.iii.org/article/understanding-medical-malpractice-insurance
  • https://www.naic.org/cipr_topics/topic_med_mal.htm

Signed Consent: Does it Prevent Litigation?

Many healthcare professionals believe that a signed document equals informed consent, and that no further documentation is necessary. While that theory is basically true, there is definitely a difference between theory and practice. The obligation (in both the ethical and legal sense) to fully inform patients of the risks, benefits, and alternatives to treatment falls to the treating provider. Informed consent is best described as a process, not a single document. Patients must demonstrate their understanding of the treatment being pursued, as well as an explanation of both the provider’s and the patient’s roles in the treatment, as well as the risk of addiction to the medications prescribed.

Consider our recent case study(1) involving a patient who allegedly died of a prescription overdose because the plaintiff contends that the multiple providers he sought treatment from were negligent in monitoring his conditions and medications. Reading through the documentation, it seems that no single provider was aware of the patient’s entire medical history, nor his current medication intake. And while the patient provided informed consent about the possibility of drug interactions to multiple providers, the seriousness of the situation did not appear evident to all involved parties, including the providers and the patient.

CARE Professional Liability Association and OmniSure Consulting Group(2) suggest the following steps to reduce your professional risk(3):

  • Customize consent forms to be as procedure-specific as possible; generic forms are too generalized to communicate proper information
  • Document the entire consent process in the patient’s medical record, including the conversation with the patient and specific questions they asked and how they were answered
  • Create policies and procedures outlining who specifically can obtain informed consent
  • Audit medical records periodically to validate that documentation and informed consent processes are being followed correctly

Patients might be too embarrassed to ask questions about the procedure, or might not even know what to ask if they don’t understand the consent form. Or they might feel rushed, or simply downplay the consent form’s importance. It’s our job as healthcare providers to make sure patients are comfortable enough to ask pertinent questions so that their consent is not simply a signature, but a complete understanding of the treatment they receive.

Contact us today. We can help you develop an informed consent documentation plan that works for both you and your patients.

Footnotes

  • https://care-ins.com/case-studies/
  • https://www.omnisure.com/
  • https://www.riskfitness.com/informed-consent-recommendations

CARE Joins Forces with Digital Surgery

At CARE, we strive to partner with other industry leaders who can bring high-quality, meaningful contributions to our members. In the spirit of that goal, we have joined forces with Digital Surgery, a leader in simulation training, surgical video management and storage, and automated surgical analytics. Digital Surgery’s award-winning mobile application Touch Surgery houses more than 200 surgical simulations across 14 specialties, and its content library is continuously growing. The company’s latest offering, Touch Surgery Professional, offers secure video storage and management, automated analytics, annotation tools, and sharing capabilities for peer review and training purposes.

Together, CARE and Digital Surgery offer unique benefits to members that make coverage through CARE an even more invaluable investment. For example, qualified* Touch Surgery Professional (TS Pro) members can receive up to 10% off their CARE insurance policy. Another benefit of combined membership is knowledge exchange, which grows exponentially as members exchange ideas, solutions, and best practices via the TS Pro platform.

Digital Surgery’s goal is to utilize digital technology to empower surgeons and surgical teams all over the world to create safer, better outcomes. Like many of us in the healthcare field, Digital Surgery wants its tools to help increase knowledge and improve the delivery of surgical care across the globe. 

Contact us today. We can help you maximize your membership through our collaboration with Digital Surgery. Working together, we bring these industry-leading tools and resources to you to optimize your and your team’s training, shared learning, and performance in the operating room. 

*Qualified Digital Surgery members are those who have signed up for the Touch Surgery Professional offering, available for $999 for an annual subscription. This subscription provides access to (1) all of Digital Surgery’s publicly available CG and video-based simulations, (2) Digital Surgery’s video upload and storage platform, with automated analytics for selected procedures, (3) tools to annotate videos; add instruments, notes, and assessments; and to share with colleagues or trainees for peer review or training purposes. A minimum of 50 surgical videos are required to be uploaded annually to the Touch Surgery Professional video platform in order to remain eligible for the CARE insurance premium discount.

Agents: Educate Both Yourself and Your Clients

Brokers and agents act as the liaison between medical malpractice insurance carriers and healthcare providers (including doctors, ARNPs, surgeons, dentists, behavioral health professionals, etc.). As a liaison, it’s important that you understand the complexities of this type of liability insurance. Some of your clients might be just out of medical school, or working as a subcontractor, or are going into business for themselves and no longer under the umbrella of a hospital policy. No matter their situation, your main goal is to educate your clients.

How can you help them decide which policy is best for them? Some key elements to discuss with them include:

  • Point out whether a policy covers bodily injury, property damage, and/or liability for personal injuries. And if so, what are the coverage limits? Be sure to note that per-occurrence and per-policy limits are two separate dollar amounts. Outline any conditions and exclusions so there are no surprises should your client be sued.
  • Know your state’s minimum requirements for insuring specific types of practices. Surgeons and OB practices have more risk potential, and therefore, need stronger risk buffers.
  • In addition to state minimums mentioned above, ask your clients how risk-averse they tend to be. How comfortable are they with lower policy caps? You don’t want them losing sleep at night (and calling you!) when they could simply make some policy adjustments to match their comfort level.
  • Discuss potential litigation costs, and specifically which legal expenses are covered by the policy.
  • Outline differences in reporting periods. Basically, they have two options: claims-made policies or per-occurrence policies.

Considering that a majority of healthcare professionals will face at least one medical malpractice lawsuit in the course of their career, their liability coverage is an important part of their success. Aligning your clients with proper coverage ensures success for both you and them.

Contact us today if you’d like to learn more about becoming an agent for CARE. We place a strong focus on serving the needs of our agent/broker network and would love to discuss partnering with you.

Adverse Anesthesia Events: Are They Inevitable?

Statistically speaking, anesthesia-related deaths are very rare: only one death is reported per every 200,000 – 300,000 events. But as with any medical procedure, there is room for improvement, including more stringent monitoring techniques and widespread adoption of best practices. Both of these suggestions can pave the way for standardized procedures to make that statistic even smaller.

The leading causes of anesthesia-related issues include:

While not all adverse events result in death, serious issues can arise, such as brain injury, brain death, increased cardiac and respiratory complications, prolonged hospital stays, and necessary mechanical ventilator support.

Patient knowledge, consent, and comfort are important factors in anesthesia care. Thoroughly discussing techniques, risks, and outcomes with patients encourages candid dialogue about patient history, current physical constraints, or even mental illness that may affect certain modes of anesthesia. Setting the proper expectations for patients creates an environment of trust and confidence in their providers.

In the unlikely event that issues arise, immediately document every aspect of the incident. While this includes a thorough description of technical events, don’t overlook the importance of engaging relevant consultants, such as neurologists and radiologists. Professionals from other disciplines can provide valuable third-party insight in determining cause and effect.

CARE members also have valuable resources at their disposal, such as the RiskFit helpline (available compliments of CARE’s partnership with OmniSure). This helpline can answer questions and provide guidance on how to best mitigate the risk arising from adverse events. The RiskFit helpline garners best practices from the volume of information it collects on similar events. Coupled with the experience level of the associates that provide consultations, this information helps members decide on the best course of action specific to their situation.

Contact us today if you would like more information about the benefits of joining CARE, or would like to see how the CARE/OmniSure partnership can benefit you too.

The Case for Case Studies

As a medical provider, you know the inherent risk and likelihood of unforeseen adverse events. You may need advice when these situations unfold. CARE, through our partnership with OmniSure, offers a helpline specifically for such issues. The helpline assists with questions about specific incidents, risk mitigation, and regulatory-related issues.

We then use the information gathered from our helpline to develop case studies, which in turn help our clients navigate the waters of incident reporting and risk mitigation. The aggregation of this data, coupled with our extensive experience, provides clients with examples, solutions, and best practices of clients that have been in similar situations.  

In this and future posts, we will explore case studies, and how learning from them helps our clients prevent future claims. As an example, this case study outlines a lawsuit wherein the plaintiff alleges that her husband died as a result of a prescription overdose after seeking care from multiple providers – including independent physicians, supervised nurse practitioners, independent advanced practice providers, and specialty clinics – who were negligent in the treatment and monitoring of the patient and his condition. While this case has not been settled yet, it does remind providers of the importance of completing a thorough patient history, as well as patient follow up.

We all make mistakes, in both our personal and professional capacities. To err is human. If you have patient safety or risk management questions, or need guidance after a potentially litigious event, get the guidance of a clinical risk specialist. Don’t go it alone. As a CARE policyholder, you have access to confidential advice-on-demand from a third-party firm that specializes in helping avoid litigation by protecting your patients, your license, and your reputation. Click here for more information.