E-mailing With Patients: Think Before You ‘Send’

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By Ericka L. Adler | September 28, 2011

 

 

Most of my communication with physician clients is conducted via e-mail. And yet, as a patient, I have never communicated with any physician in this manner. Why is this?

The use of e-mail is said to offer numerous benefits to physicians, such as an increase in efficiency and productivity. E-mailing is often faster, easier, and can be written and reviewed at the convenience of both parties, so as to cause less interruption and distraction to physicians during the work day. Additionally, e-mails are great documentation for future reference and can be printed and placed in the patient chart. E-mails can effectively be used for communicating test results, reminding patients of appointments, making appointments, prescribing medications, and, in some cases, following up on treatments and patient wellness. When used properly, electronic communication can free up valuable physician and staff time and decrease the need for in-person appointments and phone consultations.

Like anything in healthcare, however, there are always some restrictions and concerns. When it comes to e-mail, I typically warn my clients of the following:

1. E-mail should not be used for emergencies. You should set a maximum response time (i.e., 48 hours) that you will be able to meet and let patients know ahead of time. Patients should also know that the e-mail may be reviewed by others in your office in order to achieve the fastest response.

2. Limit e-mail use to situations you are prepared to handle. If you want to refill prescriptions but not give medical advice via e-mail, that is your decision. Make this policy known to your patients and do not make any exceptions.

3. Make sure patients know what security measures you have taken with your e-mail system and that you are not responsible if they choose to allow access to their e-mail account by a third party.

4. Don’t use your personal e-mail address. Set up an address that can be discontinued should the e-mail “experiment” not work. Consider a trial e-mail period to see whether e-mail is an advantage or disadvantage for your practice.

5. Be careful what you put in writing. If you do not want to give advice, limit your e-mail conversations to non-diagnosis related advice such as referrals to specialists, clarifying statements you made to patients, or answering general questions. When patients are seeking medical advice for a condition that has not been examined in person, always have them schedule an appointment. Be aware of the laws in your state and malpractice risk that may be created by unclear or untimely advice on which a patient relies.

6. Consider whether access to e-mail is something for which you should charge patients. You may not be reimbursed for time spent e-mailing with patients, and establishing a safe e-mail system may be expensive. If you choose to charge patients, consult with legal counsel to make sure you are not violating any laws or payer contracts.

7. Consider whether your e-mails should contain a disclaimer. I have a client who provided e-mail advice to a patient one Friday evening who complained of flu-like symptoms. My client recommended fluids, rest, etc., and to come in for an appointment on Monday if he did not feel better. The patient’s condition worsened and he died over the weekend. At no time did the patient contact the physician again or go the emergency room, relying instead on the e-mail. Whether reasonable or not, patients often blindly follow a physician’s advice. Although liability can never be avoided completely, a disclaimer on your e-mails that reminds patients they cannot rely on e-mail advice without an exam might help. In addition, the disclaimer should remind patients to make an appointment or to go to the emergency room if symptoms persist or worsen. Legal counsel can help you draft something appropriate for your needs.

Although I cannot cover all of the benefits and risks of using e-mail in this blog, I do recommend careful consideration when introducing e-mail to your practice. Make sure you develop a written policy for how access to e-mail will work in your practice and have such policy acknowledged by participating patients before you push that “send” button.

New Year Comes with New Challenges in Healthcare Reimbursement

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By Sue A. Irwin, MCS-P | December 12, 2011

 

Everyone in healthcare revenue management has been not so quietly “freaking out” for the past six months. This tension is going to continue for at least another 24 months. There are so many changes happening right now and yet to come that we all know and are totally convinced that this is going to substantially impact cash flow for medical providers.

First the good news, it appears that Congress is going to “fix” the SGR mess with a two-year deal in which physician reimbursement levels are either frozen or there is an up to 2 percent increase in reimbursement from Medicare. As most other contracts that doctors have with insurance companies on reimbursement are dependent on Medicare’s level of reimbursement, many feel that Congress is not going to lose political clout with the AMA and all other medical groups by making the physicians angry. The reason they are making it a two-year “fix” is thought to be because they don’t want to have to deal with the SGR next year during a big election.

Now for the scary news, 5010 is going into effect on January 1, 2012. Many people think that just because CMS stated they won’t enforce the rules for 90 days, the doctors don’t need to worry about filing 5010 claims. THIS IS NOT TRUE. Sure, you won’t get fined for not being able to process claims in the 5010 format. But, you also won’t get paid for claims not in the 5010 format to Medicare. I think that’s a heck of a “fine.”

It gets worse, many state Medicaids have stated that they will not be ready for 5010 on time. All insurance companies and clearinghouses are scrambling like mad to get the 5010 format working. All the practice management software companies are also scrambling. The problem everyone seems to be having is trying to do the testing. Since there are so many entities needing to test, scheduling is proving to be a nightmare. Remember, every practice management software system has to test with each clearinghouse and each insurance as well as any other computer programs with whom they interface. The clearinghouses have to test with all their customers as well as all their customers’ insurance carriers. Then there is the really problematic issue where the different Medicare carriers have to test with the different state Medicaid programs for “cross-over” claims. Let’s see, two government agencies have to communicate effectively. Gives you a warm, fuzzy feeling doesn’t it?

The next factor to throw into the pot is it is a new year and many people have new insurance coverage. Also, it’s time for all those deductibles to be applied. Historically, reimbursement amounts drop in January and February. Some of the drop is due to insurance reimbursements going to deductibles and the patients then being responsible. Other parts of the decrease are due to patients forgetting to give you their new insurance information. This means contacting the patients after the claims have been denied to find out the proper information and then going through that whole submission process again.

Many of us in the healthcare reimbursement world feel that the normal decrease in dollars reimbursed in January and February is just a very small portion of the decrease we will see in the first quarter of 2012. As has been reiterated everywhere, please make sure you have some type of line of credit to keep your office running during this turbulent time. It is better to be prepared for failure on the parts of the different insurance companies and not need it, than to find out you desperately need cash flow and it can’t be found.

The last factor for consideration now is the revised ABN (Advanced Beneficiary Notice of Noncoverage), Form CMS-R-131. This form (that has a release date of 3/2011 printed in the lower left hand corner) is available on the CMS website. This revised form replaces ABN-G, ABN-L, and NEMB. Use of the revised ABN form is mandatory starting January 1, 2012. Any of your old stockpiled ABNs are no longer valid and if you are audited, they will not ‘pass inspection’ and you will have problems. I’ve always been a big fan of being proactive to avoid problems.

If I have not depressed you too much, have wonderful holidays … before the ax falls!!



The Upcoming Medicare Reimbursement Decision: What Will You Do?

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By J. Scott Litton, Jr., MD | December 2, 2011


As we draw closer to the end of yet another passing year, unfortunately the story remains the same. I finished my residency in 2003 and can remember reading about the looming reimbursement decline proposed by the flawed SGR formula.

Year after year, the same Medicare reimbursement problem persists, yet our lawmakers have neglected to mend the flawed SGR formula. Rather than to correct the problem, the Congress has only placed a temporary short term fix. Now that 2011 is drawing to the end, the story yet again remains the same. Some years have seen a small one percent increase, however the past few years have essentially kept the reimbursements static without a decline being observed.

Our economic woes are essentially unchanged from last year. Physicians now find themselves faced with the difficult choice of deciding whether or not to continue accepting the flat reimbursements from CMS or to withdraw from the program altogether. The problem with the flat reimbursements is that our costs of maintaining a practice increase annually. Medical supply costs increase, insurance costs increase, and employees must be given routine raises in order to be retained. For my solo practice in the rural south, withdrawing from Medicare would be a very difficult decision to make. I have a large panel of Medicare patients who depend on me for their care. However, the perception of physicians by the general population is that we are all independently wealthy and we should be able to tolerate a decline in reimbursements for the good of the national economy.

The proposed payment reduction for 2012 is a 27 percent decrease. For those of us in private practice this reimbursement decrease will be disastrous. Unfortunately, I have already begun making preparations for this payment decrease. My practice has been receiving a large increase in new patient applications due to another physician's upcoming retirement. At this point, all new patients with Medicare are being placed on hold until a decision regarding our reimbursements has been determined by the Congress. If the reimbursement decrease is allowed to take place, I will be unable to accept any new Medicare patients.

My existing Medicare patients have been asking me what I plan to do for the past several weeks now. My answer to them is that I will not ever completely withdraw from Medicare and will never withdraw as their treating physician. I have been in private practice for more than eight years now and a very large percentage of my Medicare patients have been with me since my first year in practice. However, my answer to them is that I will not be able to take on new Medicare patients if the decrease in reimbursements does come to pass.

Being both a practicing physician and head of a business is very complex. As physicians, we long to be able to treat our patients and not discriminate regarding payment status. However, running a business (private practice) requires that we pay attention to the bottom line so that we can not only pay our staff and our bills, but pay ourselves at the same time. There are several undecided decisions regarding medicine's future. Most notably the upcoming Supreme Court case of determining whether or not the Affordable Care Act is constitutional will have a very large impact. Further, the upcoming presidential election will also have a large emphasis on economics and healthcare in general. We do not know the outcome, however we still have the job of caring for our patients at hand. Until that time, we must make the best decisions not only for our patients but for our medical practice as well.