Health Care Insights

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Try These 5 Collaborative Solutions to Prevent ED and Hospitalist Conflict

Dr. Kenneth R. Epstein, CMO & Dr. Kenneth J. Heinrich, Medical Director

Hospitals charge emergency medicine physicians and hospitalists with the same goal: to provide the best care possible for their patients at all times.

These two groups can, however, at times, find themselves working in opposition to one another due to conflicting priorities: moving patients through the ED quickly, and efficiently managing inpatient length of stay, respectively.

A two-pronged solution stressing empathy and prevention is in order.

The fundamental answer to emergency medicine/hospitalist medicine conflict is seeing things from the other’s perspective. Because such empathy is more easily counseled than practiced, it must be systematized. Anticipate where and when conflicts are likely to occur, and then create and communicate policies that avert contention before it has a chance to surface.

Using those maxims as guides, below are five steps that will enable emergency...

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New Traditions of Efficiency in Emergency Medicine: Increasing the Bottom Line

Dr. Kenneth J. Heinrich, SCP Group Medical Officer

For a hospital’s Emergency Department (ED), increasing financial efficiency largely depends on clinical throughput. This article segments the ED visit into three parts--arrival, in-room, and disposition--and discusses the financial ramifications of specific process improvements that increase patient flow and enable greater volume in each.

Before making any changes to ED operations, though, CFOs and ED leadership can capitalize on one area of opportunity that does not involve patient flow: documentation. At most EDs across the country, improving revenue can be achieved through better documentation practices.

Documentation and coding: common problems

The culture of emergency medicine, not surprisingly, perceives certain types of emergent situations as “routine emergencies,” downplaying the efforts necessary to stabilize acute patients. While this culture has evolved...

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7 Questions Residents Should Ask During Contract Negotiation

Schumacher Clinical Partners' Blog Editor

Throughout your career as a physician, you will have numerous contracts -- perhaps even multiple contracts running concurrently. As a graduating resident, understanding and negotiating contract terms is essential. Ask these seven critical questions to avoid contract negotiation pitfalls that could put you in a pinch.

1. What’s my status?
Your status can impact many elements of your contract. Make sure you understand which standard you fall into. Are you an independent contractor, employee, limited liability partner, capital contributor, or buy-in partner? Your status impacts your pay and benefits, taxes, how involved you are with practice management, and more.

2. Who will cover my credentialing expenses?
Ask who will cover credentialing, certification, and licensing expenses. Often there is a staff application fee and certification requirements as well as your own current...

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Challenges of a Hospital-Employed ED: Performance Management, Documentation & Revenue

Schumacher Clinical Partners' Blog Editor

Over the past few weeks, we've taken on the task of disproving the misconception that hospitals only have two options for emergency department management: hospital-employed physicians or turn EM physician management over to an outside group. 

The first post of our series addressed a common challenge: recruiting EM physicians; the second focused on leadership and accountability. In this, the final post of the series, we look at performance management, documentation, and revenue.

The Pressing & Perilous Challenge: Performance Management

Tracking an ED’s operational and financial performance requires considerable work, time, and data. With an entire hospital to oversee, gathering, monitoring, and analyzing up-to-the-minute ED reports is difficult but imperative; the ED is your hospital’s front door and drives both its reputation and admissions. Here are three...

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Challenges of a Hospital-Employed ED: Leadership and Accountability

Schumacher Clinical Partners' Blog Editor

One of the biggest fallacies about a hospital-employed ED model is that if you want it to succeed, your hospital must either manage the ED autonomously or relinquish control to an outside group. That's not the case. Many solutions exist to support and strengthen management of a hospital-employed ED.

To address that concern, we're looking at four major challenges hospitals face when employing emergency medicine physicians. The first, already published, focused on the most common: recruitment. This week, we examine leadership and accountability.

As the leader of an especially unique department within the larger hospital ecosystem, ED medical directors can often feel -- or operate -- like an island. The question is: Whose headache is it? Answer: If you do nothing…everyone’s. Consider these options:

1. THE BIG, OBVIOUS (BUT TIME-CONSUMING) OPTION
Dedicate time for a...

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The Increasing Need for Hospitalist Programs to Demonstrate Value

Schumacher Clinical Partners' Blog Editor

The growth of hospital medicine since its inception 20 years ago has been nothing less than phenomenal. The specialty has ballooned from just a few hundred physicians to become one of the largest in the country.

According to a recent NEJM study, more than 50,000 hospitalists currently practice in the U.S., making it the third largest specialty behind general internal medicine and family medicine. Over 75 percent of hospitals now number hospitalists among their ranks -- and demand continues to grow.

The reasons for such rapid growth are well known to any hospital executive: The presence of hospitalists leads to improved quality, patient safety, and efficiency of care. But the question is, are you finding that to be true with your facility’s hospital medicine program?

Hospitalist Revenue Gap Widening

Due to the popularity and rapid growth of this field, hospitalist salaries have...

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Challenges of a Hospital-Employed ED: Your Options and Solutions

Schumacher Clinical Partners' Blog Editor

Challenge #1: Recruitment

One of the biggest misconceptions about a hospital-employed ED model? That if you want it to excel, your hospital must either manage the ED alone--or hand it off to an outside physician management group. Not so. There are myriad solutions and services available to support and strengthen management of a hospital-employed ED.

On the SCP blog in the coming weeks, we'll look at four of the most common challenges faced when employing emergency medicine physicians, and we'll showcase 12 innovative solutions to help you overcome these challenges -- no change in model needed.

This week, we're focusing on the No.1 challenge: recruiting and retention.

Attrition happens. When it does in the ED, the pressure to find outstanding candidates--fast--can exceed the manpower of your recruiting team. What options do you have?

1. THE BIG OBVIOUS (BUT EXPENSIVE AND...

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Top 10 Last Minute Holiday Gifts for HM/EM Physicians

Schumacher Clinical Partners' Blog Editor

It's just about time for jolly old Saint Nick to make his way down the chimney. But, the lingering question on your mind might be what to get that busy hospitalist or emergency physician in your life. 

Have no fear! Here is a list of ten last minute gifts across a range of prices that you can pick up at the big box retailer, drug store, or online.

1. Magazine Subscription

Give a copy of the doctor's favorite magazine (you can likely grab a copy at the pharmacy, grocery, or bookstore). Slip a note inside saying a year's subscription is on its way. Or, you can find a subscription to one of several industry journals using this helpful list on Wikipedia.

2. Subscription Box

Magazines aren't the only type of subscription you can give. Many companies offer curated boxes of products, shipped monthly, that appeal to just about any interest or taste.

Fashionistas would appreciate a ...

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How to Transform Your ED into an Asset

Schumacher Clinical Partners' Blog Editor

Three strategies for the savvy CEO and CFO

How can you best transform your emergency department into an asset? Dr. Derik King, division president of EM/HM/eHealth Services at Schumacher Clinical Partners, recently tackled the topic during Becker's Hospital Review's 5th Annual CEO + CFO Roundtable on Nov. 7, 2016.

According to Dr. King, the transformation of an ED from drain to asset begins with understanding that the emergency department is the crux for value-based purchasing -- and the key to making sure hospitals and providers advance healthcare going forward, said Dr. King.

He outlined three strategies for making such a transformation possible:

1. Change Perception of the ED

Dr. King cited the fact that the ED is the front door of the hospital, responsible for 50 to 70 percent of its admissions.

Equally importantly, he noted, quality measures of hospital performance and the HCAHPS...

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Three Drivers of Efficiency in ED Patient Disposition

Schumacher Clinical Partners' Blog Editor

Part three of our series on ED efficiencies featured on Becker’s Hospital Review. Part one dealt with patient arrivals; part two addressed how to improve efficiency related to the in-room patient work-up. This post concludes the series by focusing on the three drivers of efficiency for the disposition of ED patients.

In his article written for Becker‘s Hospital Review -- Clinical efficiency tricks for the emergency department: Disposition -- Dr. Kenneth J. Heinrich, regional director with Schumacher Clinical Partners, lists three drivers of efficiency related to the disposition of patients from the ED: creating a culture of urgency, determining the availability of hospital beds, and fostering a partnership between the ED and hospitalists.

Creating a Culture of Urgency

"Traditionally, ED physicians would see patients and then decide when those patients were...

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Working Thanksgiving Weekend? Here's What You can Expect

Schumacher Clinical Partners' Blog Editor

Thanksgiving is a time when families gather to reconnect, enjoy a great meal and watch some football. As experienced ED physicians know, it’s also the prime time for holiday-inspired injuries and illnesses. Whether it’s your first Thanksgiving shift or yet another in a long line of them, here’s a quick look at what’s likely to head your way this holiday:

Little Activity Early

Early in the day, you’ll likely see minimal crowding in your waiting room as most folks are lounging around, watching the big game, and waiting for the turkey button to pop.

But as the day -- and meal prep -- progresses, expect to see an influx of cooking- and carving-related injuries. According to Clinical Advisor, a website for NPs and PAs, Thanksgiving dinner preparation is a leading cause of ED visits at this time of year. After all, knives are sharp, and they don't discriminate...

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ED Flow: In-room Strategies to Improve Throughput

Schumacher Clinical Partners' Blog Editor

Part two of our three-part series on improving ED patient flow featured in Becker’s Hospital Review.

Many patients who have been admitted to the ED promptly, only to be marooned in a room waiting for lab test results or to be examined by a provider, will readily admit to a sense of uneasiness and distress.

Aside from the lack of efficiency brought on by tying up an emergency room bed, there is also an inherent danger relegating a patient in dire need of care to the waiting room.

In a recent article featured in Becker’s Hospital Review, “Clinical efficiency tricks for the emergency department: In-room,” Dr. Kenneth J. Heinrich, regional director with Schumacher Clinical Partners, says it does not have to be that way.

He outlines the primary strains on in-room efficiency in the emergency department and lays out some specific measures EDs can take to avoid them.

...

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Two Innovative Ways to Streamline Emergency Department Patient Arrivals

Schumacher Clinical Partners' Blog Editor

Part one of our three-part series on ED efficiencies featured on BeckersHospitalReview.com.

Linear emergency department arrival processes typically include unnecessary patient wait time, resulting in patient and provider frustration. Fortunately, emergency departments aren’t bound by straight-and-narrow approaches to patient flow.

In a recent article featured on BeckersHospitalReview.com, “Clinical efficiency tricks for the emergency department: Arrivals,” Dr. Kenneth J. Heinrich--an experienced emergency medicine regional directors with Schumacher Clinical Partners--offers more efficient, non-linear alternatives to standard arrival processes.

Learn how Dr. Heinrich leverages parallel processing to minimize patient hand-offs, boost efficiency, and improve patient satisfaction: Read the full article here.

Stay tuned for more of Dr. Heinrich’s expert tips,...

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Common CV Mistakes Residents Make and How to Avoid Them

Schumacher Clinical Partners' Blog Editor

Hospitals don't hire CVs; they hire doctors. But the quality of your CV can be what either gets you in the door for an interview or what closes the door. And, we know that if you don't get the interview, you certainly can't get the job.

To help you make the best impression possible, in a previous post, we discussed five key points to writing a CV that captures an employer's attention. In this one, we list seven common mistakes and how to avoid them.

1. Not Proofreading for Grammar and Typos

One of the worse mistakes you can make is to prepare a professional document and fail to proofread, checking for typos and grammatical errors.

As the Adventures in Medicine blog cautioned: A physician who lets errors creep into his CV may also be susceptible to leaving the odd swab in a patient. By “proofread,” we don't mean that you do this yourself, necessarily. If you have prepared...

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8 Questions Emergency Physicians Must Ask During Contract Negotiation

Schumacher Clinical Partners' Blog Editor

Throughout your career as an emergency medicine physician you will have numerous contracts—perhaps even multiple contracts running concurrently. Whether you’re a graduating resident or a long-time ED doc, understanding and negotiating contract terms is essential. Ask these eight critical questions to avoid contract negotiation pitfalls that could put you in a pinch.

1. What’s my status? 
Your status can impact many elements of your contract. Make sure you understand which standard you fall into. Are you an independent contractor, employee, limited liability partner, capital contributor, or a buy-in partner? Your status impacts your pay and benefits, taxes, how involved you are with practice management, and more.

2. Who will cover my credentialing expenses? 
Ask who will cover credentialing, certification, and licensing expenses. Often there is a staff...

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Weathering the Storm: Providers and Staff Face Hurricane Matthew

Schumacher Clinical Partners' Blog Editor

In the early morning hours on Oct. 5, Dr. Dean Dalili, Senior Vice President of Medical Affairs, Hospital Medicine at SCP, was well aware that Hurricane Matthew was barreling down on the Florida coast and that Wuesthoff Medical Center Rockledge was in its path. 

“Working with hospital administration, our original plan was to assemble a hurricane emergency team of clinicians who could stay at the hospital for the next 24-36 hours, not really knowing what we would face or how bad the storm would be,” explained Dr. Dalili. But by the next day, Floridians were alerted that Matthew had strengthened to a Category 4 storm, with the eye headed straight for Cocoa Beach. “We were 36 hours from landfall, and our facility is classified to withstand Category 3 storms. But at this strength, we knew we had to evacuate.” 

Taking Action

With the combined efforts of...

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Why Case Management Matters Now More Than Ever

Joanne Wetch, Director of Consulting Services

With the expansion of alternative/bundled payment models, a focus on value-based care delivery, and the inclusion of care coordination in the National Quality Strategy, the role of Case Management is becoming increasingly important. In fact, Case Management should be the linchpin in an effective value-delivery strategy. Managing the financial risk in value-based reimbursement models requires optimization of care settings, avoidance of duplicate services, polypharmacy management, early detection and intervention to avoid ED visits and readmissions, and re-assessment of the care plan as the patient’s condition changes. Doing these things within the inpatient setting is one thing; doing them – and doing them well – across the full continuum of the patient’s episode of care is quite another.

Historically, hospitals have focused on what the Centers for Medicare and...

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4 Ways to Foster Better Doctor-Patient Communication and Improve Patient Satisfaction

Schumacher Clinical Partners' Blog Editor

It's been said that patients don't care how much you know until they know how much you care.

Communicating effectively, at a level the patient can understand, is one way to express care. The words you use and the way you use them is central to establishing a positive relationship that can result in improved outcomes both clinically and in patient satisfaction scores as reported in the HCAHPS survey, part of which deals with communication specifically.

In fact, many of the complaints we hear from patients have less to do with the physician's clinical competency and more with a breakdown in communication, which adversely affects the doctor-patient relationship and reflects poorly on the provider.

With that in mind, here are four ways to improve communication that will result in better patient satisfaction.

Understand Patient Expectations

A patient's satisfaction is tied to his...

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Top 6 Mobile Apps to Facilitate Doctor-Patient Communication

Schumacher Clinical Partners' Blog Editor

The importance of effective doctor-patient communication in an emergency or hospital medicine situation cannot be overstated. As SCP Chief Medical Officer Jeffrey A. Schwartz, MD, FACEP, explained, “A lack of clear communication could lead to further clinical consequences.” That’s where mobile apps can be of immense help. Dr. Schwartz helped us to identify the following six mobile apps specifically focused on providing clearer physician/patient communication.

The first three provide translation capabilities, which is particularly useful when addressing non-English speaking patients. The remaining three use images to communicate, enabling the patient to better understand the nature of their condition and its location in the body.

1. Canopy Speak

CMT-product-mockApproximately 30 million patients have limited English proficiency, and nowhere is the language barrier more critical than...

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Getting "Back to Basics" in Healthcare Management

Namar Al-Ganas and Robert Wagner, MD

Over the last six and a half years, many new and innovative strategies for delivering healthcare have surfaced, especially with the introduction of the Affordable Care Act of 2010 signed into law by President Obama. Transitioning from volume to value in healthcare reimbursement is well underway with the introduction of bundled payments for Comprehensive Care for Joint Replacements (CJR) on April 1, 2016, and soon, a bundle in cardiology. In the midst of these radical and important changes to the U.S. healthcare system, this becomes a great opportunity to excel at the basics of healthcare management in order to better respond to the turbulence that change often brings. This includes but isn’t limited to market positioning, margin awareness, revenue cycle essentials, effective recruiting, and tackling fear.

Market positioning can simply be defined by how your...

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