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TOA
President's
Update: Patient Satisfaction
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By Timothy L. Beck, MD
President, Texas Orthopaedic Association
I feel
the evidence is clear that patient satisfaction can drive
patients to become loyal advocates. At our clinic in Tyler,
patient satisfaction is paramount to the success of our
practice.
Through
the years the face of healthcare and the expectations of
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patients have
changed. It is our job to constantly be flexible and committed to
exceeding these expectations. Being able to measure those expectations
is the starting point to providing our patients with excellent care. It
is important to choose a tool that provides a medical practice with a
look at the big picture, allowing the evaluation of your own practice
and benchmarking you against other practices nationwide.
That measurement
tool should touch every facet of the patient experience – effectively
measuring how the patient felt as a result of their interaction in the
clinic. Those areas include scheduling appointments, treatment during
the visit, courtesy from the staff, concern of the nurses, doctors and
the full spectrum of patient care providers. What care providers must
learn is that the survey is a tool to find out if the patient trusts
their doctor. This is not based so much on the quality of care
received, but instead on the care and concern the practice—and the
physician--has for the patient as a person.
According to
Maxwell Drain and Dennis Kaldenberg, in a paper entitled "Will Your
Patients Return?--The Foundation for Success", a "conservative 5%
dissatisfaction rate among patients can cost a physician $150,000 in
revenue.” According to the performance improvement company Press Ganey
Associates "Patient satisfaction is a leading indicator of quality and
financial performance. Physicians who have patient satisfaction ratings
in the lowest 20% are nearly 4 times more likely to have patients leave
their practice.” – resulting in lost revenue. ” Press Ganey continues by
stating, "Patients judge a medical practice by the way they are treated
as people, not the way they are treated for their disease."
Azalea Orthopedics
has used the Press Ganey Patient Satisfaction tool since October 2006.
This tool uses scientifically valid, reliable and statistically sound
surveys delivered by mail. Although Press Ganey is the number one
choice in patient satisfaction survey tools, there are numerous
companies who process and analyze patient satisfaction data depending on
your group's strategic plan.
Azalea's last
survey report from February - April 2008 rated the practice in the 94th
percentile of the Press Ganey national medical practice database. This
is due in large part to utilizing the survey data to identify the real
needs of patients and then educating everyone at our practice,
physicians included, in order to reach the goal of providing excellent
care by exceeding patient expectations. This process helps build
patient loyalty, making our clinic one of the most highly recommended
practices in the country. This is critical for the success of any
medical practice as it costs generally 10 times as much to attract new
customers as it does to keep current ones. Essentially—the more
patients you keep in your practice – the more revenue that is
generated. And if those patients are highly satisfied – they’re more
likely to recommend the practice to their family and friends. That is
not only good medicine – but good business.
If you don’t
already use patient satisfaction survey tools, I think it would be of
benefit to your practice of orthopaedics.
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Workers’ Compensation Commissioner Says Closing The Drug Formulary
Won't Happen Until After December 2008
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By Michael
Reed, MPA, MBA
Director of Healthcare Delivery Systems for the TMA
On April
28, 2008, Workers’ Compensation Commissioner Albert Betts told
a Senate State Affairs committee that the Division of Workers’
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Compensation won’t achieve its projected December 2008
deadline for adopting a closed pharmacy formulary for workers’
compensation
patients. The Senate Committee heard reports from Betts,
Insurance Commissioner Mike Geeslin and Public Counsel Norman
Darwin of the Office of Injured Employee Counsel as part of
the committee’s duties of monitoring implementations of House
Bill 7, the workers’ compensation reform measure passed in
2005. Chairman Robert Duncan, R-Lubbock, told the three agency
heads the committee plans to invite them back to hearings in
September for additional updates, specifically including the
DWC’s next round of “report cards” on workers’ compensation
insurance carriers and providers and performance of workers’
compensation health care networks in assuring access to care
for injured workers and improving return-to-work outcomes.
Among the
reforms ordered under HB 7 was creation of a closed formulary
to help reduce costs and ensure that prescriptions reach
injured workers promptly. A status report on the formulary
work, including a possible timeline for the work, is expected
to be released in the near future. The division reported
earlier this year that it intended to establish a closed
formulary -- listing medications eligible for use and
reimbursement. However, Betts told the committee that DWC is
“not going to meet that December date,” but did not indicate a
new date for completing the work. Betts reported the division
is reviewing formularies and treatment guidelines for
prescription drugs in use in other states and is consulting
with stakeholders. DWC's medical director, Dr. Howard Smith,
is working with stakeholders on the project. The division
plans to hold stakeholder meetings on the issue throughout the
summer. Sen. Chris Harris, R-Arlington, questioned how having
a formulary would affect providing “specialty drugs,” which
were not on the formulary list, to injured workers. Betts said
the formulary is “not intended to be exclusive” as to the
drugs which can be prescribed but is intended to make it
easier for system participants to know what drugs are expected
to be approved for use in particular situations. Sen. Leticia
Van de Putte, D-San Antonio, a pharmacist, urged Betts to look
at the amount of time required for pharmacies to deal with
workers’ compensation prescriptions when drafting the
formulary and treatment guidelines. Filling an initial
workers’ compensation prescription can take pharmacy staff
members 20 minutes and refilling prescriptions also takes
longer compared to those for health care plans, Van de Putte
said.
Data on
pharmaceutical usage in Texas has been collected and published
in a pharmaceutical descriptive analysis by the Department of
Insurance’s Workers’ Compensation Research and Evaluation
Group. The group is assisting DWC with data support for
developing the formulary. The Legislature mandated that the
formulary include a fee schedule that is fair and reasonable,
helps ensure adequate access to medications and services for
injured workers and minimizes drug costs to employees and
insurance carriers. A recently released report by PMSI showed
national workers' comp drug costs increased 12% in 2007 and
according to the report the increases were mostly due
increased utilization. Last November the National Council on
Compensation Insurance reported growth in use of generic
prescriptions and withdrawal of some popular drugs from the
market appeared to have helped stabilize drug costs as a share
of total workers' compensation medical costs, but warned that
the trend might be temporary and that prescription drug costs
were continuing to rise. Alabama, California, Delaware,
Kentucky, Louisiana, Montana, New Hampshire and Texas were
listed by the council as "high-cost states” for prescription
drug use in workers’ compensation. The Centers for Medicare
and Medicaid Services reported the national growth rate in
spending on prescription drugs dropped from a peak of 18.1% in
1999 to 5.8% in 2005. The annual growth rate in the nation's
overall health expenditures declined from a high of
approximately 8% in 2002 to a little more than 6% in 2005, the
centers noted.
The Texas
Medical Association will continue to monitor the
implementation of closing the drug formulary in workers’
compensation. The Association’s guiding principles continues
to be that injured workers in Texas deserve clinically
appropriate and cost-effective health care. TMA also believes
that health care should be accessible to injured workers in a
timely manner within a reasonable geographic proximity.
Workers’ compensation rules should be clearly defined, fair,
simple to understand, accountable, and easily accessible to
all parties involved.
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This Week In Texas: Mignon
McGarry Memos
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By Mignon McGarry
TOA Legislative Advocate
TOA Online Version: All Memos
June 18, 2008 Wednesday
As we enter the dog days of summer,
everyone seems to be focused on ways to beat the heat by
finding indoor pastimes. Some will spend their
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time handicapping the field of potential
VP choices for Obama and McCain. Others will fret about whether
Tiger Woods will recover from yet another knee surgery. Will the
arsonist who set fire to our beloved Texas Governor’s Mansion be
found? Will the price of a gallon of gas hit $5 before the summer
ends? Here are some additional tidbits to consider this week:
Texas Secretary of State Phil Wilson will
leave that post on July 6th. Wilson, a former top aide to
Governor Rick Perry, will join Luminant,
a subsidiary of Energy Future Holdings
Corporation, as Senior
Vice President of Public Affairs.
Texas Democrats and Republicans have
concluded their state conventions. Both Democratic State Chair Boyd
Richie and Republican Chair Tina Benkiser won reelection to their top
posts despite facing challengers. Now it is on to the national
conventions in Denver and Minneapolis.
People who attended the Texas Republican
Party convention in Houston last weekend were buzzing about the speech
given by Texas Railroad Commissioner Michael Williams. He seems to be
on the short list each time there is speculation about a potential
vacancy in a top spot in Texas government. To hear his speech and
judge for yourself, please click
here.
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Worth Repeating: Congress Pushing Curbs On Physician-Owned
Hospitals
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The New York Times reports on
efforts in the U.S. Senate and House of Representatives to limit the
spread of hospitals that are owned by physicians. On three occasions
in the last 10 months, either the House or the Senate has approved
legislation that would bar doctors from
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referring Medicare and Medicaid
patients to hospitals in which the doctors have an ownership interest.
None of the proposals have gotten all the way through the legislative
process. Part of the problem is that
influential senators and
well-connected lobbyists are advocating for exemptions for a few
institutions. The special treatment has drawn criticism from
conservatives who oppose restrictions on physician-owned hospitals,
and liberals who favor stringent rules with no exceptions. To read
more please click
here.
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What Is
The Division of Workers’ Compensation’s Medical Quality Review Panel (MQRP)?
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By Michael Reed, MPA, MBA
Director of Healthcare Delivery Systems for the TMA
Over the years, I
have had many physicians ask me about the Division of Workers’
Compensation’s Medical Quality Review Panel (MQRP) which
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monitors the quality of health care in the workers’ compensation
system.
Medical quality reviews, conducted by the Medical Quality
Review Panel (MQRP), are intended to ensure that employees receive
reasonable and medically necessary health care in a timely and
cost-effective manner. Each year, TDI-DWC selects categories of
workers’ compensation system health care for review, based on
recommendations from the Medical Advisor, the TDI Research and
Evaluation Group, and stakeholder input. The Medical Advisor and MQRP
may apply evidence-based medical standards, including adopted fee
guidelines, treatment guidelines, and return to work guidelines in
reviews. The following categories are scheduled for review during
Fiscal Year 2008.
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Category
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Review Factor |
Review Elements |
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Designated
Doctor
Decisions |
·
Number of overturned decisions
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Very high or low impairment ratings
·
Frequency of Letters of Clarification
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Frequency and severity of complaints |
·
Thoroughness of examination
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Accuracy of Maximum Medical
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Improvement date
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Accuracy of Impairment Rating |
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Independent
Review
Organizations
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·
If reviewer has appropriate education, training and experience to
address medical issues in question
·
Frequency and severity of complaints |
·
Proof of professional certification
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Appropriate medical records supplied for review
·
Use of evidenced-based decisions |
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Insurance
Carriers
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·
Excessive approval or denial of payments for medical care
·
Frequency and severity of complaints |
·
Payments for medical services
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Accuracy of Peer Review Findings |
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Peer Reviewer
Doctors
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·
If reviewer has appropriate education, training and experience to
address medical issues in question
·
Frequency and severity of complaints |
·
Proof of professional certification
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Appropriate medical records supplied for review
·
Use of evidenced-based decisions |
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Utilization
Review Agents
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·
If reviewer has appropriate education, training and experience to
address medical issues in question
·
Frequency and severity of complaints |
·
Proof of professional certification
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Appropriate medical records supplied for review
·
Use of evidenced-based decisions |
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Surgery/Spine
Fusions
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·
Number of surgical spine patients
·
Surgical re-admission rates
·
Percent of surgeries with fusions
·
Total amount billed |
·
Accurate diagnosis and testing
·
Use of evidence-based medical treatment
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Compliance with accepted medical standards
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Reasonable cost |
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Pain
Management
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·
Total number of patients
·
Average number of services per patient
·
Total billed charges |
·
Accurate diagnosis and testing
·
Use of evidence-based medical treatment
·
Compliance with accepted medical standards
·
Reasonable cost |
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Prescription
Medications
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·
Total number of prescription medications
·
Total amount billed per patient
·
Dose and duration of medications in review |
·
Accurate diagnosis and testing
·
Use of evidence-based medical treatment
·
Compliance with accepted medical standards
·
Reasonable cost |
Treatment Review Selection
Within the selected categories, the TDI-DWC Medical Advisor identifies
workers’ compensation medical treatments that may be outside accepted
system norms. These treatments are subject to the TDI-DWC medical
quality review process. Selection for this review does not mean the
provided care was inappropriate.
Medical Advisor - Health Care Provider Communications
Health care providers whose treatment is identified for possible review
are notified in writing. The notification explains why the treatment was
selected. The letter also invites the health care provider to provide
the TDI-DWC Medical Advisor with information about their circumstances
that may satisfactorily explain the differences between their outcomes
and system-wide results. In some cases, the Medical Advisor may request
medical and other records for clinical review.
Clinical Review Process
If
a clinical review is indicated, the health care provider will receive a
detailed Notification Letter explaining the process and their rights and
responsibilities. The MQRP will conduct the clinical review and issue a
Preliminary Report to the Medical Advisor documenting medical evidence
for their conclusions. The health care provider under review has the
opportunity to respond to the report and present his or her own medical
evidence. The health care provider under review will be offered at least
one Informal Resolution Conference (IRC) to discuss issues and concerns
regarding the review.
A partial
listing of potential outcomes, including sanctions, of an MQRP review is
detailed in the Medical Quality Review Policy, available by clicking
here.
If the
Medical Advisor recommends a sanction, TDI-DWC Legal Services will send
a Notice of Intent to Sanction Letter with an attached Final Report to
the health care provider under review. The health care provider then has
20 days to request a hearing at the State Office of Administrative
Hearings (SOAH). At any time prior to the hearing at SOAH, the health
care provider may request a meeting with TDI-DWC to discuss any issues
relating to the hearing.
MQRP policies related to the TDI-DWC Office of the Medical Advisor
are located by clicking
here
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