4.8% 0.7% 10.1% 7.9% 12.6% 7.9% 2.4% 5.5% 6.6% 4.6% 3.3% 4.8% 11.2% 3.7% 1.1% 5.3% 7.3% INSIDE ▼ The Leading Source for Healthcare Business News September 2012 • Volume 9, Issue 6 • $3.50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . INDEX ▼ Breaking Ground..............3 Financial Perspectives.......4 Legal Affairs......................6 THA.................................7 Integrative Medicine.........8 Technology................. 9 Hospital Headlines.......... 10 Mergers and Acquisitions.................... 11 . . . . . . . . . . . . PRSRT STD US POSTAGE PAID HOUSTON TX PERMIT NO 13187 Legal Affairs: OCR joins the team of federal auditors, see page 6 Special Feature Duke Realty developing two MOBS in Texas see page 3 The 2012 Physician Recruiting Standard Please see PHYSICIAN STANDARD page 12 Map represents searches initiated by Delta Physician Placement on behalf of healthcare facilities from July 2011 through June 2012. MARKET DEMAND Nationwide Search Distribution Specialty Demand Comparison 2 nd Quarter 2012 2 nd Quarter 2011 1. Family Medicine Family Medicine 2. Internal Medicine Internal Medicine 3. Emergency Medicine Psychiatry 4. Hospitalist Orthopedic Surgery 5. General Surgery Emergency Medicine 6. Psychiatry Pediatrics 7. Obstetrics and Gynecology Obstetrics and Gynecology 8. Urology Gastroenterology 9. Pediatrics Otolaryngology 10. Pulmonary Critical Care Medicine Neurology 11. Family Medicine- Obstetrics Hospitalist 12. Neurology Urology 13. Gastroenterology Pulmonary Critical Care 14. Orthopedic Surgery General Surgery 15. Otolaryngology Dermatology Data compares the top 15 most requested searches initiated by Delta Physician Placement, comparing the second quarters of 2011 and 2012. BY THE DELTA COMPANIES Ever wonder what your competition is doing to attract providers to their opportunities? The answer is a little bit of everything. With a physician shortage on the rise, hiring facilities are “getting creative” in order to attract and retain desirable providers. Signing bonuses, relocation coverage, competitive base pay, and even flexible scheduling have become a standard in recruitment tools, making it difficult for hiring organizations with such packages to stand out among the influx of opportunities presented to qualified candidates. Those ahead of this curve have adopted the practice of creating appealing alternatives, some which reach outside of the box. Tools for Recruitment Housing One trend that is becoming popular with many hiring facilities is offering temporary housing at a reduced cost for the first few months of an assignment. This helps relieve some of the stress associated with relocation for incoming providers that are new to the area. Physicians can spend their first few weeks on assignment focusing on responsibilities and orientation plus have a chance to learn about their new community—instead of feeling pressured to find the perfect home without any knowledge of the surrounding area. Many facilities have purchased or rented homes to temporarily host new employees, and some have even gone as far as sending a welcoming DVD to new providers with an introductory video containing facility information and options for temporary housing. Offering an appealing package Often, creative financial packaging can be established simply by evaluating facility needs. For instance, offering a directorship with a position opening can
Transcript
4.8%
0.7% 10.1%
7.9%
12.6%
7.9%
2.4%
5.5%
6.6%
4.6%
3.3%
4.8%
11.2%
3.7%
1.1%
5.3%
7.3%
INSIDE▼
The Leading Source for Healthcare Business NewsSeptember 2012 • Volume 9, Issue 6 • $3.50
7. Obstetrics and Gynecology Obstetrics and Gynecology
8. Urology Gastroenterology
9. Pediatrics Otolaryngology
10. Pulmonary Critical Care Medicine Neurology
11. Family Medicine- Obstetrics Hospitalist
12. Neurology Urology
13. Gastroenterology Pulmonary Critical Care
14. Orthopedic Surgery General Surgery
15. Otolaryngology Dermatology
Data compares the top 15 most requested searches initiated by Delta Physician Placement, comparing the second quarters of 2011 and 2012.
BY THE DELTA COMPANIES
Ever wonder what your competition is doing to attract providers to their opportunities? The answer is a little bit of everything. With a physician shortage on the rise, hiring facilities are “getting creative” in order to attract and retain desirable providers. Signing bonuses, relocation coverage, competitive base pay, and even flexible scheduling have become a standard in recruitment tools, making it difficult for hiring organizations with such packages to stand out among the influx of opportunities presented to qualified candidates. Those ahead of this curve have adopted the practice of creating appealing alternatives, some which reach outside of the box.
Tools for RecruitmentHousingOne trend that is becoming popular with many hiring facilities is offering temporary housing at a reduced cost for the first few months of an assignment. This helps relieve some of the stress associated with relocation for incoming providers that are new to the area. Physicians can spend their first few weeks on assignment focusing on responsibilities and orientation plus have a chance to learn about their new community—instead of feeling pressured to find the perfect home without any knowledge of the surrounding area. Many facilities have purchased or rented homes to temporarily host new employees, and some have even gone as far as sending a welcoming DVD to new providers with an introductory video containing facility information and options for temporary housing.
Offering an appealing packageOften, creative financial packaging can be established simply by evaluating facility needs. For instance, offering a directorship with a position opening can
Construction is moving full speed ahead on two Duke Realty-developed Scott & White Healthcare medical office buildings (MOBs) in Texas. Scott & White, which operates the largest multi-specialty physician group in the state, will lease 100 percent of both buildings for its employed physicians as well as clinical outpatient services.
The facilities will include a three-story, 66,500-square-foot Scott & White Specialty Care Clinic, which will be located at the Wayne & Eileen Hurd Regional Medical Center in addition to a planned 60-bed hospital at the intersection of U.S. Highway 281 and State Highway 71 in Marble Falls, Texas, approximately 50 miles northwest of Austin. The MOB will house multiple primary care, urgent care, and specialty and diagnostic clinics.
Duke Realty also will develop a four-story, 120,000-square-foot College Station Clinic on the campus of a prospective 143-bed acute care hospital at the intersection of Texas Highway 6 and Rock Prairie Road in College Station, Texas, which is approximately 90 miles northwest of Houston, Texas. The MOB, which will be connected to the hospital on two levels, will house numerous medical specialties, including obstetrics/gynecology services, general surgery, orthopedic surgery, expanded rehabilitation and therapy services, and a comprehensive sleep center.
“We are looking forward to increasing Scott & White’s presence in College Station and Marble Falls and providing residents with greater access to quality healthcare,” says Dr. Robert W. Pryor, Scott & White President and CEO. “The new medical office buildings will enhance staff and physician efficiency and collaboration and provide for convenient access to our new hospitals.”
“We are proud to partner with one of the preeminent health systems in the country,” says Don Dunbar, Duke Realty Regional Executive Vice President. “The medical office buildings will serve as important assets on the Marble Falls and College Station hospital campuses and bring needed new health services to these growing communities.”
The Scott & White Specialty Care Clinic at the Wayne & Eileen Hurd Regional Medical Center is expected to be completed in the first quarter of 2013, and the adjacent Scott & White hospital will be open by the fall of 2014. The College Station Medical Clinic and hospital are expected to be completed in the third quarter of 2013.The Scott & White Specialty Care Clinic at the Wayne & Eileen Hurd Regional Medical Center
will be owned by Duke Realty Marble Falls Development LLC, and the College Station Medical Clinic will be owned by Duke Realty College Station Development LLC., both wholly owned by Duke Realty Limited Partnership.
The architect for both MOBs is Pasadena, Calif.-based Jacobs Engineering Group. The general contractor for the Scott & White Specialty Care Clinic is California-based DPR Construction, and the general contractor for the College Station Clinic is Kitchell Contractors Inc. of Arizona.
Scott & White Healthcare is a non-profit collaborative health care system established in 1897 in Temple, Texas. Scott & White Healthcare includes 12 hospital sites with two additional announced facilities (including Scott & White Hospital – College Station), and 143 clinics at more than 65 clinic locations throughout Central Texas providing adult and pediatric care in 46 medical specialties. Integrated, high-quality care is delivered by a dedicated staff of more than 12,000 (including 1.000 physicians and scientists and more than 300 specialized health care providers).
With more than 20 years in the industry, Duke Realty’s healthcare team offers proven experience in providing hospitals and physician groups comprehensive planning, development, ownership and facility management services. Projects have ranged from small medical office buildings to large ambulatory care centers with diagnostics, oncology and surgery services. Duke Realty owns and operates approximately 138.9 million rentable square feet of industrial and office assets, including medical office, in 18 major U.S. cities. t
At the University of Texas Medical Branch(UTMB Health), minimally invasiveprocedures are performed by the mosttalented and experienced surgeons usingthe most advanced laparoscopic and robotictechnologies.These internationally recognizedsurgeons are the very people who you wanttaking care of you and your family. In fact,they are the doctors who are teaching othershow to do what they do. The technology isbreakthrough. The surgeons are the best.The benefits are numerous. Minimallyinvasive procedures are safe, and resultin faster and easier recovery.
So if you are scheduling surgery for yourselfor a loved one, be sure to ask if it can bedone using a minimally invasive procedureat UTMB Health. The skills, the knowledge,the leadership and the confidence makethe difference. It’s all here in the Houston/Galveston Bay Area.
This is what happens when the mosttalented surgeons use the most advancedsurgical applications.
This is taking charge of your health.
eUniversity of Texas Medical BranchMember, Texas Medical Center
eartof surgery:Minimally invasiveprocedures guidedby the same surgeonswhoare teachingothers their art.
Left: Guillermo Gomez, MDDirector of the Center for Obesity and Metabolic Surgery
Center Left: Daniel Beckles, MD, PhD, FACS, FACC, FCCPDirector, Minimally Invasive Cardiothoracic Surgery
Center Right: Eric Walser, MDDirector of Vascular and Interventional Radiology
Right: Kimberly Brown, MD, FACSMinimally Invasive Liver and Pancreatic Surgery
The four surgeons featured here are representative of the more than thirty UTMB surgeons usingstate of the art minimally invasive surgical techniques across a wide variety of medical specialties.
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BREAKINGGROUND
. . . . . . . . . . . . . . . Duke Realty developing two MOBS in Texas
Does your clinic or healthcare organization live and breathe what you put in writing?
BY REED TINSLEY, CPA, CVA, CFP, CHBC
I was recently at a physician’s office and in the waiting room was a framed copy of the following:
Patient Bill of Rights
As a patient of our Clinic, you have the right to considerate and respectful treatment from all staff members of the Clinic.
You have the right to information you can understand on your condition, treatment and progress.
You have the right to refuse treatment to the extent permitted by law, and the right to be informed of the alternatives and consequences of refusing treatment.
You have the right to expect reasonable confidentiality of all records and communication about your medical care.
You have the right to request a copy of your medical records. (A fee may apply.)
You have the right to request an explanation of your bill.
You have the right to know the name and role of your attending physician and any other caregiver(s) participating in your care.
You have the right to be well-informed about your illness, possible treatments and likely outcomes and to discuss this information with your physician in a manner which you can understand.
You have the right to receive information about any proposed treatment or procedure in order to make an informed decision whether to consent to or refuse a course of treatment. Except in emergencies, this information shall include the purpose and description of the procedure, probably result, significant risks and alternate courses of treatment.
You have the right to actively participate in decisions regarding medical care, including managing pain effectively.
When I see this and other mission-type statements by healthcare organizations, I often wonder if the organization really lives and breathes their vision, values, and/or mission on a daily basis. I also wonder if management knows the difference between
real action and inaction.
Well there’s a way to find out – simply survey your organization’s owners and employees. Did you realize that most statements like the one above and other mission statements can be turned in to a simple questionnaire? Here are a few examples of how you can break down the Patient Bill of Rights into questions:
• Do we provide considerate and respectful treatment to all of our patients?• When asked by a patient, do we provide information he or she can understand concerning their condition, treatment and progress?• Do we hold confidential of all the records and communications about any patients’ medical care?• When asked by a patient, do we provide a timely explanation of their bill and do we provide it in a courteous manner?• Do we encourage patients to become actively involved in decisions regarding their medical care?
You get the point. Create your questionnaire, give it to your owners and employees, and see if their answers support whether or not you are in fact living, breathing, and achieving what you say you’re supposed to be doing in your mission statement – you just might be surprised by the answers.
Understanding Master Limited Partnerships
BY DAVID SKIPPERCEO, ASSURANCE CAPITAL MANAGEMENT LLC
If you are affluent and purchase investments through a full service broker,
then you have most likely been solicited to purchase the debt and equity securities of Master Limited Partnerships. Master Limited Partnership or MLP’s are very popular investments today. MLP’s are popular because they can offer significant yields and tax deferral opportunities to investors. However, MLP’s are not very well understood by individual investors and can carry additional risks.
MLP’s are in the business of exploring for, developing, mining, producing, processing, refining, and transporting minerals and natural resources. Therefore, an investment in a MLP is most likely an investment in the energy industry. Today there are over 100 publicly traded MLP’s. The largest share of MLP’s are in the
It’s a great time to purchase or refinance.With a commercial real estate loan from BBVa compass, you’ll get a great low rate.
Plus if you apply before the end of the year, you’ll also save with:
•Up to $5,000 off closing costs on loans $1 million and up
•Up to $1,000 off closing costs on loans under $1 million
In addition your Healthcare practice will also enjoy:
•low fixed rates for the entire term up to 25 years
•no balloon payments
•80% ltV for owner-occupied property; up to 95% ltV with sBa financing
Most importantly, you can trust the healthcare lending experts at BBVa compass
to make your loan experience simple and easy.
For more information or to apply, stop by any BBVa compass branch today.
1-800-COMPASS•bbvacompass.com
Application must be received between 07/01/2012 and 12/31/2012 and loan must be booked by 03/31/2013 to be eligible for this special offer. All loans subject to eligibility, collateral and underwriting requirements, and approval, including credit approval. Special closing costs offer available for a limited time only on qualifying commercial real estate loan applications received and booked within the specified offer dates. Up to $5,000 off closing costs on loans over $1 million; up to $1,000 off closing costs on loans under $1 million. Your actual closing costs discount may vary based on several factors. Offer applies to qualified types of owner-occupied commercial real estate and qualified borrowers. Offer not valid in conjunction with any other discount or offer. Customer is responsible for any closing costs and fees outside of any special promotions and reimbursement of any third party costs if loan is paid off within 36 months of loan closing. All promotions and offers subject to change without notice. Please contact a BBVA Compass banker for details. BBVA Compass is a trade name of Compass Bank, a member of the BBVA Group. Compass Bank, Member FDIC. #894
BY MARY M. BEARDEN and ALLISON SHELTONBROWN & FORTUNATO, P.C.
IIn June, the Office for Civil Rights (OCR) released results from the initial twenty audits of the HIPAA Audit Program. In the next few months, OCR will implement the final phase of the pilot audit program, auditing a total of 115 covered entities by the end of December 2012.
Historically, enforcement of HIPAA has been reactive—that is, OCR initiated an investigation only after it received a complaint or a covered entity reported a breach. In 2009, Congress expressed its desire for the enforcement efforts to be more proactive. Section 13411 of the HITECH Act, therefore, requires the Department of Health and Human Services to periodically audit covered entities and
business associates to ensure that they are in compliance with the HIPAA Privacy and Security Rules and the standards for breach notification. Accordingly, in November of 2011, OCR initiated a pilot audit program to identify compliance issues.
OCR contracted with KPMG, Inc., a private corporation, to develop and conduct the audits. The pilot audit program was divided into two phases: the initial phase, during which KPMG audited the first twenty entities and developed audit protocols, and the final phase, in which KPMG will audit the remaining 95 entities. In June, OCR released data gathered from the first twenty audits. According to this data, small entities tended to have more compliance deficiencies than larger entities, and most of the deficiencies for both large and small entities came from failure to comply with the Security Rule.
In June, OCR also released the audit protocols developed by KPMG during the initial phase of the program. Consisting of 169 protocols, the audit program will continue to develop, add, and delete protocols during the final phase. At this time, 78 of the protocols focus on the HIPAA Security Rule, 81 protocols concern the Privacy Rule, and 10 protocols focus on the breach notification standards.
Because the audit protocols were designed by a private entity, and not by OCR, some of the protocols represent KPMG’s interpretation of the law rather than actual legal requirements. For example, 45 C.F.R. § 164.308(a)(3)(ii)(C) requires covered entities to “implement procedures for terminating access to electronic protected health information when the employment of a workforce member ends.” The audit protocol for this regulation requires that covered entities have “separate procedures for terminating access to ePHI when employment of a workforce member ends, i.e., voluntary termination . . . vs. involuntary termination.” Obviously, KPMG’s protocol goes over and beyond the requirements stated in the regulation. Nevertheless, the protocols will guide the audit process and influence the final report submitted to OCR.
By the end of December, KPMG will audit the 95 remaining entities. These entities will be randomly selected and will include health plans, health care providers, and clearinghouses of all sizes. When KPMG selects an entity for an audit, KPMG will send notice and a request for documents to the entity. The document request will require the entity to produce a variety of documents, including policies and procedures, demographic information, and forms. After receipt of the notice letter,
the entity will have only fifteen days to produce the requested documents. KPMG will treat any documents not produced as non-existent. This may result in a finding of non-compliance, even if the entity has the necessary document.
Between thirty and ninety days after KPMG sends the notice letter, KPMG will perform an on-site audit, which will take from three to ten days. During the on-site audit, three to five auditors will interview personnel, walk through and observe the entity’s operations, and request more information. These auditors will use the audit protocols as a guide to assess the entity’s compliance with HIPAA. After the on-site audit, KPMG will prepare a draft report of the findings and send the report to the entity. Once the entity receives the draft report, the entity will have ten days to prepare a written response. Both KPMG’s report and the entity’s written response will be provided to OCR. In the event OCR believes more action is required, OCR may initiate an investigation that could lead to an enforcement action.
The HIPAA Audit Program has received fiscal appropriations for 2013 and 2014; therefore, the audits are likely to continue and to grow. To implement a compliance
Please see LEGAL AFFAIRS page 10
LEGALAFFAIRS
. . . . . . . . . . . . . . . OCR joins the team of federal auditors
Consider it a HolistiC approaCH to Managing Your praCtiCe’s FinanCes.When it comes to your patients, you don’t just treat symptoms. You look
at their overall health and lifestyle. And make a diagnosis based on the
big picture. That’s how we approach your finances. Both your personal
and your practice’s. Making for a healthy, wealthy and wise financial outlook.
personal solutions
Residential mortgage, including 100% financing
Life and disability insurance services
Investment management
Estate and retirement planning
Specialized healthcare deposit products
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Term financing for partnership buy-ins
Equipment financing and lines of credit
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Deposit solutions
THA
. . . . . . . . . . . . . . .
Special to Medical Journal – Houston BY DAN STULTz, M.D., President/CEO, Texas Hospital Association
Texas hospitals know the importance of being prepared for potentially catastrophic storms, and they prepare all year by making significant investments in training and capital improvement projects to ensure their communities’ safety.
In 2005, Texas hospitals and healthcare systems played an important role in the aftermath of Hurricane Katrina, and three weeks later, Hurricane Rita’s 120 mph winds wreaked havoc on the Texas Gulf Coast. Three short years later, Hurricane Ike blasted the Galveston area, wiping out one of only three Level 1 trauma centers in the Houston-Galveston region and closing one-third of Texas’ burn centers for over a year. Those three storms taught e m e r g e n c y management coordinators around the country the impor t a nce of being prepared and the necessary steps to protect patients before and after the storm. Often, these steps require a significant investment from the hospital.
CHRISTUS Hospital - St. Elizabeth in Beaumont went through a series of efforts to prepare its structure for a storm of Hurricane Ike’s magnitude following Hurricane Rita. According to Pat Briggs, regional director for CHRISTUS Health Southeast Texas Region, the hospital added several upgrades to ensure the continuity of care in the event of a disaster. Public funding from the Hospital Preparedness Program aided the installation of a flood mitigation system, but the hospital also invested $500,000 of its own money for hurricane-strength protective window film.
“It was a significant post Rita internal investment, but it saved us from property loss and damage from Ike,” Briggs said.
Briggs also noted the importance of being
able to serve the community as a fully functioning hospital at the height of a storm.
“You’re almost like a city within a city that is still functioning while the rest of the city is still down.”
Allen Johnson, executive director of emergency services for HCA’s Gulf Coast Division, which includes 10 hospitals from Brownsville to Conroe, talked about their system’s investment in 12 generators mounted on semitrailers, which provide mobility for their backup power strategy. The generators cost HCA approximately $70,000 per month, an amount that does not include actual usage. This is but one of the many often unseen, yet vital, investments Texas hospitals make every year to keep patients and their communities safe.
T e x a s hospitals also make hefty investments in staff training and certifications.
T h e s e include non-surge zone h o s p i t a l s , which drill and train annually for any number
of disaster possibilities from tornadoes to hazardous materials spills. Jorie Klein, director of Parkland Health System’s trauma and disaster programs, said they spend approximately $250,000 annually on disaster planning just to prepare for an “all hazards” approach to emergency preparedness.
“If you’re going to prepare, you have to do that,” Klein said, noting that some of the costs address capital equipment investments as well as training and certifications. “The disaster training is the same as having an insurance policy on your house. If you’re not preparing, it’s not just the hospital that loses. It’s every person in the community.”
Texas hospitals are proud of the approach we have taken to ensure continuity of care in the event of a storm. Although we can never be certain when or where a disaster will strike, we do know that patients will still need care, and Texas hospitals will be there to address their needs in a time of crisis. t
Hospitals invest all year long in emergency preparedness
BY VICTOR S. SIERPINA, MD, ABFP, ABIHM, Distinguished Teaching Professor, Family and Integrative Medicine, UTMB Health
“Generosity he has, such as is possible only to those who practice an art and never to those who drive a trade; discretion, tested by a hundred secrets; tact, tried in a thousand embarrassments; and what are more important, herculean cheerfulness and courage. So it is that he brings air into the sick room and often enough, though not so often as he desires, brings healing.”
---Robert Louis Stevenson
Last month, we started on the journey to discuss the challenges of creating an optimal healing environment in the tough zone that is medical practice today. We discussed personal and professional characteristics that could enhance this setting.
This month, we will look at practical business and practice structures that may be useful to you. If you would like more detailed and practical methods of optimizing the environment of your healing practice, consider attending the upcoming Holistic Primary Care’s Heal Thy Practice-Transforming Patient Care conference, Nov 9-11, 2012 in Long Beach, CA (1). A preview by one of the speakers, Dr. Kennealy is about freeing yourself from “McMedicine.’ She offers three tips: 1) Shift your perspective and embrace business thinking, 2) Tap your entrepreneurial spirit and engage in acts of radical creativity, 3) Master authentic from-the-heart marketing. This annual conference is a chance to truly reform your practice and approach to medicine and this is just one of the many practice-related presentations.
Optimizing the healing environment can and should incorporate several levels of change. Holding the intention to create a healing environment among all doctors, nurses, and staff in the practice is essential. You wish to promote an authentic, heartfelt desire and concerted effort to provide a patient centered medical home and relationship based experience. This should result in a service-oriented encounter perceived as a “Wow!” experience by
patient. This changes things in the radical way they need to move.
Transform your office into a healing space by incorporating natural elements such as light, music, wood, water effects, art, and comfortable seating and exam rooms. This gives a powerful message, “We care how you feel and how you experience your visit from start to finish.” Such changes don’t have to be highly expensive or complicated. Simple effects and conscious design can offer patients a holistic, artistic, positive healing space that invites them to activate their innate healing response and to feel respected as whole persons. For those so inclined, there are a number of “green” and “holistic” architects and interior designers that specialize in making medical spaces less coldly clinical and more warm and inviting.
Rakel’s textbook of Integrative Medicine(2) introduces the 4 A’s of the healing encounter: 1) Awareness, 2) Awakening, 3) Authenticity, 4) Awe. This approach incorporates nothing less than a mindful approach and consciousness that both sides of the healing encounter are in a mutual transformation. As Carl Jung stated, “The meeting of two personalities is like the contact of two chemical substances: if there is any reaction, both are transformed.”
An example of this is what Rakel refers to as the “salutogenesis-orieneted session” (SOS) healing encounter. The term comes from the Latin, salutaris, meaning health. Salutogenesis is thus the generation of health. It can be fostered in either a brief encounter or a prolonged discussion. Longer sessions require protecting time in your schedule and framing patient expectations about the visit. This requires deliberate planning, the creation of ceremony, and ritual. This extended visit cannot be applied to every patient, but can certainly be planned for some.
For example, though my primary care practice is fully booked and closed to new patients, I continue to offer holistic consultations, which include an extended initial session of at least an hour, plus follow-up visits as needed. This allows me to manage the practice and my panel size. It also provides an opening for complex, intensive visits that are challenging for me
INTEGRATIVE MEDICINE
. . . . . . . . . . . . . . .
Optimizing the healing environment in an era of healthcare reform (Part 2)
Please see INTEGRATIVE MEDICINE page 14
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Winkler County Memorial Hospital in Kermit, Texas, signed an agreement with Prognosis Health Information Systems (Prognosis HIS) and is implementing its financial solution, including its general accounting and patient accounting and billing solution. Backed by strong county and hospital board support, the 19-bed critical access hospital, managed by Preferred Hospital Leasing Co. in Shawnee, Okla., selected Prognosis HIS to ensure the hospital’s information technology (IT) capabilities for revenue cycle management are “on par” with the health care IT world. Prognosis HIS specializes in electronic health record and financial solutions for community hospitals, including rural and critical access hospitals. “Health care has been a staple in Kermit since the 1930s. Because of that, it is important that we stay on top of all the changes happening in healthcare care, especially in regard to information technology,” said Winker County Memorial Hospital CEO William Ernst. “That’s why we began looking for the total health care IT package.” “A financially sound hospital is crucial to a community’s health and well-being,” said Prognosis HIS CEO Ramsey Evans. “Prognosis HIS is a proven partner for rural and community hospitals that understand the value of streamlining financial operations and ensuring reimbursement for all the care delivered. Ultimately, these will translate into greater efficiency and profitability.” Prognosis HIS’ financial system includes the following features: • Discharge HIM abstract completion• Billing• Claims processing• Payments and adjustments• A/R collection• Early out / collection agency data transfer• General ledger• Accounts payable• Payroll / time and attendance• Materials management• Patient registration and scheduling
Ernst identified Prognosis HIS’s communication capabilities between its inpatient, emergency department and financial systems; the ease of billing, easy-to-use functionality and user experience;
and clearly outlined training program as key factors in Winkler’s selection process. “We sought the total package, but being a smaller hospital we must proceed slowly and
make sure our entire team is on board every step of the way,” Ernst added. “We’re excited to move forward with Prognosis and get caught up with the 21st century.” t
Patients and families at HealthSouth Rehabilitation Hospitals hear a lot about a higher level of care. What does this mean to
you? Our rehabilitation teams work with patients and their families, providing superior care with quality outcomes to return patients to maximum independence at home and in the community.
To a patient recovering from an illness, injury or surgery, a higher level of care means:
• Personalized goals for a faster return home• Comprehensive team approach to rehabilitative care• Advanced technologies for the latest treatments• Physician visits every day• Three hours of therapy over a day, five days a week• 24-hour certified rehabilitation nursing care
For a higher level of care, choose a rehabilitation leader that makes a difference for patients and families. Choose HealthSouth Rehabilitation Hospitals.
program that will withstand an audit, entities should refer to the audit protocol, available at http://www.hhs.gov/ocr/privacy/hipaa/enforcement/audit/index.html, and ensure that they have the necessary policies and procedures in place. When a provider adopts policies and procedures, the provider should not only put the policy in writing, but also ensure that the policy is implemented and practiced at the entity. Thus, providers should orient, train, and evaluate personnel on the policies and
procedures. Furthermore, the policies and procedures should be organized in a readily retrievable form, because an entity selected for an audit will only have fifteen days to produce these documents. Finally, providers should recognize that many of the audit protocols represent best practices rather than legal requirements. Therefore, in the event that a provider is selected for an audit, the provider should engage legal counsel to assist in the response to the audit. KPMG’s final report may lead to an enforcement action by OCR; therefore, entities should ensure that the report focuses on the legal requirements and should challenge the accuracy of any such report. t
VA study to better understand schizophrenia and bipolar disorder The Michael E. DeBakey VA Medical Center is conducting research involving Veterans with schizophrenia or bipolar illness. This effort is part of a national multicenter study of approximately 25 sites across the country, coordinated by the VA Cooperative Studies Program. At each site, participants are asked to give a small (one-tube) blood sample, answer a short questionnaire, and complete paper-based assessments; however, they are not asked to take any study medications nor undergo any invasive procedures.
Schizophrenia and bipolar disorder are chronic mental health conditions that can generate considerable lifelong disability. Both conditions are known to have major genetic or inherited components, possibly explaining how severe the disease is, how well treatments work, and how day-to-day functioning is affected. The goal of this study is to compare the DNA or the genes of Veterans with schizophrenia or with bipolar illness to the DNA of Veterans without these conditions. This approach will help researchers identify genetic risk factors related to these conditions and how severely they affect Veterans. Researchers will also evaluate tests shown in the past to describe real-world functional problems, such as managing a checkbook. The study will also establish a specimen and data bank for future research to help
Veterans with schizophrenia and bipolar disorder. Treatments for these conditions have improved in the last few years, but are still associated with relatively high rates of side effects. The study could therefore also possibly help to identify which patients do better receiving certain medications. Veterans are eligible to participate if they have been given a diagnosis of schizophrenia or bipolar illness and receive health care at a VA facility. The 3-hour sessions take place at the Michael E. DeBakey VA Medical Center and consist of providing a small blood sample, filling-out questionnaires about symptoms and medical history, and completing tests of memory and thinking.
UTMB launches Hurricane Isaac relief and supplies drive Two institutes at the University of Texas Medical Branch at Galveston have launched a relief effort to help people and communities in Louisiana and Mississippi who were victims of Hurricane Isaac.
The UTMB National Institute of Environmental Health Sciences’ Core Center in Environmental Toxicology and the UTMB Institute for Translational Sciences are accepting donations such as cleaning supplies, tools and personal hygiene items. In conjunction with the
Louisiana Environmental Action Network the UTMB institutes have already begun to assess disaster response needs and to provide aid to residents in the form of material goods for reentry and cleanup, especially those needed or related to the prevention of injuries or diseases associated with the flooding and extensive damage to homes and community infrastructures. To this end, faculty from both UTMB institutes will be engaged in a series of Community Science Workshops in southeast Louisiana, a mechanism that enables UTMB faculty and staff to interact with and respond quickly to their community partners in the face of emergency situations. Please contact UTMB for a list of supplies that are needed to help. As relief efforts move into recovery stages, UTMB will also continue to work with its non-profit partners, including LEAN. t
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Elements Behavioral Health acquires majority interest in Right Step network of addiction
treatment centers in Texas and New MexicoMERGERS ANDACQUISITIONS
. . . . . . . . . . . . . . .
Elements Behavioral Health, a leading provider of addiction and mental health treatment programs, recently announced that it has acquired Right Step network of addiction treatment centers in Texas and New Mexico.
Right Step is a network of outpatient and inpatient addiction treatment centers located throughout the Southwest. Its family of programs also includes Spirit Lodge, for ages 26 and older, a high-end residential treatment center with panoramic vistas of the rolling hills outside Austin, Texas, and San Cristobal, an adventure-based addiction treatment center in Taos, NM, for males between the ages of 18 and 26.
Right Step offers a full spectrum of care to fit each individual’s needs, including:• Medical Detoxification• Residential Addiction Treatment• Day Treatment• Intensive Outpatient Treatment• Sober Living• Aftercare
• Alumni Groups
Certified by The Joint Commission, Right Step is one of the country’s premier alcohol and drug rehab treatment companies. Its chief executive officer, George Joseph, has more than 28 years of experience in the
field and its chief medical officer, Dr. Jason Powers, has been recognized as a “Top Addiction Doctor” in Houston for three years running by H Texas magazine.
“After 18-plus years of leading the growth of Right Step, Spirit Lodge and, more recently, the San Cristobal program, I
have decided to partner with Elements Behavioral Health, the national leader in addiction treatment. I am extremely excited to work under the leadership of Elements and the world-renowned Dr. David Sack. I will continue to oversee our operations for a minimum of 2 years.” said George Joseph,
CEO of Right Step.
Keith Arnold, Vice President Operations for Elements Behavioral Health and previous Sierra Tucson Executive Director said, “We are looking forward to working with George’s team and enhancing their comprehensive programming for the local
community. Since 1990, Right Step has provided compassionate, comprehensive substance-abuse treatment at an exceptional value. Today, Right Step is the largest, most trusted private chemical dependency treatment provider in the Southwest.”
“We are thrilled to welcome Right Step into the Elements family of programs,” said Dr. David Sack, CEO of Elements Behavioral Health. “George Joseph brings with him over two decades of experience delivering high-quality, affordable treatment to families and individuals in Texas. Right Step, Spirit Lodge, and San Cristobal will be integral parts part of our mission to help individuals with substance abuse and emotional disorders create extraordinary lives.”
Elements Behavioral Health is a family of behavioral health care programs that includes Promises Treatment Centers, The Sexual Recovery Institute, The Ranch, and The Recovery Place. Elements offers comprehensive, innovative treatment for substance abuse, sexual addiction, trauma, eating disorders, and other mental-health disorders. t
fulfill administrative responsibilities within your organization and attract incoming physicians looking for leadership experience. Some organizations have also adopted the policy of presenting open contracts to candidates, which allow physicians the freedom to terminate an assignment without penalty. Under this contract, managers aim to boost engagement and pride within an organization by making the facility an enjoyable place to work—so their physicians would never want to leave.
Another practice to consider is providing stipends to incoming graduates for signing-on to an organization. After agreeing to work with a facility, these quality-of-life stipends help support students as they complete necessary school and training prior to employment.
Adding a personal touchMaking the extra effort to stand out among preferred candidates can often help finalize an offer—sometimes, even small details can have a huge impact. Incoming physicians, particularly those who will be relocating to your facility, are very interested in the community they will be servicing. For
some clients, sending a welcoming package with the local newspaper, information about the facility, and tidbits from the surrounding area (particularly if customized to the candidate’s interests) help to make an incoming physician feel welcome in their new home. Perhaps something as simple as leaving a new lab coat in an interviewee’s hotel room can help translate a welcoming and encouraging culture for your facility. Many hiring organizations have paid to bring a favored candidate’s spouse into town for a facility and community tour, prior to the candidate’s interview. Facility managers in these cases recognized the spouse was such a large part of the decision making process that they invested in bringing them out to assess the community, and if the spouse was sold upfront, it took a lot of pressure off of the interview.
What is a creative day-to-day?Flexible SchedulingWhile offering a choice between four 10-hour days, or working a regular 8 a.m. to 5 p.m. schedule has become somewhat of a norm in recruitment, offering a creative solution to flexible scheduling is still
Data indicates total number of days - highest and lowest for a state to close credentialling from July 2011 through June 2012. This data represents all states Delta Locum Tenens has done business in during the past 12 months.
Map represents the percentage of licensed physicians by region working with Delta Locum Tenens.
Data indicates the top five specialties by days requested from July 2011 through June 2012.
This data represents average statistics of placements and interviews by Delta Physician Placement over the twelve-month survey period. Since these averages only include placements and interviews, the compensation information presented indicates the rate at which candidates are choosing to interview or sign. Average
days information can be used to forecast a probable timeline for a recruitment effort in a particular specialty.
possible. Job sharing, or dividing a fulltime position into multiple part-time positions, is becoming a popular trend, particularly with difficult to fill positions. Some facilities may have difficultly in finding a provider willing to work fulltime due to the community’s location or a provider’s preference. However, allocating this same position into part-time schedules and adjusting the compensation accordingly may be more appealing for providers interested in open schedules. This also opens the doors to a larger pool of candidates that would consider part-time employment. This form of flexible scheduling can be determined by facility and provider preferences, and can range from two physicians working certain days per week, or alternating a one-week-on, one-week-off setup.
Other trendsCommunity forgiveness loans are a rare practice that can be very attractive to physicians during their first few years of service. Once a physician has agreed to work with a particular organization, the surrounding community offers a welcoming loan, which is forgiven over a set period of time. For example, for every year a physician
agrees to service a community, 25 percent of the loan is relieved.
Boosting RetentionCommunication is the key to retention—this can be said of any type of organization. When an employee feels their voice is being heard, they feel engaged; engagement boosts pride; proud employees typically work harder and remain loyal to their organization. One way to ensure you are receiving feedback from your staff is by issuing reoccurring surveys that poll providers on what types of
improvements they would like to see implemented within the facility. Once this feedback is available, facility managers can act on the information.
A great example of this technique was demonstrated by a bustling facility in Tennessee. After conducting a poll, an
overwhelming majority of physicians with children expressed a need for childcare during working hours. To accommodate this need, facility managers invested in an onsite, higher learning facility with no charge to employed physicians. The daycare facility was also opened to the surrounding community for a regular fee. The return on this investment was a facility full of focused providers whose needs had been resolved—not to mention, a direct link to community members with children in need of daytime care. t
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Data reflects averages from placements and interviews by Delta Physician Placement from July 2011 through June 2012. “Potential Compensation” data reflects average yearly compensation at full production excluding benefits. “Average Days” data does not include off-contract placements. “Average Days Total Placement” data is calculated from profile to placement.
Starting Compensation
Sign-on Bonus
Potential Compensation
From Interview to Placement
Total Placement
Fastest Days-to-Fill
Family Medicine $191,355 $20,196 $248,022 46 175 3
Internal Medicine $212,613 $24,561 $291,438 62 161 28
professionally and personally. These SOS visits stimulate my mind by making me bring out the best of all I have learned in medicine. In these consults, I incorporate tools from the entire integrative spectrum of nutritional medicine, mind-body therapies, functional medicine, acupuncture and Chinese medicine, spirituality, motivational interviewing, botanical medicine, and lifestyle change.
Billing and coding is an essential part of maintaining your integrative practice. It is essential that you create a consistent cash flow to manage the expense of your time and other overhead expenses. Some practices do this by making such consults a cash only basis. Others incorporate them in the standard insurance billing model. Attention to proper documentation on complexity of decision making, key elements to history and physical will allow insurance coders to allow the highest level of reimbursement for your time spent. One way to improve your collections are to use the “counseling” statement. This requires your statement that at least 50% of the visit was spent on counseling. This counseling service needs to be detailed, for example, lifestyle, changes, mind-body instruction, nutritional advice, exercise prescription,
coordination of services with other specialists of alternative practitioners, etc. Any time over 45 minutes is likely qualify for a level 5 visit and over 30 minutes for a level 4 if all other documentation requirements have been met. This is the way I manage to get reimbursed for the SOS type, extended or comprehensive level visit.
Though it is a challenge to optimize the healing environment in the current health care system, practices can utilize some of the principles described here to make a big difference in how medical services are delivered. Incorporating health coaching, developing the Patient Centered Medical Home, modifying the physical environment, working to improve people attitudes, making processes more efficient with are all useful tools to improve the patient interface.
By changing the way we do medicine and changing the medicine that we do, we embrace the opportunity to revitalize ourselves, our practices, and most importantly, the health of our patients. This allows us to face squarely whatever surprises health care reform may deliver to our doorstep. We do this by returning to our root Oslerian principles, bringing joy and idealism to our work once again if we have sadly lost them. t
1.http://hol ist icpr imarycare.net/heal-thy-pract ice-conference 2. Rakel D. Integrative Medicine. Edition 3, Elsevier/Saunders. 2012, p.22-24
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midstream business of the energy industry. The midstream business is where pipeline companies ship oil and gas from the field where it is produced to the residential or industrial consumer. The midstream business is favorable to MLP’s due to the fact that it generally produces a steady stream of income that the partnership can distribute to its unit holders. Other MLP categories include Exploration & Production, Refining, Marine Transportation, and Coal. A key distinction in terminology between corporations and partnerships is that corporations pay dividends and partnerships pay distributions. Another key distinction in terminology is that investors own shares in a corporation and units in a partnership.
Additionally, MLP’s are publicly traded limited partnerships. Limited partnership are structured so that limited partners, usually outside investors, put in the majority of the capital while the general partner manages the operations and investments of the partnership The general partner usually contributes a limited amount of the capital to the partnership and receives compensation for managing the partnership. Usually the general partner maintains managerial control of the partnership and the limited partners have very little input into the day-to-day operations of the partnership. A similar structure would be a doctor starting and managing a new practice by purchasing equipment and supplies with money from investors while he or she maintains control of the practice. The doctor would be compensated out of the income of the
practice and control the practice; however, the investors would own a portion of the practice and therefore be entitled to a portion of the practice’s profits.
In general Master Limited Partnerships fund themselves differently than regular corporations. For the most part, corporations in the United States are able to fund their expansion out of internally generated cash flow. In other words, the amount of cash that the business generates is reinvested into new equipment and facilities to expand the company. However, MLP’s operate differently. Because distributions are valued so highly by MLP investors, MLP’s distribute as much cash as they can to their owners. Therefore, most of the cash that is generated by the partnership is distributed to the unit holders. Any funds needed for additional expansion are borrowed or the partnership sells additional units to the public. Borrowing is usually the first option. This means that MLP’s usually have more debt and are less financially secure than comparable corporations. The manner in which MLP’s fund themselves is usually safe during a rising market; however, during a bear market their funding can be problematic. Their high debt loads can make solvency a concern and they often need to reduce their distributions to unit holders during a recession.
Due to their funding mechanisms MLP’s can carry additional risks; therefore, it is important to assess these risks before purchasing their equity or debt. Master Limited Partnerships are most appropriate for sophisticated investors who are willing to spend the time and effort to understand their investment or are willing to pay adviser to manage their investments for them. t
Our neurosurgeons successfully perform complex surgeries others won’t attempt.At the Mischer Neuroscience Institute at Memorial Hermann–Texas Medical Center, we were the first in the region to perform vagus nerve stimulation, an innovative procedure that prevents seizures in epileptic patients. We complete more of these surgeries than anyone in the nation. And that’s just a fraction of what we do. From brain tumor resections to aneurysm repairs, we perform more than 2,000 neurological procedures every year—more than anyone in Houston. This level of groundbreaking medical care is just what you would expect of an institution that’s affiliated with The University of Texas Health Science Center at Houston (UTHealth) Medical School. Together, we make more neuroscience breakthroughs every day. Learn more at mhmni.com.
