diabetes practice options, april 2012

OPTIONSDIABETES PRACTICE

™

Improving Patient Care Through Increased Practice Efficiency

Visit www.DiabetesOptions.net to view our digital edition and for more practice options information.

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The Physicians' Foundation

www.physiciansfoundation.org

APRIL 2012

EDITORIAL

3 | DIABETES STRATEGYCommunication Skill Is Critical in Providing Patient-Centered Diabetes Care

6 | CODING UPDATEHow Practices Can Begin Preparing Now for the ICD-10 Transition

11 | TECHNOLOGYClinical Knowledge Systems Improve Health Outcomes, Reduce Hospital Time

14 | CAPITAL IDEASFringe Benefit Plans Can Help Physicians Accumulate Wealth for Retirement

18 | PRACTICE MANAGEMENT NEWSStudy Shows Health Care Consumers Make Better Decisions When Given More Information

I’m on the board of directors of a community health center that is preparing to become acertified medical home. One requirement is creating a patient portal to enhance com-munication between patients and the health center. Although the center’s IT systems are

secure, many staff physicians are concerned about privacy and liability issues, and howcommunicating with patients via e-mail will affect their productivity.

Most service-related organizations communicate via e-mail with the people they serve.Physicians typically use e-mail with patients to schedule appointments or send remindersabout follow-up care. Some practices have patient portals that give patients access to partsof their medical records, such as lab results and immunization history. Fewer practices,however, have established procedures for ongoing, direct e-mail communication betweenphysicians and their patients.

Continued on page 2

CONTRIBUTORS

Carole Foos, CPA

Rhonda Buckholtz, CPC

Debate Continues Over E-MailCommunication With PatientsBy Michael Bihari, MD, contributing editor

Page 3

IN THIS ISSUE

Neil Baum, MDUrologistNew Orleans

Daniel BeckhamPresidentThe Beckham Co.Bluffton, S.C.Physician and Hospital ConsultantsWhitefish Bay, Wis.

Harold B. Kaiser, MDAllergy & Asthma Specialists, PAMinneapolis

Nathan KaufmanPresidentThe Kaufman GroupDivision of Superior Consultant Co. Inc.Physician and Hospital ConsultantsSan Diego

Peter R. Kongstvedt, MDP.R. Kongstvedt, LLCMcLean, Va.

John W. McDanielPresident and CEO Peak Performance Physicians, LLCNew Orleans

James M. Schibanoff, MDEditor in chiefMilliman Care GuidelinesMilliman USASan Diego

Jacque Sokolov, MDChairmanSokolov, Sokolov, BurgessScottsdale, Ariz.

This newsletter is published by Premier Healthcare Resource, Inc., Morristown, N.J.

© Copyright strictly reserved. This newsletter may not be reproduced in whole or in part without the written permission of PremierHealthcare Resource, Inc. The advice and opinions in this publication are not necessarily those of the editor, advisory board, publishingstaff, or the views of Premier Healthcare Resource, Inc., but instead are exclusively the opinions of the authors. Readers are urged toseek individual counsel and advice for their unique experiences.

EditorRev DiCerto845/[email protected]

Art DirectorMeridith Feldman

PublisherPremier Healthcare Resource, Inc.150 Washington St.Morristown, NJ 07960973/682-9003; Fax: 973/682-9077 [email protected]

EDITORIAL

EDITORIAL BOARD

I recently chatted with a group of physi-cians about exchanging e-mail with patients.Those in favor felt that e-mail enhances theexchange of information. One physiciannoted that using e-mail provided her with awritten record of the issues discussed andallowed her patients to share accurate infor-mation with loved ones. The physiciansopposed cited privacy issues, liability relatedto e-mail content, and the sense that theprocess would consume more of their alreadyrestricted schedules. Interestingly, the physi-

cian most adamantly opposed to using e-mailis the only member of a group practice whohas not been able to adapt to the group’s elec-tronic medical record.

E-mail communication may be most help-ful for patients who are being treated for achronic illness. I have type 2 diabetes andview electronic communication with myphysician as a great way to help me stay incontrol. My scenario would include person-alized communication coupled with accessto appropriate resources. For example, if Iwas recently diagnosed with diabetes, mypatient portal would include links to infor-mation about the disease as well as access tomanagement resources, such as diet andexercise. After a visit, a follow-up e-mailcould include a diabetes checklist to down-load, what I need to accomplish before mynext appointment, and links to informationrelated to the visit.

Since I wrote this editorial on my iPad2,you can guess where I stand on this issue. �

STAFF

Continued from page 1

2 Practice Options/April 2012

More information is available atwww.DiabetesOptions.net

Michael Bihari, MD

Diabetes patients’ success in self-management has meaningfulconsequences for clinical out-

comes, but too often patients do notsuccessfully adopt the difficult lifestylechanges—including those related todiet, exercise, and medication adher-ence—that are required to achieveglycemic control. The reasons are mul-tifactorial: diabetes patients may feeloverwhelmed by the diagnosis, be frus-trated when their efforts do not yieldimprovements in health indicators, orsuffer from “diabetes distress,” a condi-tion in which patients become highlystressed by the implications of the dia-betes diagnosis. However, many dia-betes experts believe that one wayphysicians can improve patients’ self-management ability—and, therefore,clinical outcomes—is to improve thequality of their communication withtheir patients.

Patient Communication“As demonstrated by many researchstudies, the most significant barrier toself-management is the patient’s nega-tive emotional response to dealing withdiabetes,” says Martha M. Funnell, MS,RN, CDE, assistant research scientist inthe Department of Medical Education

at the University of Michigan’s DiabetesResearch and Training Center. A studyby Zulman et al published in the August11, 2011, issue of Patient Education andCounseling found that diabetes distresswas associated with self-managementdifficulty, poor glycemic control, andworsening diabetes status over time.According to Funnell, diabetes distressaffects about half of all diabetespatients. “Physicians are understand-ably frustrated by patient noncompli-ance with self-care,” she notes. “But byavoiding the issues that drive noncom-pliance, physicians cannot help theirpatients enhance their self-care skills orachieve optimal outcomes.”

Funnell notes that there are twoaspects to communication: the contentof the message and the way in whichthe message is delivered. “The content,information related to medications andlifestyle changes, is well understood byphysicians,” says Funnell. “But mostphysicians have not been trained inhow to deliver that information effec-tively. Medical school curricula do notemphasize communication, and mosthands-on physician training occurs inhospitalized patients, who are typicallyless involved in decision-making thanoutpatients.”

Funnell, who has studied physician-patient communication in diabetescare and who offered advice in an arti-cle published in the Journal of FamilyPractice’s September 2011 issue, notesthat physicians perceive visit time limi-tations as a barrier to thorough com-munication. “Physicians believe that ifthey stray from their usual way ofimparting information and address thepatient’s specific concerns, they willextend the length of the visit,” Funnellsays. “In reality, studies have shownthat addressing patient-identified con-cerns makes the visit more efficient andeffective. By not addressing the issuesthat are most important to the patient,the physician runs the risk that he orshe will spend time providing informa-tion and then at the end of the visit thepatient will identify a significanthealth-related concern. This actuallylengthens the visit and may even negatethe previous discussion.”

Relationship Building“As with all chronic conditions, optimaldiabetes care requires that patients and physicians cultivate a trusting,long-term relationship,” saysMohammadreza Hojat, PhD, researchprofessor in the Department ofPsychiatry and Human Behavior anddirector of the Jefferson LongitudinalStudy of Medical Education at JeffersonMedical College in Philadelphia, Pa.“Empathetic, patient-centered commu-nication is central to the developmentof this relationship. Research hasshown that better physician-patientcommunication leads to better patientcompliance with the treatment plan,which can help the patient optimize hisor her health outcomes.”

“Knowing that improvement ofempathy could affect patient outcomesshould spur physicians to enhance thisattribute,” asserts Hojat. “Medicalschool curricula and residency trainingprograms do not focus on the impor-tance of empathetic communicationfor patient care and related clinical out-comes. Empathy as a critical ingredient

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Practice Options/April 2012 3

DIABETES STRATEGY

Communication Skill Is Critical inProviding Patient-Centered Diabetes Care

DIABETES STRATEGY

of physician competence should beenhanced during medical educationand furthered by continuing medicaleducation activities.”

“To be effective in disease preven-tion, we as physicians have toget to know our patients,understand their perspective,and then try to work with themto improve their health-relatedbehaviors,” says FredMarkham, MD, a practicingphysician, professor at JeffersonMedical College, and co-authorwith Hojat of a study of theassociation between physician empathyand diabetes outcomes. Markhambelieves this type of physician-patientrelationship is particularly importantin diabetes care because it is a commonchronic disease that leads to manyother complications. “Because self-careis so critical to diabetes outcomes,physicians must get buy-in from thepatients with regard to pursuing treat-ment recommendations,” he says. “Ifpatients don’t believe in the value of therecommended self-management activ-ities, they will not achieve good blood

glucose control in the long run.” Physicians can improve their com-

munication style by practicing shareddecision-making and developing anovertly empathetic demeanor when

working with patients. Hojat, whosearticle on 10 approaches for enhancingempathy in health care settings waspublished in the Spring 2009 issue ofthe Journal of Health and HumanServices Administration, believes thatseveral educational strategies canenhance empathy. Examples include areview and analysis of audio or videotapes of patient-provider encounters,exposure to role models, role playing,exposure to literature and arts thatexplore human pain and suffering, nar-rative skill training, and experiential

storytelling. Workshops that focus onpatient-centered communicationstyles, listening skills, body posture andgestures, motivational interviewingand other topics related to developing

interpersonal skills can alsobe of value.

Hojat highlights a study atThomas Jefferson UniversityHospital in which emergencymedicine residents shadowedpatients for up to six hours tounderstand the patient expe-rience. The shadowing expe-rience prevented erosion of

empathy in the experimental comparedto the control group.

Other StrategiesAnother approach implemented byHojat and colleagues at ChicagoCollege of Osteopathic Medicine andChicago College of Pharmacy involvedasking medical and pharmacy studentsto view a short theatrical performancehighlighting challenges faced by elderlypatients. This study was published inthe February 2012 issue of theAmerican Journal of Pharmaceutical



While it is reasonable to acknowledge that empatheticcommunication is a positive aspect of care, empiricalresearch confirming the link between empathy and out-

comes is relatively new. Last March, a study evaluating the asso-ciation between physician empathy and diabetes outcomes byMohammadreza Hojat, PhD, research professor in the Departmentof Psychiatry and Human Behavior and director of the JeffersonLongitudinal Study of Medical Education at Jefferson MedicalCollege in Philadelphia, Pa., and his colleagues was published inAcademic Medicine. The researchers believe this study is the firstto report an empirical link between a validated measure of physi-cian empathy and quantifiable measures of patient outcome.“Other published studies have been based on anecdotal or sub-jective reports such as patient satisfaction or patient preferencefor physician, or measures that have not been validated in thecontext of patient care,” explains Hojat.

The study, which involved 29 primary care physicians who com-

pleted the Jefferson Scale of Empathy and 891 diabetes patients,found that 56% of patients of empathetic physicians were able toachieve good control of HbA1c, compared with only 40% ofpatients treated by physicians with low empathy scores. A statis-tically significant difference was also found with regard to LDLcholesterol control (59% vs. 44%).

The Jefferson Scale of Empathy, a validated, 20-item question-naire developed by Hojat and colleagues at Jefferson MedicalCollege, includes a variety of statements such as “My patients feelbetter when I understand their feelings,” “Because people are dif-ferent, it is difficult for me to see things from my patients’ per-spectives,” and “I believe that emotion has no place in the treat-ment of medical illness.” Providers indicate agreement or dis-agreement with each item according to a seven-point scale.Information about the Jefferson Scale of Empathy and an orderform are available at http://tinyurl.com/7qmlnsj.

—DJN

SCALE SUPPORTS THE VALUE OF EMPATHYIN COMMUNICATION WITH DIABETIC PATIENTS

“Slowing down and spending time with patients is critical for good

chronic disease care.” —Fred Markham, MD

Jefferson Medical College, Philadelphia, Pa.


Education. In another study at JeffersonMedical College, students viewedselected movie clips illustrating positiveand negative physician-patient encoun-ters, followed by a discussion of stu-dents’ perceptions. “These types ofstrategies can be incorporated into con-tinuing medical education efforts toincrease practicing physicians’ under-standing of patients’ pain and suffer-ing,” adds Hojat.

Funnell suggests that physicians havea conversation with each patient earlyin the course of treatment about theneed to work together and the value ofthe patient’s input. “Physicians mustconvey the importance of the patient’srole in diabetes management, since thepatient is the expert in his or her ownhealth,” she says.

In general, physicians should try tohone in on the patient’s behavioral, psy-chosocial and physical experience ofliving with diabetes, says Funnell.“Physicians can ask, ‘How is this affect-ing your life? What is hardest for youright now?’ Until physicians uncoverthe patient’s central challenges, theywill not be able to help patientsimprove their self-management skills.”This type of discussion is not a waste oftime, Funnell asserts. “Rather, this dis-cussion can have a positive impact,because it will help patients clarify themost important issues they face andlead to a discussion about self-manage-ment solutions that can have a positiveeffect on clinical outcomes.”

Funnell also emphasizes the value ofshowing empathy. “By showing patientsthat their point of view is important,physicians convey that they are interest-ed in their patients as people,” she notes.“Furthermore, physician acknowledge-ment that it is hard to make all thelifestyle adjustments necessary for dia-betes management can have a meaning-ful impact on a patient’s motivation.”

Avoiding PitfallsFunnell says that physicians shouldavoid the temptation to be overly pre-scriptive or to set goals for the patient.“Rather, they should help patientsidentify the underlying issues, and thencollaboratively identify a solution,” shesays. “This is much more effective thansaying, ‘Here’s what you should bedoing.’ It is hard for medical profession-als to communicate in this way, becausewe are trained to be lifeguards, not toteach people how to swim.”

Patient-centered communication isparticularly critical when patients facea treatment escalation. “For example,moving to insulin therapy is a hugeissue for both patients and providers,”says Funnell. “Physicians should notexpect that this is going to happen afterone conversation; this big step requiresmultiple conversations. Physicians canset the stage at the beginning of a rela-tionship with a patient by conveyingthat over time, various treatments willbe needed; insulin is not the last resortor a reflection of previous failure, but

rather an expected step in care.Eventually, physicians can say, ‘I thinkit is time to start thinking aboutinsulin; what do you think about that?’The patient’s answer will give the physi-cian the information he or she needs toaddress the patient’s concerns. A litanyof information about insulin will be awaste of time if the patient is not ready.”

Referral to diabetes educators, dieti-cians, and diabetes nurses can be a pos-itive step for both physicians andpatients. Physicians can share the taskof self-management promotion andteaching with colleagues, while patientscan benefit from working withproviders who have the time, and, often,the training to help them develop self-management skills. “Unfortunately,only about 20% to 30% of diabetespatients are referred to these profes-sionals,” says Funnell. “Part of patient-centered care is considering how todeliver care in the best way, and leverag-ing the skills of these professionals canbe beneficial for patients.”

“As we move toward electronichealth records, we run the risk that thefocus of the medical visit will becomethe computer rather than the conversa-tion with the patient,” notes Marhkam.“As physicians, we must not lose sightof our relationships with our patients.Slowing down and spending time withpatients is critical for good chronic dis-ease care.”�—Reported and written by Deborah J.Neveleff, in North Potomac, Md.

STUDIES SHOW EFFECTIVE COMMUNICATION BENEFITS DIABETES PATIENTS

Research has shown that patient-centered communicationcan pay off when dealing with diabetes patients, demon-strating the link between communication, self-management

skill, and diabetes outcomes. Higher patient ratings of physicianparticipatory decision-making style and communication wereassociated with better self-management, a study by Heisler et alpublished in the Journal of General Internal Medicine’s April 2002issue found. Patient-provider collaboration was associated withbetter diabetes outcomes, including diabetes control and adher-

ence to lifestyle and medical treatment recommendations, accord-ing results from the Diabetes Attitudes, Wishes and Needs(DAWN) survey published in the June 2006 issue of DiabetesCare. Another study by Heisler et al, published in the December2007 issue of The Journals of Gerontology Series A: BiologicalSciences and Medical Sciences, found that physician efforts toactively involve diabetes patients in decision-making were associ-ated with improved self-management activities related to diet,exercise, and blood glucose monitoring. —DJN

Implementing ICD-10-CM in late2013 does not have to be a dauntingtask for physicians if they take a

strategic look at the business areas oftheir practices. Putting off the imple-mentation of ICD-10-CM could hurtmedical practices and ultimately stoptheir revenue streams.

Changes for Administrative StaffIn the administrative realm, all vendorcontracts will need to be scrutinizedand updates may need to be made.Practice managers should check thelanguage on government mandates andwhether or not those mandates are cov-

ered in maintenance agreements.Working with vendors early will be cru-cial to a practice’s success in implement-ing the new codes.

Health plan contracts should bereviewed to see how payment will con-tinue under ICD-10-CM and what revi-sions to payment policies might be nec-essary. Practices will need to decidewhat payers to continue to participatewith.

Practices’ budgets will need to bemodified and monitored. Hardwareupgrades may be necessary if a prac-tice’s computer system is not capable ofhandling both ICD-10-CM and ICD-9-CM codes during the transitionprocess. Everyone in each practice willrequire some level of ICD-10-CM train-ing to make the transition.

For medical providers, clinical docu-mentation will need to withstand thehigher level of specificity found in ICD-10-CM. Providers will be required todocument laterality, stages of healing,trimesters in pregnancy, and episodesof care in order to assign a code.Changes in forms for labs, x-rays, andother diagnostic testing will be neces-sary. Pre-existing prescriptions willneed to be filled, which could causepractices to receive a flood of phonecalls as pharmacies look for the addi-tional information needed.

Providers still existing in a paperworld will need to determine if they cancontinue using a paper superbill orwhether they will need to transition toan electronic version. The ability to puta top 20 list on the superbill will disap-pear with the transition to over 69,000codes.

Coding and Billing ChangesUnder ICD-10-CM, coders will need to transition from about 14,000 to just over 69,000 codes, which could

cause a loss of productivity duringimplementation. Both ICD-10-CM andICD-9-CM will have to be used duringthe transition and even after. ICD-10-CM is date-of-service driven, so ser-vices provided before October 1, 2013will still be billed using ICD-9-CMcodes. Workers’ compensation and autoclaims are not mandated under theHealth Insurance Portability andAccountability Act. If these carriers donot switch to ICD-10-CM, coders mayhave to continue assigning ICD-9-CMcodes indefinitely.

Every national coverage determina-tion, local coverage determination, andpayer policy that is tied to medicalnecessity will need to be revised, creat-ing new payment rules and coveragedeterminations. Practices will need toadapt to these new policies.

Nurses will need to make sure theydocument with greater specificity aswell. Policy changes by health plans will affect requirements for diagnostictesting and services rendered.Advanced beneficiary notifications willneed to be revised to match the chang-ing policies regarding documentation.Requirements for ordering of diagnos-tic tests may change and forms may berevised to fit the new coding system.

Prepping for TransitionOutside of hardware concerns, clinicaldocumentation will be one of the largestfactors affecting a provider’s office.Performing documentation audits nowis a good way to start preparing forICD-10-CM implementation.

The level of specificity required inICD-10-CM may wreak havoc on apractice if providers fail to documentenough detail in the medical record. Adocumentation audit for ICD-10 pur-poses can be relatively simple if brokendown into steps.

CODING UPDATEHow Practices Can Begin Preparing Now for the ICD-10 TransitionBy Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, vice president of ICD-10 Education and Training, American Academy of Professional Coders

Rhonda Buckholtz is the vicepresident of ICD-10 Training andEducation for the AmericanAcademy of Professional Coders(AAPC). A seasoned coder andcoding educator, she previouslyserved AAPC as director of localchapter relations and as a mem-ber of the organization’s NationalAdvisory Board. She is a certifiedcoder and PMCC coding instruc-tor, and speaks frequently at cod-ing conferences.

Continued on page 10


1. Run a practice management report ofthe most frequently utilized ICD-9-CM diagnosis codes currently used inthe practice.

2. Pull charts associated with thosediagnosis reports. Start with the mostutilized codes; those will be the onesthat affect the practice most.

3. Use the ICD-9-CM code with theGeneral Equivalence Mappings(GEMS) to determine what the ICD-10-CM codes will be. This can bedone using the code translating tool on the AAPC website(www.aapc.com/ICD-10/codes/index.aspx).

4. Determine whether documentationis specific enough to assign a code inICD-10-CM.

5. Train physicians as necessaryto ensure compliance.Following these steps should

help practices determine theirrisk level for code assignment inICD-10-CM. AAPC has per-formed thousands of ICD-10readiness audits; approximately35% of the time the documentation cur-rently found in medical records does notcontain enough information to appro-priately assign an ICD-10-CM code tothe level of specificity required. Amongthe facets of ICD-10-CM coding thatproviders have not been providing inmedical records consistently are laterali-ty, stages of healing, trimesters in preg-

nancy, and status of encounters.

Case StudiesA patient presents for foreign bodyremoval in the nose. This situation isespecially common in pediatric offices.In ICD-9-CM it was associated withonly one choice for coding: 932, foreignbody in nose. In ICD-10-CM, choicesinclude whether the foreign body wasin the nostril or the sinus cavity, and if itwas removed during the initialencounter or subsequently, or if theencounter was a sequela to a previousevent.

Documentation for this encounternow should read, “Timmy is a 3-year-old male who put a raisin in his nose

about an hour ago. His mother wasunsuccessful in removing it. Uponexamination raisin was easily graspedand removed via forceps from the leftnostril.” The completed documentationgives a full understanding of the natureof the encounter and where the raisinwas removed from. Based on this information we are able to assign all the

necessary components of the code,which include location and the initialencounter.

Another example of necessary docu-mentation is when documenting nico-tine use. There are over 20 codes fornicotine use in ICD-10-CM. Is theproblem dependence, abuse, or addic-tion? Is it complicated or uncomplicat-ed, or a history of? Providers will needto become familiar with the code sets inorder to ensure their documentation iscompliant enough to accurately assign acode.

It will take considerable training tobring practices’ documentation intocompliance. Start with four or five ofthe most frequently used codes, show

the providers what additionaldocumentation is necessary toassign a code, and then revisitthose codes over a series ofmonths until there are no moreerrors. Once that is achieved,introduce new codes, but con-tinue to revisit the ones alreadycovered to ensure that docu-

mentation is not reverting back to theoriginal mistakes.

This is also a great way to work withproviders on actual code set training. Byusing their own records they are able towork on applying the codes. By takingsmall strategic steps over the comingmonths, practices will be ready to go onOctober 1, 2013. �

Putting off the implementation of ICD-10-CM could hurt medical

practices and ultimately stop their revenue streams.


The transition from ICD-9-CM codes to ICD-10-CM codes onOctober 1, 2013 will mean changes for every aspect of amedical practice. In addition to administrative and coding and

billing staff, the following functions within practices will also beaffected:Lab. Changes to national coverage determinations regarding

covered services will need to be revised and new policies and pro-cedures implemented. All forms will need to be revised to meetpolicy changes.Front desk. Patient coverages will potentially change with

ICD-10-CM, creating patient concerns and the need for discussion.

Practices may need to revise their Health Insurance Portability andAccountability Act (HIPAA) notifications to fit the higher level ofspecificity, since more information will be shared under ICD-10-CM. Vendor updates to systems may require additional training forfront desk staff.Information technology. IT departments will need to handle

the transition to HIPAA version 5010 before focusing on ICD-10-CM implementation. Allowances will need to be made in IT sys-tems to handle the new, longer code sets. Hardware space maybecome an issue once practices are faced with the need to utilizedual coding systems. —RB

ICD-10-CM TRANSITION WILL AFFECT ALL ASPECTS OF PRACTICE

CODING UPDATE



The ability to quickly access themost targeted, current, and reli-able medical information has

arrived in the form of computerizedclinical knowledge management(CKM) systems. Physicians have longfound that these systems decrease bar-riers to answering patients’ clinicalquestions. Now research proves thatsuch electronic clinical aids alsoimprove patient care and hospital out-comes.

Clinical ImprovementsA study published in the February 2012issue of the Journal of Hospital Medicinefound that U.S. hospitals using an evi-dence-based, physician-authored CKMsystem had shorter hospital stays, fewerpatient deaths, and better quality per-formance compared to controls.Researchers at Harvard Universityexamined quality and efficiency dataquarterly among Medicare beneficia-ries at 1,017 U.S. hospitals using a CKMsystem versus 2,305 hospitals without aCKM system. Results showed that thehospitals using a CKM system savedapproximately 372,500 hospital daysper year and 11,500 lives over thethree-year study period. In addition,CKM hospitals had better quality per-formance for every condition of theHospital Quality Alliance metrics,which include ratings for the care pro-vided to heart attack, heart failure, andpneumonia patients.

The improvement in length of stay(0.1 to 0.3 days shorter lengths of stayfor each of the six conditions exam-ined) may seem unremarkable at firstglance, but it indicates a significant andmeaningful trend, according to thestudy’s lead investigator, Thomas Isaac,MD, MBA, MPH. Isaac works in theDivision of General Medicine andPrimary Care at Beth Israel DeaconessMedical Center in Boston, Mass., and is

an instructor of medicine at HarvardMedical School.

“You can argue that the improve-ment is small, but I think across anation with many hospitals, someshortened length of stay can eventuallyreduce costs,” says Isaac. “That 0.1might be no days for many patients, butit might be one less day for somepatients. In that case, I think when youmultiply the cost, it is meaningful.”

Unlike a previous study that report-ed similar findings, this recent assess-ment examined the relationshipbetween computerized CKM use andlength of stay and mortality, andreported similar findings. This assess-ment used publicly available data, anational sample, a validated risk-adjustment approach, and a muchlonger time period. “The consistency ofthe findings across the two studies,despite differences in the approaches,help lend confidence that the results areunlikely to be due to chance alone,” thestudy authors wrote.

Ease of AccessThe particular knowledge system eval-uated in this study and numerous oth-

ers is UpToDate (www.uptodate.com),a physician-authored clinical knowl-edge system used by 600,000 cliniciansworldwide to make point-of-care deci-sions. UpToDate, Inc., a division ofWolters Kluwer Health based inWaltham, Mass., utilizes 5,000 physi-cian authors, editors, and peer review-ers, who synthesize the most recentmedical information into evidence-based recommendations that can beused by private and group practices, aswell as medical institutions.

The site is updated daily following acontinual comprehensive review ofpeer-reviewed journals, clinical data-bases, and other resources. Subscriberscan search from more than 9,000 topicsthat are revised whenever importantnew information is published. Updatesare integrated with specific statementsas to how the new findings can beapplied in clinical practice. Importantpractice-changing updates are high-lighted in the “What’s New” section,and in a topic called “Practice-Changing Updates.” The site also offersopportunities for subscribers to earnCME credit.

A new online subscription for one

TECHNOLOGYClinical Knowledge Systems Improve Health Outcomes, Reduce Hospital Time


year costs $495 for individual cliniciansand $195 for trainees, with discountedrates for renewals. For institutional orgroup practices, subscription pricesvary. Nearly 90% of academic medicalcenters in the United States useUpToDate; but its uses and benefits arenot restricted to the hospital setting,according to Isaac.

“UpToDate is used by both inpatient

and outpatient facilities and by smalland larger practices,” Isaac says.“Physicians log in with their usernameand password. Then they can type inqueries on almost any clinical matter,ranging from pediatrics to internalmedicine. For example, a physicianmight put in ‘treatment for communi-ty-acquired pneumonia,’ and whatwould appear on the screen is a recent

review article on that topic, written byexperts in the field, discussing the bestguideline-recommended treatmentsfor [that condition]. It briefly talksabout other relevant factors: epidemi-ology, clinical findings a doctor maysee during the physical exam, andappropriate diagnostic tests. There’salso a list of clinical topics doctors canclick through. At the end of each


Incorporating virtual office visits in which a patient uploads adigital image of his or her medical complaint along with adescription and history onto a medical practice’s server into a

primary care practice allows physicians to achieve better outcomesfor patients and to simultaneously create a more satisfying andfinancially sound practice, says Michelle Eads, MD. In an article inFamily Practice Management, this Colorado Springs, Colo.-basedfamily physician shares her experiences with jumpstarting her vir-tual practice.

Clinical decision support (CDS) systems are tools that “provideclinicians, staff, patients, and other individuals with knowledgeand person-specific information, intelligently filtered and present-ed at appropriate times, to enhance health and health care,”according to a report by the Agency for Healthcare Research andQuality. Some examples include drug-drug alerts, electronicreminders, and clinical knowledge management (CKM) systemslike UpToDate (www.uptodate.com). The most common use ofCDS is for addressing clinical needs (i.e., ensuring accurate diag-nosis, initiating timely screening for preventable diseases, or avoid-ing adverse drug reactions; Table 1).

While all CDS tools have the potential to improve processes ofcare and enhance quality to some degree, computerized CKM sys-tems have unique advantages over other computerized CDS tools.For example, they usually do not require electronic health records.In addition, they can provide guidance to clinicians over a broad-er spectrum of diseases, clinical scenarios, and target areas of care.Physician-authored computerized CKM systems also helpproviders answer questions rapidly, which can lead to changes indecision-making that can improve management and efficiency.1

When preparing to select and use a new CDS tool (such as aCKM system), consider the following rules of thumb taken from agrowing body of literature:2

• Computer-based systems are more effective than manualprocesses for decision support.

• CDS interventions that are presented automatically and fit intothe workflow of the clinicians are more likely to be used.

• CDS tools that recommend actions for the user to take are moreeffective than CDS tools that simply provide assessments.

• CDS interventions that provide information at the time andplace of decision-making are more likely to have an impact.

—S.C.

TECHNOLOGY


TABLE 1: EXAMPLES OF CDS INTERVENTIONS BY TARGET AREA OF CARE

1. Isaac T, Zheng J, Jha A. Use of UpToDate and outcomes in US hospitals. J Hosp Med. 2012;7(2):85-90.2. Berner ES. Clinical decision support systems: State of the Art. AHRQ Publication No. 09-0069-EF. Rockville, Maryland: Agency for Healthcare

Research and Quality. June 2009. Available at: http://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.html. Accessed February 29, 2012.

Target Area of Care ExamplePreventive care Immunization, screening, disease management guidelines for

secondary prevention

Diagnosis Suggestions for possible diagnoses that match patient’s signs and symptoms

Planning or implementing treatment Treatment guidelines for specific diagnoses, drug dosage recommendations, alerts for drug-drug interactions

Follow-up management Corollary orders, reminders for drug adverse event monitoring

Hospital, provider efficiency Care plans to minimize length of stay, order sets

Cost reductions and improved patient convenience Duplicate testing alerts, drug formulary guidelines

WHAT ARE CLINICAL DECISION SUPPORT SYSTEMS?


article, there is a quick summary andguideline area that physicians canquickly scan, as opposed to having toread through a very dense article.”UpToDate can be set up as a link on

the patient’s electronic medical record,allowing clinicians to convenientlyaccess it at the point of care. In an officesetting, all that is needed is any com-puter, smartphone, or device withInternet access. “In my clinical practice,on average, I probably look atUpToDate at least twice per clinical ses-sion per half day, either to reaffirmsomething or to double-check some-thing,” says Isaac.

Staying Informed“I have no objection to pulling upinformation in front of patients,” Isaacsays. “Sometimes I’ll say, ‘I believe thisis the best care based on what I know.I’m just going to double-check on afact.’” Another benefit of usingUpToDate during patient time is that,in some cases, it has lay versions of top-ics that can be printed for the patient totake home. Isaac cites the example ofback pain.

“For a physician, there is a muchmore detailed article about the latestliterature on what you should do for

back pain, but for laymen, there’s alsoan appropriate topic for back pain,” hesays. When patient information on atopic is not available, Isaac finds thatsome patients appreciate receiving aprintout of the physician version.

A system that can provide synthe-sized and organized clinical informa-tion on a wide variety of topics offersdistinct advantages over a general Websearch, as well as over other types ofclinical decision support tools, Isaacasserts. “If you don’t have UpToDate,”he says, “you can possibly find similarreview articles in medical journals—orpossibly not. The information inUpToDate is a coalesced version of thebest available literature and sometimesexpert opinions on a topic. Though youmay find some of that information onthe Internet, it might not be in the sameformat or as accessible as whatUpToDate provides.”

Easily Adopted The information Isaac has accessed forhis primary care practice (topics suchas back pain, respiratory infections,and joint aches), has been appropriateand useful, he says. When expert com-mentary is given, it is clearly docu-mented as such, and all recommenda-

tions are graded depending on whetherthey are evidence-based or opinion-based. Physicians who find theUpToDate information lacking canvoice their views via a feedback button(located in the upper right corner ofevery topic and recommendation), orby answering the question at the bot-tom of each topic and recommenda-tion: “Did UpToDate answer yourquestion?” Clicking on the “yes” or“no” button will open a window withcomment boxes.

Isaac has been using UpToDate sincethe start of his medical career, but hehas witnessed veteran health care pro-fessionals adopt the technology just aseasily. “Speaking anecdotally, I’ve seenvery experienced physicians who havebeen practicing for 30 or 40 years usingit, and I haven’t heard any negative crit-icism of it,” he says. “People often findit very helpful.”

Clearly, Isaac finds CKM systemssuch as UpToDate helpful. “I thinkUpToDate is a very useful system forboth inpatient and outpatient care toquickly get information that can helpdecision-making and improve qualityof care,” he concludes.�—Reported by Editor Rev DiCerto. Writtenby Stacy Clapp, in Orangeburg, N.Y.

OpenClinical, a nonprofit organization based in the UnitedKingdom, was created as a public service with support fromCancer Research UK to help health care professionals

throughout the world learn about developments in advancedknowledge management technologies for health care such aspoint-of-care decision support systems, “intelligent” guidelines,and clinical workflow. The development of such tools is critical,according to this organization, because its members believe that,without them, it is “humanly impossible” for health care profes-sionals “to possess all the knowledge needed to deliver medicalcare with the efficacy and safety made possible by current scien-tific knowledge.”

“A potential solution to the knowledge crisis is the adoption ofrigorous methods and technologies for knowledge management,”the OpenClinical website states. Among other services,OpenClinical offers its members:

• A single portal for information about developments in the fieldof medical knowledge management;

• Access to demonstrations of knowledge management technolo-gies and their applications;

• Papers and other information on standards, including currentneeds, issues and proposals, for open discussion;

• Open source knowledge content, including knowledge basesand reusable components;

• Directories of projects, technologies, and services.Both clinicians and technology developers can register with

OpenClinical by filling out a registration form. Registering allowshealth care professionals to support the development of quality,safety, and best practice in clinical knowledge management, con-tribute to discussion and debate, and help influence opinion onimportant topics in the field, OpenClinical says.

For more information, visit www.openclinical.org. —SC

ORGANIZATION ADVANCES CLINICAL KNOWLEDGE SUPPORT WORLDWIDE


CAPITAL IDEAS Fringe Benefit Plans Can Help Physicians Accumulate Wealth for RetirementBy Carole Foos, CPA, and Michael Berry, ChFC


Authors of books on financialplanning specifically for physi-cians have the opportunity to

speak with hundreds of doc-tors of various ages.Experience has proven to thesetwo authors that two doctors inthe same specialty with similarincomes can have very differ-ent income levels in retire-ment. Three reasons physi-cians may have very different qualitiesof life in retirement are “devastatingincidents” (lost lawsuit or divorce),poor investment decisions, and lack of

attention to taxes. Fortunately, bothqualified retirement plans and fringebenefit plans can help physiciansaddress these three challenges.

Unfortunately, most physicians onlyutilize traditional qualified plans(QPs), such as pensions and 401(k)s,which are restrictive and burdensome,while completely ignoring more flexi-ble fringe benefit plans. Only a handfulof the thousands of doctors we havespoken with over the years employfringe benefit plans in a significant way.This is unfortunate.

Limiting Tax ExposureThe term “qualified plan” means that aplan meets the definition of a retire-ment plan under Department of Laborand Internal Revenue Service rules cre-ated under the Employee Retirementand Income Security Act. These typesof plans may be in the form of a definedbenefit plan, a profit sharing plan, amoney purchase plan, a 401(k), or a403(b). Properly structured plans offertheir holders a variety of benefits.Holders can fully deduct contributionsto a QP when filing taxes, funds withinthe QP grow tax-deferred, and if non-owner employees participate, the fundswithin a QP enjoy superior asset pro-tection.

Despite the benefits QPs can offer,they are also subject to a host of disad-

vantages that physicians must under-stand:• Mandated maximum annual contri-butions exist for defined contribution

plans ($50,000 for pensions, profit-sharing plans; $17,000 employeedeferral for 401(k) plans in 2012).

• Participation by employees is manda-tory.

• The employers are potentially liablefor the management of their employ-ees’ funds in the plan.

• Restrictions exist for controlledgroups and affiliated service groups.

• Penalties are incurred when funds arewithdrawn prior to age 59½.

• Beginning at age 70½, distribution offunds is required and no longeroptional.

• Distributions from the plan are fullytaxed as ordinary income.

• When the plan’s holder dies, plan balances are subject to full income andestate taxation; the combined tax rate

on these balances can be over 70%.Despite these numerous disadvan-

tages, nearly all physicians in theUnited States participate in QPs. Thetax deduction is such a strong lure,most physicians are unable to resist it.For some doctors, using QPs as theirretirement strategy makes sense. Butfor many others, the cost of contribu-tions for employees, the potential liabil-ity for mismanagement of employeefunds, and the ultimate tax costs ondistributions to the doctor and his orher family may outweigh the currenttax savings offered by QPs.

This is especially true if onebelieves that income tax rateswill increase over the coming decades.When a physician uses a QP,he or she trades today’s taxrates on contributions for thetax rates that will exist in the

future when money is taken out of theplan. If tax rates rise in the future, the physician’s QP might prove not to be a good deal at all. While no one

Carole Foos, CPA, is a tax con-sultant at the national physician-focused consulting firm OJMGroup (www.ojmgroup. com),where Michael Berry, ChFC (notpictured), is a managing director.They can be reached at carole@ ojmgroup.com, [email protected], or 877-656-4362.They are currently offering physi-cians a free (plus $5 shipping andhandling) copy of their book ForDoctors Only: A Guide toWorking Less and Building More.

Rates today are the third lowest they have ever been in the history

of the federal income tax.


knows what the future will bring, thehighest marginal federal tax rates in theUnited States were well above 50% formost of the twentieth century and thehighest rates today are the third lowestthey have ever been in the history of the federal income tax. Thus, the taxrate bet that accompanies the use ofQPs is one that, at minimum, should be hedged against—which can be done with the use of certain fringe benefit plans.

A Better PlanIt is astonishing to think that fringe ben-efit plans are relatively unknown tophysicians, despite the fact that mostFortune 1,000 companies make fringebenefit plans available to their execu-tives. While many of the plansused in public companies, suchas the stock options enjoyed bymany executives, cannot beused in a private medical prac-tice, many use structures that aphysician could easily employin a practice.

Although fringe benefit plans are notsubject to the QP rules listed above,they are based on many of the sametenets. Some fringe benefit plans areexplicitly compensation plans that pro-vide some long-term retirement bene-fits and present tax reduction benefitsto the key employee(s). Other plans areaimed primarily at a goal other thancompensation, such as asset protectionor employee retention.

Here’s an example of a fringe benefit

plan that could be utilized by practical-ly any medical practice. This plan hasbeen in the federal tax code for decades,and within the last decade the InternalRevenue Service issued “safe harbor”rules related to it. This makes itstraightforward to implement properlyfrom a tax point of view. The financialplanner simply needs to follow the rulesthat have already been established.

Plan BenefitsAdditional benefits of this plan include:• The plan can be used in addition to aQP such as a pension, a profit-sharingplan, or a 401(k) or SEP-IRA.

• Contributions to the plan qualify forcurrent tax deductions.

• The assets grow within the plan in a

tax-deferred manner and can beaccessed tax-free.

• The plan acts as an ideal tax hedgetechnique against future income andcapital gains tax increases; thus, it canbe used to hedge against the tax raterisk inherent in QPs described above.

• Maximum contribution levels are$100,000 per doctor in practices with10 employees or fewer. In larger prac-tices, these levels can be even higher.

• In a group practice, not every doctorneeds to contribute the same amount.

This flexibility is extremely beneficialfor group practices in which doctorswant to put away differing amountstoward retirement.

• Employees’ participation requires aminimal funding outlay.

• There are no minimum age require-ments for withdrawing income from the plan (no early withdrawalpenalties).

• The transfer of assets at the time ofthe doctor’s death is income tax-freeto his or her heirs.While these benefits are powerful, a

plan like this is not the right choice foreveryone. Like most plans, this benefitplan is only appropriate for physicianswho are looking to build long-termwealth. It is not one that is designed for

contributions, growth, andaccess in a short time frame.

Every successful physicianshould consider initiating afringe benefit plan. QPs areburdened with a host ofrestrictions, costs, and tax

limitations. This often makes themextremely expensive for the physicianand does not allow for significant accumulation of retirement wealth.Fringe benefit plans do not have these restrictions and, therefore, arerelatively inexpensive to implement.For physicians for whom buildingretirement wealth is an important goal of their financial plan, investigat-ing instituting fringe benefit plans witha financial adviser is a good way to getstarted. �

This benefit plan is only appropriatefor physicians who are looking to

build long-term wealth.

Asimplified employee pension individual retirement arrange-ment (SEP-IRA) is not officially a qualified benefit plan. It isa custodial account, but in many ways it is similar to a qual-

ified plan (QP) such as a pension or a 401(k). A SEP-IRA carries thesame tax restrictions on annual contribution amounts, penaltiesfor early withdrawals, mandatory withdrawal rules, and taxationon distributions and plan balances at death as a traditional QP. However, a SEP-IRA may not enjoy the same level of asset

protection that a QP does. The protection is not federally mandat-ed; it is handled on a state-by-state basis.

For these reasons, a SEP-IRA is typically no better financiallythan a QP. SEP-IRAs and QPs are not sufficiently effective plans formany physicians in terms of building retirement wealth over time.A financial adviser can help a physician determine what types ofplans can help him or her prepare effectively for retirement.

—CF, MB

SEP-IRAS ARE NOT SUPERIOR TO QUALIFIED PLANS IN BUILDING WEALTH


CAPITAL IDEAS


When asked to choose a healthcare provider based only oncost, consumers choose the

more expensive option, according to anew study funded by the United StatesDepartment of Health and HumanServices (HHS) Agency for HealthcareResearch and Quality (AHRQ;www.ahrq.gov) in the March issue ofHealth Affairs. The study found thatconsumers equate cost with quality andworry that lower cost means lower qual-ity care. But higher costs may indicateunnecessary services or inefficiencies, socost information alone does not helpconsumers get the best value for theirhealth care dollar, according to the study.

Many public report cards are availableto help consumers compare health careproviders. However, few report cardsinclude information on cost, and therehas been little scientific evidence toguide the presentation of that informa-tion.

The study, “An Experiment ShowsThat a Well-Designed Report on Costsand Quality Can Help Consumers

Choose High-Value Health Care,” foundthat when consumers were shown theright mix of cost and quality informa-tion, they were better able to choosehigh-value health care providers,defined as those who deliver high-qual-ity care at a lower cost.

A team of researchers at theUniversity of Oregon in Eugene studied1,400 employees in a randomizedexperiment. When providers wereclearly identified as high quality, costhad less influence on consumers’ deci-sions and consumers were more likelyto choose a provider with lower cost butbetter quality than a high-cost provider.The study explored a number of ways topresent cost and quality informationeffectively.

The study’s findings have implica-tions for the design of public reportcards that offer consumers informationon the quality and cost of health care providers. For additional AHRQinformation about public reporting,please visit http://www.ahrq.gov/path/publicreporting.htm.

PRACTICE MANAGEMENT NEWSStudy Shows Health Care Consumers Make Better Decisions When Given More Information

The American Medical Association (AMA) on February 24released a how-to manual to help physicians evaluate, nego-tiate, and manage budget-based payment systems that are

becoming alternatives to the predominant fee-for-service modelfor reimbursing physicians. Typical budget-based payment sys-tems include payment bundling, pay-for-performance, withholdsand risk pools, capitation, and shared savings.

The manual, Evaluating and Negotiating Emerging PaymentOptions, analyzes budget-based payment systems and providesessential information and practical tools that can help physicians:

• Understand the differences between fee-for-service and bud-get-based payment systems;

• Master concepts associated with budget-based systems, includ-ing actuarial soundness, risk adjustment, and risk mitigation;

• Estimate, monitor, and manage the financial risks and rewardsof a budget-based payment system.Evaluating and Negotiating Emerging Payment Options is

available free to all physicians on the AMA’s newly updatedPractice Management Center website (http://tinyurl.com/7hjt6dn).

AMA RELEASES HOW-TO MANUAL ON EMERGING PHYSICIAN PAYMENT MODELS

The National Committee for QualityAssurance (NCQA) announced onMarch 8 the certification of 13

vendors for their software related to theHealthcare Effectiveness Data andInformation Set (HEDIS). Vendor soft-ware collects relevant data from healthplan databases and calculates rates forhealth care measures that assess thequality of service and care. Health plansusing NCQA-certified software canforgo the manual source code reviewportion of the HEDIS Compliance Auditand P4P Audit Review.

NCQA validates vendors’ softwareby generating test data sets. Vendorsprocess the test sets and compare theiroutput to the expected results to deter-mine whether their software computesresults in accordance with NCQA spec-ifications. Vendors who achieve certifi-cation through this process are exemptfrom manual source code review byNCQA compliance auditors during anNCQA HEDIS compliance audit andP4P audit review. Each vendor’s certifi-cation report indicates which measuresare certified.

For more information on softwarecertification and a complete list of eachvendor’s status, visit www.ncqa.org/HEDIS/softcert.aspx.

NCQA RELEASESDATA ON CERTIFIEDSOFTWARE VENDORS

Key health care organizations areteaming up to help take the mys-tery out of using personal health

records (PHR) by rolling out two newinformational brochures to help pro-mote the understanding and use ofPHRs among consumers and clinicians.The brochures, “Your Personal HealthRecord” and “A Clinician Guide to aPersonal Health Record,” will be avail-able online at the Blue Cross and BlueShield Association website(www.BCBS.com).

The brochures, which include screen-shots of PHRs, user testimonials, and aninformative Q&A, were created througha collaboration of health care groupsincluding the Blue Cross and BlueShield Association (BCBSA), theAmerican Health InformationManagement Association (AHIMA),the American Cancer Society (ACS), theAmerican College of Physicians (ACP),the American Diabetes Association(ADA), the American HeartAssociation (AHA), the AmericanOsteopathic Association of Medical

Informatics (AOAMI), and the MedicalGroup Management Association’sAmerican College of Medical PracticeExecutives (MGMA-ACMPE).

By making these brochures available,key health care stakeholders hope toincrease the adoption and use of PHRsby showing consumers how they canuse PHRs to store vital health informa-tion such as medical conditions, aller-gies, medications, and doctor or hospi-tal visits in one secure place. For clini-cians, the brochures describe the bene-fits of using PHRs in delivering qualitycare to their patients and making theirpractices run more efficiently.

To encourage the continued growthof PHR usage, these brochures weredesigned to help improve consumers’familiarity and comfort level with PHRtools and encourage more participationand adoption. To download copies ofthe PHR Quick Reference Guides for consumers or providers, please visit www.bcbs.com/phr_brochure,www.aoami.org/phr_brochure.cfm, orwww.mgma.com/phrguide/.


Health Care Groups Issue New Personal Health Record Guides

The American Medical Association (AMA) on February 28 released an online train-ing module (at www.ama-cmeonline.com/myplate/) to help physicians counsel theirpatients on healthy eating habits using the USDA’s new resource,

ChooseMyPlate.gov. The MyPlate icon has replaced the traditional food pyramid andserves as a visual reminder to eat healthy.

This activity is a part of the AMA’s Educating Physicians on Controversies andChallenges in Health (EPoCH) program. It offers tips for physicians on accessing theinformation on the ChooseMyPlate website and presenting that information to patientsas part of an overall conversation on the importance of maintaining healthy eatinghabits. The activity also describes misconceptions and barriers to counseling patientsabout healthy eating.

This activity has been certified for AMA PRA Category 1 Credit. To view the activity,visit http://www.ama-cmeonline.com/myplate/.

ONLINE RESOURCE CAN HELP PHYSICIANSCOUNSEL PATIENTS ON HEALTHY FOOD CHOICES

Hospitalists and primary carephysicians agree that bettercommunication between

providers who manage complexpatients is needed to meet the chal-lenges of health care reform, accordingto a new study of more than 4,000physician members of Waltham, Mass.-based medical learning networkQuantiaMD, conducted by the Societyof Hospital Medicine (SHM) andQuantiaMD. Complex medically ill(CMI) patients have two or more con-current chronic conditions that requireongoing medical attention or limitactivities of daily living. These four mil-lion patients account for nearly 70% ofall Medicare spending and up to 20%of emergency department visits. CMIpatients also have a significantly high-er likelihood of hospital admission andreadmission, according to the study.

This research has been published ina white paper (at www.quantiamd.com/cmi_care_coordination). Anonline series is also available fromQuantiaMD that outlines opportunitiesand features innovative examples ofhow to improve care of CMI patients.

“Direct communication betweenhospitalists and primary care physi-cians who jointly care for CMI patientsis essential,” says Michael Radzienda,MD, SFHM, project physician lead forthe Medically Complex Ill Project andmoderator of the QuantiaMD series.“Without this fundamental practice,patients can suffer the effects of dis-coordinated care. Findings from thestudy identified barriers to timely andeffective communication betweenproviders who care for CMI patientsand solicited ideas and opportunitiesthat can improve the quality, safetyand effectiveness of medical care.”

COMMUNICATIONKEY TO PREVENTINGREADMISSIONSIN COMPLEXMEDICALLY ILL

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