Program - Ophmasters · 2018-11-27 · Saturday, June 29 7:00‒8:00 AM BREAKFAST Ponce de Leon...
Transcript of Program - Ophmasters · 2018-11-27 · Saturday, June 29 7:00‒8:00 AM BREAKFAST Ponce de Leon...
www.ophmasters.com
Sponsored by the Florida Society of Ophthalmology
June 29, 2013 The Breakers | Palm Beach, Florida
Program
S Y L L A B U S
Saturday, June 29 7:00‒8:00 AM BREAKFAST Ponce de Leon IV-VI 8:00 AM WELCOME
Steven R. Robinson, FASOA, COE 8:00–8:45 AM Social Networking for the Medical Practice‒
Five Effective Ways to Engage in the Conversation Cindi Green, RN, BA, AS 8:45–9:30 AM Risk Prevention for the Electronic Age‒
EMR, E-Mail, Texting, Social Media and the Internet Sandra C. Strickland, RN, MSN, LHRM, CPHRM 9:30–10:15 AM Flow and Efficiency Considerations‒
What You Can Do to Enhance Productivity and Profitability Sherri L. Boston, MBA, COE, OCS 10:15‒10:45 AM BREAK Ponce de Leon IV-VI
10:45‒11:00 AM Comments from the American Academy of Ophthalmology EVP/CEO
David W. Parke, II, MD 11:00 AM–12:00 PM ICD-10 Update E. Ann Rose
12:00–1:00 PM LUNCH Gulfstream 4 1:00–1:30 PM Worker’s Compensation Update Tom Murphy 1:30‒2:00 PM 401K Updates Wes Caldwell 2:00–3:00 PM Risk Management Strategies for the Ophthalmic Practice Steven I. Rosenfeld, MD, FACS 3:00‒4:00 PM Organizational Management
Steven R. Robinson, FASOA, COE
4:00‒4:15 PM QUESTIONS AND ANSWERS 4:15 PM ADJOURN
ACCREDITATION This program has been approved for 5.75 COE Category “A” credit hours by the National Board for the Certification of Ophthalmic Executives. You must sign in at the beginning of the program to receive credit.
AGENDA
*2013 Office Administrator Program Chair
FACULTY Sherri L. Boston, MBA, COE, OCS Eye Care Business Advisor Allergan Tampa, FL Cindi Green, RN, BA, AS Director of Community Relations Florida Eye Institute Vero Beach, FL Wes Caldwell Danna Gracey Delray Beach, FL Tom Murphy Danna Gracey Delray Beach, FL Steven R. Robinson, FASOA, COE* Senior Consultant S&R Consulting Chattanooga, TN
E. Ann Rose Owner/President Rose and Associates Duncanville, TX Steven I. Rosenfeld, MD, FACS Voluntary Professor University of Miami Miller School of Medicine Bascom Palmer Eye Institute Delray Eye Associates Delray Beach, FL Sandra C. Strickland, RN, MSN, LHRM, CPHRM Director of Patient Safety-SE Region The Doctors Company Jacksonville, FL
Cindi Green, RN, BA, AS
Cindi Green, RN, BA, BS has been Director of Community Relations for Florida Eye Institute in Vero Beach since 2010. Her self-made title, Protector of the Brand, describes her ongoing mission to enhance the reputation of the growing practice through the mediums of advertising, public relations, charity events, physician outreach, customer service, and social media.
Cindi attended Randolph-Macon Woman’s College, a small liberal arts school in Lynchburg Virginia, where she majored in theater and was puzzled about a career direction. During an interview for her first ‘real job’, she was told - “Cindi, I have never heard anyone describe Waitressing Experience in quite the same way before!” – and realized she might have a future in marketing.
After beginning her career in retail management with companies like The Gap, Cindi advanced to direct media sales and became an account executive for an advertising agency specializing in healthcare. She was then recruited to a plastic surgery practice as Marketing Manager where she began nursing school, received her RN, and progressed to patient care coordinator. She continued her studies and additionally became a licensed healthcare risk manager for the plastic surgery practice.
Cindi moved to Vero Beach in 2001 and has served her local medical community as Director of Business Development for HealthSouth Treasure Coast Rehab Hospital and as Physician Liaison with the Visiting Nurse Association. She has been an enthusiastic supporter of Toastmasters, an international public speaking and leadership association, where she served as Vice President of Education from 2009-2010.
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Social Networking for the Medical Practice
Cindi Green, Director of Community Relations
Florida Eye Institute
Let’s introduce ourselves
Why should I use social media?
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Why should I use social media?
Social Media Revolution 2013
What is the conversation all about?
The Social Media Revolution
Video Clip
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Where do I
begin?
Step One
Secure your Band across all platforms
Don’t forget about these!
Secure your Band across all platforms
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Step Two
Plan your strategy and create guidelines
According to a survey by Symantec and Applied Research, the cost of public relations disasters, lawsuits, security breaches and other risks associated with social media blunders averages $4.3 million. The survey also reports that after a social media mishap, 28% of companies have reported damage to their brand, or a loss of customer trust averaging a cost of over $638,000. So to avoid putting our businesses and ourselves on the virtual chopping block, let’s get our social media etiquette on and learn from the missteps of others.
Why do you need a plan?
What does your Social Brand say about you?
Who are you?
What do you talk about?
Where can people find you?
How quickly can you respond to others?
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What does your brand bring to the Social Media party?
Are you this guy?
Personalize the face of your business
Personalize the face of your business
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Assign a spokesperson
Who is the face of your Practice?
Step Three
Create unique and engaging content
What should I
talk about?
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Personalize
Our most popular post *1,300 people saw this post
Personalize
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Testimonials
Educate
Educate
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Educate
Engage
Ask patients to share positive thoughts
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Patients are finding their voice in Social Media
The Future of Patients - Kru Research (2:41)
The Future of Patients - Kru Research
Video Clip
What are patients saying about you?
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“I will write 1 well researched
review and post it to Google
Places for $5.”
Step Four
Understand the benefits
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Brand: What’s your name?
Secure your name across all platforms.
Create rules: Who. What. Where. When.
Choose a Platform: Stop. Look. Listen.
Update your status. Link an article. Upload a video. Post a photo. Make some comments. Share a Like. Write a blog.
Count your fans. Check your ranking. Know your ratings. Monitor inbound calls & email.
Social Media Hierarchy of Needs
Step Five
Don’t take it too seriously- go ahead & make mistakes
But don’t be despised
The 15 Most Frustrating Companies in America
By Max Nisen | Business Insider – Thu, May 23, 2013 10:52 AM EDT
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The 15 Most Frustrating Companies in America By Max Nisen | Business Insider – Thu, May 23,
2013 10:52 AM EDT
7 (tie) Twitter Rated 64/100 — This is the first year it has been rated Though it's the first year many social networks have been included in the survey, as a category, social media is rated poorly. Increasing worry about the sharing and use of personal data, the sheer omnipresence of these sites, and increased advertising might be behind the extremely low scores.
The 15 Most Frustrating Companies in America By Max Nisen | Business Insider – Thu, May 23,
2013 10:52 AM EDT
#6 LinkedIn
Rated 63/100 — The second-lowest-rated social network LinkedIn's inaugural rating puts it near the bottom, along with other social networks like Twitter. ACSI finds that "Monetizing schemes appear to be at the core of user dissatisfaction with both sites." In LinkedIn's case that could possibly mean its "Recruiter" platform, which gives companies that subscribe access to account information.
The 15 Most Frustrating Companies in America By Max Nisen | Business Insider – Thu, May 23,
2013 10:52 AM EDT
#3 Facebook Rated 61/100 — A five-point decline from last year — The lowest-rated social network Facebook comes in at the very bottom of the social media pile after a turbulent year. Customers were dissatisfied with the forced change to the "Timeline" style profile, and a particularly messy IPO in May couldn't have helped. It remains by far the largest social network.
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Research Tools:
Allergan Access
PhysiciansPractice.com
PewInternet.org
Blogs:
symplur.com
amednews.com
E-Tools:
Hubspot.com
HootSuite.com
Resources
Sandra C. Strickland, RN, MSN, LHRM, CPHRM
Sandra Strickland is Director of Risk Management Services for The Doctors Company. She earned a Master in Nursing degree from Medical University of South Carolina and her Bachelor of Nursing degree from Barton College in Wilson, North Carolina. Mrs. Strickland is a Licensed Health Care Risk Manager, Certified Professional Healthcare Risk Manager, and a Registered Nurse with over twenty years of experience in the healthcare and over fifteen years in healthcare risk management. She is a member of the American Society of Health Care Risk Managers and the Florida Society of Health Care Risk Managers.
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06.01.06
A Risk Management Seminar
Presented by
Sandra Strickland, RN, MSN, LHRM, CPHRM
Director of Patient Safety Services – SE Region
Risk Management
in the
Ophthalmology Practice
COURSE OBJECTIVES
Recognize current liability and patient safety issues in an
ophthalmology practice;
Identify high-risk clinical and administrative exposures in the
ophthalmology practice; and
Describe risk management strategies to reduce loss exposure
and increase patient safety.
At the conclusion of this Risk Management
Seminar, the participant will be able to:
What is your risk?
Duty
Breach
Injury
Causation
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How Often Do Medical Errors Occur?
If death from medical errors was a disease–it
would be the third leading cause of death in the
U.S. (cancer, heart disease)
During the next hour of this presentation, 11
people in the U.S. will die as a result of medical
errors
1 in 12 ophthalmologists will experience a claim
U.S. Department of Health and Human Services,
National Center for Health Statistics, Health, United States, 2002, Table 33, p.132
Risk Exposures
Communication factors
Unclear lines of authority
Variability
Time pressured environment
System deficiencies
Human fallibility
National Patient Safety Foundation
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Swiss Cheese Model
Ophthalmologist
fails to examine
eye
Wrong eye
blocked
Patient HOH
Breach in Universal
Protocol
Teamwork/
Leadership
Failures
Risk Management Strategies
PRACTICES AND PROCEDURES
PATIENT RELATIONS/COMMUNICATIONS
DOCUMENTATION
Risk Management Pearls
Scheduling &
coverage
Non-compliance
Tracking & Follow-up
• Wait times
• Practitioner present
• Call coverage
• Document & manage
• Assign and oversee
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Case Study
65 y/o male. Reduced vision. Age related cataracts OU.
OS cataract extraction in May.
Pre-op CXR: Abnormal – Nodular density L hilum…not reviewed by
ophthalmologist.
4 months later - OD cataract extraction
2nd pre-op CXR: enlarging hilum with significantly enlarged lobulated mass.
Ophthalmologist notified after induction.
CT confirmed lung mass. L thoracotomy & pneumonectomy. Poorly
differentiated adenocarcinoma w/ 4 of 8 hilar lymph nodes positive for
metastasis.
Risk Management Pearls
Medications
Diagnostics
• 5 Rs
• LASA – Storage
• Concentrations
• Reconcile
• Allergies
• Quality Controls
• Calibration
LASA Medications
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Case Study
37 y/o male with c/o L lower lid swelling x 3 days. PCN allergy –
currently on no medications.
DX: Hordelum Rx: Ampicillin 250 mg tid X 5 days. Warm
compress to L lid.
After 2 doses, patient called office with c/o skin rash and itching.
Ampicillin d/c’d. Tetracycline 500 mg tid x 5 days rx’d.
Treated with Benadryl and Medrol Dose-Pak.
Three days later patient admitted w/ confluent, erythematous
rash over entire trunk and extremities. Treated with IV
steroids, H1 & H2 blockers and topical steroids. Discharged
after 3 days to continue oral and topical steroids and
Benadryl.
Risk Management Pearls
Emergencies
Triage/Calls/Advice
• Training
• Kit
• Response drills
• Training
• Protocols
• Responsive
• Document
Risk Management Pearls
Universal Protocol
Consent
Training
Checklists
Specific
Forms
Checklists
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Case Study
• 59 y/o female – c/o glare, decreased visual acuity – OS
• Corrected VA 20/20 OD and 20/25 OS.
• Glare testing VA 20/80 OD and 20/100 OS.
• Uncomplicated cataract surgery OS
• PO day 1: VA w/ pinhole 20/150 OS. Anterior chamber 2+ cells. Tobradex gtts 4x/day. Return 1 wk.
• Informed by OR nurse of wrong IOL = 17.0 diopter vs. 20.5
• Patient informed. Lens exchange planned.
• Mishap during lens exchange – VA remained 20/150 after 2 months. Referred to corneal specialist for corneal transplant.
• Post transplant – VA w/ refraction of 20/25 OS, with continued c/o residual cloudiness d/t posterior capsule haze
Risk Management Pearls
HIPAA
OSHA/Infection
Control
P&P, training,
documentation,
oversee
Training, P&P,
inspections
PPE, Hepatitis B
vaccine,
Handwashing
Autoclaving
Risk Management Pearls
Scheduling
Coverage
Non-Compliance
Tracking & Follow Up
Medications
Emergency Preparedness
Universal Protocols
Diagnostics
Consent
Telephone Triage
Returning Calls
Medical Advice
HIPAA
OSHA/Infection
Control
Medical Records
PRACTICES & PROCEDURES
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The most prevalent root cause of medical errors is
Communication
Fact: The diagnostic interview, evaluation or consultation is
the most prevalent procedure resulting in malpractice claims.
PIAA Data Sharing
2000
Staff Communication: Liability or Asset?
Impression
Information
Reflection
"
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Communication Challenges
Diversity
Language
Medical Jargon
Knowledge Deficits
Physical & Emotional Stressors
Internal Communication Issues
“And would you be performing the actual surgery?”
Low Health Literacy
90 million people have literacy related health
risks
1 out of 5 read at _______ grade level
50%–Understand directions for taking
medications correctly
www.npsf.org
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Ocean Spray
“Save the two”
once
Yale University School of Medicine
Techniques for High Impact Contact
Review the chart
Eye Contact
Pleasant Expression
Patient Name
Personal Comment
Inquire
Handshake
Listen
Verify – Buy In
Summarize-Confirm
First and Last 1 - 4 MINUTES
Trouble Areas
Telephone
Ignoring
Waiting
Patient’s Name
Waiting
Interruptions
Explanations
Expectations
Talking around
Routines
Complaints
Apologies
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Managing Complaints
Acknowledge
Apologize
Amend
Documentation of Telephone Calls
• Date and time of call
• Person making the call
• Patient’s name
• Chief complaint or concern
• Brief history
• Assessment – P/A Symptoms
• Any advice given
• Symptoms which require a call back
• Identity of advice-giver
• Date and time call is returned to the patient
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Problematic E-Communications
Sensitive test results
Requests for narcotics
Facetime/Photo diagnosing
Information from family members
J Gen Intern Med. 2005 October; 20(10): 959–963 Preventing Communication Errors in
Telephone Medicine–A Case-Based Approach, Anna B. Reisman, MD and Karen E. Brown, MD
Case Study
E-mail on Friday afternoon:
CC: Poor vision. “Spots.”
Response: Follow up with optometrist on Monday.
Outcome: Retinal Detachment. Vision loss.
What would have prevented this?
Handoff communication
Triage training
Auto-reply
Risk Exposures
• Creation of professional relationship
• Response delays
• Lost or incomplete communications
• Misinterpretation
• Questionable receipt & understanding
• Privacy breach
• Abandonment
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Risk Management Pearls
Patientcentric
culture
Awareness
Team building
Training Protocols–
checklists
Eye contact
Slow down
Listen
Language
Visual aids
Limit and repeat
Ask Me 3
Verify with teach
back
Documentation
• A pivotal factor in pursuing litigation
• Most important piece of evidence in a medical
malpractice defense
“She has no rigors or shaking chills, but her husband states
she was very hot in bed last night”
Bad Medical Records = Bad Medical Care
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Good or Bad Documentation?
• Patient was hostile and threatening
• Continue same medications
• Systems review remains unchanged
• Follow-up visit
• Consent obtained
• Pt. non-compliant
• Patient c/o sharp stabbing eye pain
• Patient difficult and argumentative.
• Patient screaming and pounding fist on exam table. States “You’re going
to be sorry you ever met me. I’ll get you for this.” Points at abdominal
incision line and states “You’re going to have one of these when I’m done
with you.”
• Complains of sharp, stabbing pain in R eye after sun exposure and reading
for 20 minutes. No c/o floaters or flashers.
Documentation Deficiencies
• Generic – lack detail
• Inconsistency
• Status of conditions not
noted
• Unclear medication orders
• Unclear instructions
• No evidence of medical
decision making
• Diagnostic results not
incorporated
• Lack objectivity
• No evidence of resolution
• Communications not noted
• Unable to ID author
• Patient non-compliance not
addressed
• Errors/omissions/blanks not
addressed
• Patient’s progress not noted
Documentation Concerns
• Follow-up
• Diagnostic reports
• Referrals
• Telephone care
• No-show & non-compliance
• Termination of care
• Consents and refusals
• Non-FDA approved prescriptions
• Non-standard care
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Visit Preparation
Review chart
Problem list
Diagnostic/Referral results
Telephone communications
Previous visit notes
Alerts
Documentation Pearls
Assessments
Admission Data
Demographics
HT/WT/BMI/VS
Past Histories
Medical/Surgical – Family
Social – Medications & Allergies
Chief Complaint
Documentation
P Patient’s concerns
Q Quality & Quantity
R Response
S Signs & Symptoms
T Timing
Current Medications/ Allergies
Current Treatments - Compliance
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Documentation
Medications
• Allergies
• Samples
• Instructions/Cautions
• Side Effects
• Refills
• RECONCILE
DID I WRITE THAT?
“By the time he was admitted, his rapid heart had stopped, and he was feeling better”
“Healthy appearing decrepit 69 year old male, mentally alert but forgetful”
“Patient left hospital feeling much better except for her original complaints”
“She has no rigors or shaking chills, but her husband states she was very hot in bed last night”
“Patient may increase her meds, unless we decrease her meds”
“Between all of us, we should be able to get her pregnant”
“Patient has been depressed since she began seeing me in 1999.”
“The patient has no history of suicides.”
“She is numb from her toes down.”
“Patient has chest pain if she lies on her left side for over a year.”
“She slipped on ice and apparently her legs went in separate directions early in December.”
Medical Record Pearls
• Train
• Audit
• Accurate & complete
• Reflect medical decision making
• Reconcile
• CC = Evaluation (ROS/Exam Findings) = Diagnosis = Plan of Care = Response
• Pertinent + and –
• Communications
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Their Trust Is In You
Click to edit Master title style
Click to edit Master text styles
Second level
Third level
– Fourth level
» Fifth level
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“The pessimist complains about the wind; the optimist expects it to change;
the realist adjusts the sails.”
--William Arthur Ward
Prevention of Medical Errors /
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Thank You for Attending this
Risk Management Presentation
Sherri L. Boston, MBA, COE, OCS
Sherri Boston is a business advisor with the Eye Care Business Advisory Group of Allergan, Inc., an eye care company based in Irvine, California. She has worked for Allergan since 1989. Ms. Boston advises medical practices, physician networks, and ambulatory surgery centers. Her advisory expertise includes leadership training, team building, sales training, marketing, business development, strategic planning, clinical operations, financial management, and overall practice efficiency. Other responsibilities include training and support for internal Allergan customers. Ms. Boston has more than 23 years of experience in the health care industry, working with a variety of providers and health plans. Before joining the Eye Care Business Advisory Group, Ms. Boston worked as a senior sales executive with the Eye Care Team at Allergan, where she gained expertise in strategic planning, financial analysis, and creating high-performance teams. Ms. Boston received her MBA from the University of Rhode Island and a Bachelor of Science degree in medical technology from St. Joseph College in Connecticut. She holds certifications through the American Society of Ophthalmic Administrators and the Joint Commission of Allied Health Personnel in Ophthalmology as a Certified Ophthalmic Executive (COE) and as an Ophthalmic Coding Specialist (OCS).
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FLOW AND EFFICIENCY CONSIDERATIONS
Presented by:
Sherri L. Boston, MBA, COE, OCSEye Care Business Advisor
Masters in Ophthalmology 2013Administrator Program
Disclosures
Eye Care Business Advisor, Allergan, Inc.
Scientific Advisory Board Member, y ,Hawaiian Eye Foundation
Session Objectives
Enhance knowledge base on the subject matter of patient flow and efficiency.
Review practice resources availableReview practice resources available.
Recognize when to triage and invest in outside resources.
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What is the primary concern when it comes to patient flow?
Survey says …
Patient Flow and Efficiency
Wait Time
Wait Time
Wait Time
The most frequent complaint on patient satisfaction surveys.
The most frequent complaint from physicians.
“No lunch time and have to stay late” complaints from staff.
What is the practice’s chief complaint?
Extensive wait times.
Competency of technical staff.
The need to increase productivity and revenue.
3 Areas of Focus
Physical capacity
Space
MD/OD
T h i l
Staff Deployment/Delegation
Template design
Scheduling
capacity
Flow design (circular, linear, in/out)
Technical design
MD/Tech
3
Patient Flow and Efficiency Assessment:3 Areas of Focus
Space
Evaluate Room Allocation:
2 lanes per provider
1 lane per technician
Dedicated room for each test or groups of tests
Dedicated procedure room
Look for:
Technicians waiting for rooms
Patients occupying rooms to dilate (versus seated in designated dilating areas)
Patient Flow and Efficiency Assessment:3 Areas of Focus
Staff
Are they interrupting each other or other providers with questions?
Protocol book
Training opportunitya g oppo tu ty
Are patients waiting for testing?
Need proper staff allocation
Who is the technical supervisor?
Working Clinic Manager
Clinical Director
Lead Technician
Patient Flow and Efficiency Assessment:3 Areas of Focus
Schedule
Is there a consistency in appointments per hour?
Even distribution per hour
Look for “clumping” of appointment types:
Too many new patients or long exams per hourToo many new patients or long exams per hour
Where are emergency patients or “add-ons” booked?
Are they triaged appropriately?End of session?
Diagnostic Testing
Ordered and scheduled in advance (same day or different day? On the fly?)
Procedures, lasers, injection and special clinics
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Differential Diagnoses of the 3 Areas
Build-out or relocation
Reallocation of resources
Space
Staff
Competency assessment and provide re-training
Delegation of tasks
S a
Facility being used to its maximum?
Predictable: Specific return to office or generic reference (“4-month IOP check” versus “follow-up”)
Schedule
Re-design of facility/schedule
Review of findings based
Process Review
Space / Facility layout
Assessment Analysis Recommendation
Staff training opportunity and accountability
MD commitment
d gs basedon assessmentsStaff
assignments/ benchmarks
Scheduling template
Time-study
Clinic capacity worksheet
Summary
Proper flow and efficiency is based on the building blocks of:
Space
Staff
Schedules
When all else fails……
Invest in outside resources.
APC33SQ12
E. Ann Rose
Ann Rose, owner and president of Rose & Associates, is a Medicare reimbursement and compliance consultant who has been associated with the health care industry for 30+ years. Rose & Associates specializes in Medicare coding, billing, documentation, and training for physician practices with medical record auditing being their main focus. Ann’s professional experience began as a member of the Medicare acquisition team at Blue Cross and Blue Shield of Texas shortly after they were awarded the Medicare contract in 1966. She was instrumental in helping develop the HCFA 1500 claim form (now known as the CMS-1500 claim form) and served as a team member in developing the paperless claims processing system known today as electronic billing. For the past 30 years Ann has been devoted to assisting ophthalmologists with coding and reimbursement issues for maintaining compliance with government regulations. She is a member of the American Society of Ophthalmic Administrators (ASOA), the Medical Group Management Association, the American Academy of Ophthalmic Executives (AAOE), and the American Academy of Professional Coders. She is also editor and publisher of The Messenger, a newsletter written and developed specifically for the specialty of ophthalmology and serves on the editorial board of the reimbursement section of Ocular Surgery News.
Rose & Associates 1-800-720-9667 1
ICD–10 Update
Masters in Ophthalmology 2013
Office Administrators Program
Palm Beach, Florida
June 29, 2013
Presented by: E. Ann Rose
Financial Interest
E. Ann Rose is President of Rose & Associates and a consultant for:
Alcon Surgical, Inc.
Heidelberg Engineering
Implementation
• October 1, 2014 – go live date
– Per CMS – implementation date is firm and
not subject to change • There will be no delays
• There will be no grace period
• ICD-10 not accepted prior to 10/1/14
• ICD-9 diagnosis not accepted on or after
10/1/14
• Planning must start now!!
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Rose & Associates 1-800-720-9667 2
Background
• ICD-9 is current diagnosis code set used in
the U.S.
– ICD-10 updated diagnosis code set moving
away from 30 year-old ICD-9 code set
• Technology and medicine has changed
• ICD-9 has outgrown level of specificity
– Many ICD-9 codes don’t accurately describe
the diagnosis they are assigned to represent
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Who is Affected?
• All Healthcare
• Providers (including nurses & technicians)
• Payers
• Software vendors
• Clearinghouses
• Third-party billers
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Why The Change?
• Patient benefits
– Enhance healthcare by tracking and trending
diseases
– Will precisely identify diagnoses and
procedures
• Payer benefits
– Will enhance accurate payments for services
rendered
6
Rose & Associates 1-800-720-9667 3
Why The Change?
– Improved care coordination
– More effective case management
– Improved utilization management
• Provider Benefits
– Will enhance accurate payments for services
rendered
– Improved care coordination
– More effective case management
– Improved utilization management
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What You Should be Doing
• Creating an implementation team
– Project manager
– Steering committee
• Evaluating effects of ICD-10 on other
projects
– Quality reporting
– Meaningful Use
– Improvement in chart documentation
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What You Should be Doing
• Implement strategies to address areas
lacking or weak
– Particularly in coding injuries
– Determine top 80% of your diagnosis codes
and devise cross-walks
– What are your most frequently denied ICD-9
codes?
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Rose & Associates 1-800-720-9667 4
What You Should be Doing
– Periodically address staff knowledge
• Coders, billers, EOMB denial teams
– Determine any potential for lost revenue
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Know What Vendors are Doing
• Know what your vendors are doing
– Do they have a readiness plan in place
– Will they provide any training on ICD-10
– Any additional configurations needs to practice
management system or software
– What are the testing plans of your vendors
• Currently no framework for testing between payers
and provider
• To be announced at a later date
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Learn about ICD-10 Differences
• Specificity and detail have been greatly
expanded
– Expanded codes
• Injuries
• Diabetes
• Post-operative complications
• Alcohol/substance abuse
– Includes more combination codes
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Rose & Associates 1-800-720-9667 5
Learn about ICD-10 Differences
– Injuries grouped by anatomical site rather than
type of injury
– Additional characters allow for identifying:
• Body system
• Root operation
• Body part
• Approach
• Device involved in a procedure
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Learn about ICD-10 Differences
– Majority of primary ophthalmology codes now
in one chapter (Chapter 7)
• Eye codes no longer combined with ear codes
– There are a lot more ICD-10 codes than ICD-9
• 17,000 ICD-9 codes
• Now over 70,000 ICD-10 codes
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Learn about ICD-10 Differences
Differences
ICD-9-CM ICD-10-CM
3 - 5 Characters 3 - 7 Characters
All Characters are Numeric
No laterality
Character 1 is alpha (A-Z, not case sensitive)
Character 2 is numeric
Characters 3-7 are alpha or numeric
Laterality
Supplemental chapters:
Alpha and numeric characters
-----
366.22 - Total Traumatic Cataract H26.131 - Total Traumatic Cataract, Right Eye
H26.132 - Total Traumatic Cataract, Left Eye
H26.133 - Total Traumatic Cataract, Bilateral Eye
H26.139 - Total Traumatic Cataract, Unspecified eye
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Rose & Associates 1-800-720-9667 6
Learn about ICD-10 Differences
ICD-10 Features
Combination Codes Expanded Ambulatory and managed
Care Encounter Details
Added Laterality Timeframes Added
Episodes of Care Added External Cause Codes – no longer
supplementary classification
Expanded codes (diabetes, post-
operative complications) Greater Specificity
Addition of Placeholder “X” – allows for
future expansion Enhanced Quality Reporting
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What Changes Need to be Made
• Policies and
Procedures
• Forms and superbills
• Health Plan and
Payer Policies
• Systems
• Prior Authorizations
• Clinical Knowledge
• Clinical
Documentation
• Training
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Policies and Procedures
• Any policy or procedure involving a
diagnosis code, disease management,
tracking or PWRS must be reviewed and
revised
• If Privacy Policies are revised, patients will
need to sign new forms
• Vendor/payer contracts
18
Rose & Associates 1-800-720-9667 7
Forms and Superbills
• Review all forms for any needed updates
– Advance Beneficiary Notice (ABN)
– Superbill/Encounter Form
– Consult letters/templates
– HIPAA notifications
– Lab, DME orders
– Clinical notes
19
Payers and Health Plans
• Patient Coverage
• Payer Reimbursement
• Reporting Requirements
• Ordering Requirements
• Prior Authorization Policies
20
Clinical Documentation
• Will need to be more comprehensive due
to ICD-10 level of specificity
• Documentation in chart must be able to
translate to the proper ICD-10 code
– Remember, if it isn’t in the chart, it wasn’t done
(according to Medicare). If it wasn’t done, it
can’t be billed.
21
Rose & Associates 1-800-720-9667 8
Clinical Documentation
• Documentation must address:
– Story of what was performed and what is
diagnosed accurately
– Must thoroughly reflect the condition of the
patient
– What services were rendered
– What is the severity of the condition
– Key work for documentation is SPECIFICITY
22
Documentation
• ICD-10 will require more (or improved)
chart documentation
– Has more unique, precise diagnosis codes
• Substantiates medical necessity
– ICD-10 will impact how you do your job
• How you deal with patients
– More questions specific to patient’s complaint or condition
• How you interact with staff
– ICD-10 will require more specificity
23
Documentation
• Documentation becomes critical with
trauma or injuries
– You may need to ask more questions specific
to the patient’s complaint
• What were you doing at the time of the injury?
• Where were you?
• Was this the first injury of this type?
24
Rose & Associates 1-800-720-9667 9
Documentation
• Will be required to collect more information
in more detail when documenting chart • Will permit coders to select the right ICD-10 for
symptom, disease, or provided service
• In the past, diagnoses were general
– In ICD-10, there’s a diagnosis for just about
everything
• If chart not documented properly, could lead to
denials
25
Documentation
• New documentation to consider
– Laterality plays a big part in ICD-10
• Assessment must be specific to each eye or each
eyelid
– Specificity is more important than ever
• Impression must be as specific as it can be for that
particular complaint or condition
– Particularly important for injuries
– Manifestation is critical where applicable
• Must list disease and manifestation
26
Documentation
Documentation Differences
Current New
Chalazion OS Chalazion LLL
Cataract NS cataract, OS, floppy iris syndrome
CME CME OS after cataract surgery
Eyelid laceration Laceration, left eyelid, hit in eye with tree
branch
Diabetic Type II diabetes using insulin
Myopia Myopia OU; regular astigmatism OD
27
Rose & Associates 1-800-720-9667 10
Documentation
Documentation Differences
Current New
Corneal Foreign body
FB in cornea, OD, initial encounter, subsequent
encounter, or sequela (condition that is
consequence of previous disease or injury)
Ptosis Mechanical ptosis OU
BDR, OU Type II diabetes w/mild NPDR w/o macular
edema; on insulin
28
Documentation
• Other documentation impacts on ICD-10
– Acuity of disease
– Supporting diagnostic test results
– Causative agents, drugs, diseases, genetics
– Specific site of disease or disorder
• Eyelid, retina, globe, iris, pupil
– Alcohol, drugs, and tobacco use
29
Documentation
• Glaucoma
– Must assign as many codes from Glaucoma
category H40 as needed to identify type of
glaucoma, the affected eye, and the glaucoma
stage • Expanded chart documentation will be required
– In some cases, even laterally will apply
• Nurses/technicians/physicians will need to be more
specific particularly as it relates to glaucoma stage – Coder won’t be able to code claim unless chart is properly
documented
30
Rose & Associates 1-800-720-9667 11
Documentation
• Cataract
– Some descriptors are different requiring better
chart documentation • Age-related cataract
– Senile
• Age-related nuclear cataract – Cataracta brunescens/nuclear sclerosis cataract
• Complicated cataract – Cataract with neovascularization
– Laterality will also play very important part in
cataract documentation
31
Documentation
• Blindness and low vision
– Some of the descriptors are different • ICD-10 – Blindness & low vision
• ICD-9 – Profound impairment
– Moderate impairment
– Severe impairment
– Blindness
– ICD-10 will have manual to define blindness
and low vision • Again laterality critical
32
Documentation
• Diabetes
– 5 Categories in ICD-10
• E08 – Diabetes mellitus due to underlying condition
• E09 – Drug or chemical induced diabetes mellitus
• E10 – Type 1 diabetes mellitus
• E11 – Type 2 diabetes mellitus
• E13 – Other specified diabetes mellitus
– Chart documentation will have to be specific to
these categories
33
Rose & Associates 1-800-720-9667 12
Documentation
– Combination codes will be important
• Three character category shows type of diabetes
• Fourth character shows underlying conditions with
specific complications
• Fifth character defines specific manifestation
– Diabetic retinopathy
• Nonproliferative: mild/moderate/severe
• Proliferative & unspecified
• With/without macular edema
– Diabetic cataract
34
TRAINING
Training
• Everyone in practice will need to be trained
– Create training plan
– Topics
• Codes
• New updated policies and procedures
• New computer systems/software
• Clinical knowledge – anatomy and medical
terminology
• Clinical Documentation
36
Rose & Associates 1-800-720-9667 13
Training
• Training should focus heavily on clinical
documentation excellence
• Need to correctly and sufficiently provide clinical
details to support coding in ICD-10
– Will be critical in conversion process to avoid
claim denials
37
Training
• ICD-10 will require more engagement with
physician
– Physician input may be key to proper
documentation
– Suggest physicians/nurses/technicians get
same training at same time
• That way everyone will be on board with same
information
38
Training
• Prepare listing of the most frequent
conditions treated with ICD-9 codes
– Compare chart documentation to
corresponding ICD-10 codes
• Does documentation allow selection of ICD-10
code at highest level of specificity?
• If yes, move on to next code
• If not, discuss with doctors and allied staff what
documentation will help code that level of service in
the new ICD-10 codes
39
Rose & Associates 1-800-720-9667 14
Training
– Train, train, and re-train on the new ICD-10
codes
• Discuss how your chart documentation will be
impacted
• Additional information that may be required
– Train on additional codes that may be required
for specific conditions
• Diabetes
• Glaucoma stage diagnoses
• Type of injury or where it occurred
40
Training
• Time needed to train personnel
– Initially, 4 to 10 hours recommended
– Other studies suggest:
• 16 hours for experienced coding
• 24 hours for less experienced staff
• Learning curve might not be as steep for
ophthalmology
• Limited number of codes to deal with
41
Training
• May want to take refresher on-line
anatomy course
– Eye anatomy becomes important in ICD-10
• Is not required in ICD-9
• Understanding the differences between
ICD-9 and ICD-10 will be key
– Also the impact it will have on the practice
42
Rose & Associates 1-800-720-9667 15
Training
• Staff training crucial to successful transition
– The train has left the station
• No time to put it off
• Train 6 months prior to implementation
– 9 months for larger practices
– Need to get involved in the process now
• Taking baby steps a little each month is better than
no progress at all
43
Case Scenarios
Case Scenario
• A 68-year old male patient experiences
sudden vision loss with the sensation of a
veil over his right eye
• Seen by ophthalmologist the same day
• Ophthalmologist examines patient and diagnoses
him with proliferative vitreo-retinopathy with retinal
detachment
– Patient is scheduled for laser therapy to be performed
that afternoon
45
Rose & Associates 1-800-720-9667 16
Case Scenario
• Alphabetic index:
• Detachment retina serous traction
H33.4-
• Tabular list:
• H33.4 Traction detachment of the retina, right
eye H33.41
• Correct code:
• H33.41
46
Case Scenario
• A 67-year old patient has had type 2
diabetes mellitus for 10 years • On insulin for blood sugar control for past 3 months
– Blood sugar doing well on insulin and diet
• Family doctor referred her to ophthalmologist with
suspected condition related to the diabetes
• Ophthalmologist examines patient and finds
diabetic retinopathy that is nonproliferative, with
macular edema – condition is moderate
– Physician recommends surgery same day
47
Case Scenario
• Alphabetic index: • Diabetes Type 2 diabetic retinopathy
nonproliferative moderate with macular
edema E11.331
• Tabular list: • E11.331 Type 2 diabetes mellitus with moderate
nonproliferative diabetic retinopathy with macular
edema (must use addt’l code to identify insulin use) – Z79.4 Long term insulin use
• Correct code sequence: • E11.331, Z79.4
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Rose & Associates 1-800-720-9667 17
Case Scenario
• A patient who had cataract surgery on the
right eye two days ago now experiencing
pain in right eye • Following a slit lamp exam of affected eye,
physician discovered lens fragments in right eye
– Returned patient to OR to remove fragments
• Alphabetic Index: • Complications Postprocedural Following
Cataract Surgery Cataract (lens) fragments
H59.02
49
Case Scenario
• Tabular List:
• H59.021 - Cataract (lens) fragments in eye
following cataract surgery, right eye
• Correct Code Sequence:
• H59.021
• H57.11 – Ocular Pain
– Chapter 7 (Eye and Adnexa) includes instructional note to
use external cause code following code for eye condition,
if applicable, to identify cause of eye condition
50
Case Scenario
• 67 year old male jet skiing at South Beach
– Was driving recklessly and fell off jet ski • Hit in left eye with handle bar before entering water
– Does not recall accident and admits to
drinking too many beers before getting on jet
ski • Presented to office next day with complaint of eye
swelling when he blows his nose
• Diagnosed with orbital floor fracture
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Rose & Associates 1-800-720-9667 18
Case Scenario
• Alphabetic index: • Fracture, traumaticorbitfloor (blow out) – S02.3
• Tabular list: • S02.3 – Fracture of orbital floor
• Correct code sequence: • x7th - S02.3XXB – Fracture of orbital floor
– No 5th & 6th digits available
– “X” place holder must fill empty spaces
– “B” is 7th digit for initial encounter for open fracture
• V93.33XA – Fall on board jet ski – Injury also requires secondary code for external cause
– “X” is place holder – diagnosis requires 7 digits
– “A” is for initial encounter [for injury]
52
Websites to Know
• CMS
– http://www.cms.gov/Medicare/Coding/ICD10/L
atest_News.html
• AAPC
– www.aapc.com/ICD10/
• AHIMA
– www.ahima.org/ICD10/
53
Overcome Obstacles
• ICD-10 is not an option
– Required by HIPAA
• ALL HIPAA covered entities must convert to ICD-10
– Does not affect CPT or HCPCS codes
• ICD-9 codes based on date of service will
continue to be sent and received for some
time • Will need to file claims/appeals after
implementation of ICD-10 for earlier dates of
service
54
Rose & Associates 1-800-720-9667 19
Overcome Obstacles
• Anticipate problems!
– Possible delays in payment from carriers until
everyone is fully trained
– Inaccurate coding, reporting, and processing
increasing delays in payment
• Denials, and/or rejections
• Biggest obstacle to overcome may be
resistance to change • May have some staff turnover during transition
55
Questions
Rose & Associates
1-800-720-9667
www.roseandassociates.com
56
Tom Murphy
As an agent with Danna-Gracey, Inc., Tom Murphy is a frequent guest lecturer for numerous medical societies, sharing his expertise with the medical community while gaining additional insight into the business of medicine. Prior to joining Danna-Gracey, Tom worked at FCCI, RAB, and Allstate where he developed extensive experience in claims and risk management, giving him a unique ability to understand his clients’ true needs and exposures. He holds a bachelor’s degree in marketing and management from Florida State University. Tom and the Danna-Gracey team focus on medical professional liability insurance, workers’ compensation coverage, and employee benefits. They educate clients about their insurance options and tailor coverage’s and benefits to meet specific needs. By building strong relationships with his clients, Tom is able to provide service that’s unmatched elsewhere in the industry.
1
Workers’ Compensation
FAQs
Who needs Workers'
Compensation coverage?
• If you are in an industry, other than construction, and have four (4) or more
employees, full-time or part-time, you are required to carry workers'
compensation coverage (an exempted corporate officer does not count as an
employee).
• If you are in the construction industry, and have one (1) or more employees
(including yourself), you are required to carry workers' compensation coverage
(an exempted corporate officer or member of a limited liability company does not
count as an employee).
• If you are a state or local government, you are required to carry workers'
compensation coverage.
• If you are a farmer, and have more than five (5) regular employees and/or twelve
(12) or more other workers for seasonal agricultural labor lasting thirty (30) days
or more, you are required to carry workers' compensation coverage.
How does an employer obtain
workers' compensation insurance?
You have several options:
• By purchasing a policy from an insurance agent that represents
approved insurance companies.
• From the Joint Underwriting Association (JUA), http://www.fwcjua.com
• By qualifying as an individual self-insured; for additional information,
contact the Division of Workers' Compensation at (850)413-1784.
• Or, an employer may contract with a professional employer organization
(employee leasing) that has secured workers' compensation coverage.
2
Where do I get a supply of the injury
report forms that I am required to
complete when one of my employees
is injured?
• Your insurance carrier is required to provide you a
supply of the Form DWC-1 First Report of Injury or
Illness. Forms can also be downloaded from the Florida
Workers' Compensation web site Rules & Forms page,
located at:
http://www.myfloridacfo.com/wc/forms.html.
Who can I contact with questions or
concerns regarding risk classification
codes and premium amounts?
• Call your insurance carrier or service representative. If you
have a dispute regarding the risk classification codes, you
can call the National Council on Compensation Insurance
(NCCI) at 1-800-622-4123.
Does the injured worker pay any
part of my workers' compensation
insurance premium?
• The law is very specific on this point. It is the
employer's responsibility to pay the entire
premium for workers' compensation
insurance coverage.
3
What kinds of employee
injuries are covered?
The law covers all accidental injuries and occupational
diseases arising out of and in the course and scope of
employment. This includes diseases or infections resulting
from such injuries. The law also covers death resulting
from such injuries within specified periods of time. Even if
you do not think an injury is covered, you must still file the
First Report of Injury or Illness (DWC-1) with your
insurance carrier for determination of responsibility within
7 days of your first knowledge of the accident/injury.
What injuries are not covered? The law does not provide compensation for the following conditions:
• a mental or nervous injury due to stress, fright, or excitement;
• a work related condition that causes an employee to have fear or dislike for another individual because of the individual's race, color, religion, sex, national origin, age, or handicap;
• "pain and suffering" has never been compensable in Florida, nor is it compensable in any other state. The employer may not sue an injured worker for causing a catastrophe nor can the injured worker sue the employer for their injury. This trade-off makes it possible for injured workers to receive immediate medical care, at no cost to the injured worker, without any consideration for who was at fault, the employer or the employee. In civil law, negligence must be established through litigation before any compensation is awarded.
• Reference: Section 440.02(1), Florida Statutes
Compensation will not be paid in several other instances:
• if the injury is caused by the employee's willful intention to injure or kill himself or another;
• if the injury is caused primarily because the employee is intoxicated or under the influence of drugs;
• if the injury or death of the employee is covered by the Federal Employer's Liability Act, the Longshore and Harbor Workers' Compensation Act, or the Jones Act (if the injured worker is a "seaman" or member of a crew).
Can an employer be liable for
double compensation?
An employer can be liable for double compensation if a
minor child is injured while employed in violation of any of
the conditions of the child labor laws of Florida. The
employer alone, not the insurance carrier, is liable for up to
double the normal compensation as provided by the
Workers' Compensation Law. To receive further
information regarding the Child Labor Law, call the Child
Labor Office at (800)226-2536.
4
As a small business owner, I fail to see how I can
be sued by an injured worker if I provide all the
necessary care, light duty work, and offer to
retrain the employee.
Under the provisions of Chapter 440, Florida Statutes, an injured
worker has two years from the date of the accident to file a petition for
benefits with the Division of Administrative Hearings. If an employer is
providing benefits and return to work options, that should be sufficient
to meet the ultimate goal of returning an injured worker to gainful
employment. However, an employer/carrier's definition of "necessary
care" and that of an injured worker may differ. When that happens, the
injured worker has no remedy except to file a petition for benefits and
have a judge of compensation claims determine whether the benefits
that are being provided are sufficient, or if additional benefits not being
provided are required by Florida law. If the employer is providing
benefits, all expenditures must be reported to the employer's workers'
compensation insurance carrier for statistical purposes.
If I suspect an employer should have Workers'
Compensation insurance coverage, but does not,
or if I suspect fraudulent activity in a workers'
compensation claim, where do I report this?
Suspected workers' compensation fraud can be reported directly to the
Department of Financial Services, Bureau of Workers' Compensation
Fraud, 200 E. Gadsden Street, Suite 100A, Tallahassee, Florida
32301, or to the bureau's toll free hotline number at 1-800-378-0445.
Suspected fraud can also be reported to the Florida Workers'
Compensation, Bureau of Compliance's toll free hotline at 1-800-742-
2214. Anonymous calls are accepted. You can also fill out the Non-
Compliance Referral Form to report employer's who do not have
workers' compensation insurance coverage. This form can be
accessed at the Division's website at:
www.myfloridacfo.com/wc/databases.html.
What in the system would prevent an injured
worker, who wanted to leave his employer anyway,
from claiming to be hurt, waiting out the treatment,
still claiming to be hurt and then trying to settle? It
would not cost him anything but a few hours to do
this and he would have nothing to lose.
By law, pain or other subjective complaints alone, in the
absence of objective relevant medical findings, are not
compensable. However, sometimes these types of claims do
occur and they are sometimes settled by insurance carriers for a
nominal amount of money to rid the employer/carrier of a
nuisance case.
5
Is compensation payable if an
employee refuses to use a safety
appliance like a hard hat, safety
goggles or observe a safety rule?
Compensation will still be paid, but indemnity benefits
(partial wage replacement) may be reduced by 25 percent
if the employee knew about the safety rule prior to the
accident and failed to observe the rule, or if the employee
knowingly chooses not to use a safety appliance which the
employer has directed him to use.
Will becoming a drug-free
workplace save me money on
my insurance premiums?
If you implement a drug-free workplace program in accordance with the criteria set forth in s.440.102, Florida Statutes, you may be eligible for a 5 percent premium credit from your insurance carrier to your workers' compensation insurance premium. In addition to the premium credit, having a Workers' Compensation Drug-Free Workplace Program may make your workplace safer, resulting in fewer accidents, which may reduce your workers' compensation costs.
Am I required to become a
carrier certified drug-free
workplace?
Becoming a carrier certified drug-free workplace is voluntary. However, without the certification, you would not be eligible for any of the benefits provided under this program.
6
Under the Workers' Compensation
Drug-Free Workplace Program,
can I conduct random drug testing
of my employees?
In addition to the situations in which testing is mandatory, the law does not prohibit a private employer from conducting random testing or any other lawful testing of employees. A public employer may institute random testing of employees in "safety sensitive" or "special risk" occupations.
Can I use a breathalyzer as a
valid drug testing method?
Under the Workers' Compensation Drug-Free Workplace Program, the use of a breathalyzer cannot be used as a testing method for initial or confirmation tests.
What if an employee refuses to
take a drug test?
If an injured worker refuses to submit to a test for drugs or alcohol, the employee may forfeit eligibility for medical and indemnity benefits. If an employee or job applicant refuses to submit to a drug test, the employer is permitted to discharge or discipline the employee or may refuse to hire the applicant (if specified in the written Drug-Free Workplace Policy), since, by law, refusal to submit to a drug test is presumed to be a positive test result.
7
If a terminated employee files for
unemployment compensation benefits, may I
inform the adjudicator that the employee was
terminated as a result of a positive drug test?
The adjudicator is bound to maintain this information confidential under s.443.1715(3)(b), Florida Statutes, until introduced into the public record pursuant to a hearing conducted under s.443.151(4), Florida Statutes. Under all other instances employers may not release any information concerning drug test results obtained pursuant to section s.440.102(8), Florida Statutes, unless such release is compelled by an administrative law judge, a hearing officer, or a court of competent jurisdiction or is deemed appropriate by a professional or occupational licensing board in a related disciplinary proceeding.
Can I post the results of my
employees' drug tests?
All information, interviews, reports, statements, memoranda and drug test results, written or otherwise, received by the employer through a drug testing program is confidential and cannot be posted in any public manner.
Am I responsible for payment for services
when my employee participates in an
Employee Assistance Program (EAP)?
No, but if you choose to pay for an Employee Assistance Program, you have the right to choose the facility providing treatment. If an employee does participate in an Employee Assistance Program, you, the employer, are required to extend the same considerations as reflected under the federal guidelines established for the Americans with Disabilities Act and the Family and Medical Leave Act.
8
How many days does the employee have
to re-test the specimen if he or she
wishes to contest a positive test result?
During the 180 day period after written notification of a positive test result, the employee who has provided the specimen shall be permitted by the employer to have a portion of the specimen re-tested, at the employee's expense, an Agency for Health Care Administration (AHCA) licensed or a USHHS certified laboratory of his or her choice.
Who pays for the drug test?
The employer is responsible for payment of all drug tests they may require. However, if an employee wishes to have the specimen re-tested at a laboratory certified by the Agency for Healthcare Administration (AHCA), it will be at the employee's expense. If the workers' compensation insurance carrier uses a positive test result to determine the compensability of a claim, the carrier would be responsible to cover the costs of the test.
Delray Beach • Jacksonville • Miami • Orlando • Pensacola
At Danna-Gracey, it is our privilege
to be a partner with
9
Did you receive money back on your workers’ comp insurance premium last year?
Many doctors have through the Florida Society of Ophthalmology
Workers’ Compensation Program.
The rates for workers’ compensation insurance are set by the State of Florida. Your practice will pay the
same price no matter where you choose to secure coverage. However, under the OptaComp program,
you may be eligible for a potential dividend of up to 24.8%:
・ $10K premium has returned an average dividend of 20%, or $2,000.
・ $5K premium has returned an average dividend of $1,000.
・ $2K premium has returned an average dividend of $400.
Your membership with the Florida Society of Ophthalmology (FSO) can provide savings that can be paid
back in dividends. OptaComp has returned a dividend for 12 straight years, with over $4 million over
the past six years to medical societies’ members in Florida. The OptaComp (rated “A” by A.M. Best)
program is endorsed by the FSO and is offered by Danna-Gracey, Inc.
For more information on the workers’ compensation insurance program through OptaComp, call the
experts at Danna-Gracey.
Delray Beach ・ Orlando • Miam • Jacksonville • Pensacola
800.966.2120 • [email protected] • www.dannagracey.com
Wes Caldwell
Wes currently heads up the benefits division for Danna-Gracey, a leading medical malpractice provider with offices in Delray Beach, Orlando, Miami and Jacksonville. He has spent the last 28 years in the insurance industry working with professionals in the areas of health, life disability and non-qualified retirement plans. Wes is a native of Delray Beach, Florida and holds a Bachelor’s Degree from Florida Atlantic University. He is Past President of the Sunrise Kiwanis Club of Delray Beach and the Juvenile Diabetes Research Foundation of North Florida. He has served on the boards of the Rotary Club of Mandarin, San Jose Country Club and the National Board of the Juvenile Diabetes Research Foundation where he was a Liaison for the State of Florida. Wes lives in Jacksonville Florida where he enjoys singing, cooking and serving his church.
1
www.dannagracey.com
FRF 401(k) Advantage
Wes Caldwell June 2013
Introducing…
Since ERISA (Employee Retirement Income Security
Act) was enacted in 1974, there has been an
amendment or regulation almost every year which
affects the compliance and operation of your Qualified
Retirement Plan.
Why is FRF Advantage a solution for my company’s
retirement plan needs and responsibilities?
2
• 1,000+ new audit/enforcement agents
• 25% increase in plans audited
• Litigation, required money restorations, fees and penalties
FRF Advantage
Beginning in 2009 - 2010, the Department Of Labors
focus changed from voluntary compliance to
mandatory enforcement.
• Most employers who sponsor retirement plans do not fully
comprehend the extent of their fiduciary liability.
• Product Providers have an inherent conflict
• Most Plan Sponsors do not know that they can delegate their
responsibility.
The SEC and DOL independent investigations have
confirmed that:
FRF Advantage
Why do I, as a Plan Sponsor of my Company’s Retirement Plan
need Fiduciary protection?
FRF Advantage
• ERISA Sec 409 makes a Fiduciary personally liable for any breach of responsibility that he
commits either by act or omission.
• “Any person who is a Fiduciary with respect to a plan who breaches any of the responsibilities,
obligations or duties imposed upon Fiduciaries shall be personally liable to make good to such
plan any losses to the plan resulting from each such breachノ”
• “The Law and Courts encourage those in control of the plan to delegate the responsibility to
“skilled professionals” who are familiar with such matters . US Court of Appeals - Katsaros v.
Cody 744F2d at 270.”
• “A fiduciaryノ.will be liable for responsibilities delegated to him.” ERISA 405 (c) (2) Bulletin 75-8,
FR-13 and FR-14
3
• Becomes Named Fiduciary
• Plan Governance Review
• Maintain Plan Fiduciary File
• Managed Plan Calendar
• Benchmarking Costs/Fees
• Provide 404(c) Compliance
• Supervise and Manage Annual Notices
• Annual Audit
• Help on Demand: Provide One-Point of Contact for all Questions/Needs
• Review Plan Design
How We Do It
401(k) Levels of Responsibility
The FRF 401(k) Advantage EMPOWERS SUCCESS through a proactive
ongoing process, which:
• Effectively manages your plan, its vendors, and the costs your
participants pay.
• Ensures that your plan offers only the highest quality investment
options.
• Guides your participants to save.
• Guides your participants to invest wisely.
• Constantly reviews your plan design to ensure it remains effective.
• Employer Controlled ミ Each adopting employer can maintain their
unique plan.
• Provisions and plan design.
• Individualized for your participants ミ Investment options chosen for
your plan/participants.
• Employee Education ミ Communication Network available to participants.
• NO 5500 to File.
• NO Plan Audit.
In Summary
4
“..401(k) MEPs are one of the few options available for most
employers that wish to comprehensively mitigate their fiduciary
responsibilities and exposire to liability, and outsource their
administrative compliance burden..”
- A White Paper by C. Frederick Reish, Esq.; Bruce L. Ashton, Esq.;
Joshua L. Waldbeser, Esq.; September 2011, Drinker Biddle
What They are Saying
Delray Beach • Jacksonville • Miami • Orlando • Pensacola
800.966.2120 • www.dannagracey.com • [email protected]
Delray Beach • Jacksonville • Miami • Orlando • Pensacola
Steven I. Rosenfeld, MD, FACS
Dr. Steven I. Rosenfeld is a board-certified, fellowship-trained ophthalmologist who specializes in medical and surgical treatments of corneal conditions, infectious and inflammatory eye diseases, refractive surgery, and cataract surgery. Dr. Rosenfeld has been in private practice with Delray Eye Associates, PA since 1985. He is a Fellow of the American College of Surgeons and the American Academy of Ophthalmology, and an Associate Examiner for the American Board of Ophthalmology. Dr. Rosenfeld currently serves as a Voluntary Professor on the clinical faculty at the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, where he has been on the faculty since completing his fellowship. Dr. Rosenfeld has been a Committee Member on the Board of OMIC since 2010.
Dr. Rosenfeld has authored dozens of textbook chapters and scientific articles on the topics of cataract surgery, PRK and LASIK surgery, corneal transplant surgery, and ocular infections. He has co-authored two recent textbooks — one on Lens and Cataract Surgery and one on Refractive Surgery — under the auspices of the American Academy of Ophthalmology. He is on the editorial review boards of EyeNet magazine and Focal Points Clinical Modules and is a reviewer for Ophthalmology and the American Journal of Ophthalmology. Dr. Rosenfeld has been honored with numerous awards from the American Academy of Ophthalmology, including the Achievement Award, Senior Achievement Award, Secretariat for Education Award and Lifelong Education for the Ophthalmologist Award. He is also a recipient of the Physician's Recognition Award from the American Medical Association and is listed as one of the best doctors in Best Doctors in America, Who's Who in America, Who's Who in the World, Top Doctors, and Florida Super Doctors, just to name a few. Dr. Rosenfeld frequently lectures at ophthalmic meetings nationwide.
Dr. Rosenfeld earned his undergraduate degree with honors at the Johns Hopkins University and was elected Phi Beta Kappa. He obtained his medical degree at the Yale University School of Medicine, where he was elected into the Alpha Omega Alpha Honor Medical Society. He completed his medical internship at Yale/New Haven Hospital and his ophthalmology residency at Barnes Jewish Hospital at Washington University School of Medicine in St. Louis. Dr. Rosenfeld continued his extensive training with a Heed Foundation Fellowship in Cornea and External Diseases at the Bascom Palmer Eye Institute in Miami.
Dr. Rosenfeld is a member of numerous professional associations, including the American Academy of Ophthalmology, the American Society for Cataract and Refractive Surgery, the Association for Research in Vision and Ophthalmology, the Ocular Microbiology and Immunology Group, the Cornea Society, the Society of Heed Fellows, the Eye Bank Association of America, the Paton Society, the International Society of Refractive Surgery, the Florida Medical Association, the Florida Society of Ophthalmology, the Palm Beach County Ophthalmology Society and the Palm Beach County Medical Society.
1
Risk Management Strategies for the Ophthalmic Practice
Steven I. Rosenfeld, MD
OMIC Board Member
Practice
Administrators
June 29, 2013
Course Objectives
• Provide information that will aid the practice
in implementing successful telephone
screening procedures and protocols
• Help you organize your practice to minimize
patient injury and decrease risk of
malpractice claims
Course Outline
• Review roles and responsibilities of staff and
ophthalmologists
• Review delegation of services
• Review in-office protocols
• Review after hours protocols
2
Handout Material
• “Telephone Screening of Ophthalmic
Problems” at www.omic.com for:
– Sample screening guidelines
– Patient telephone screening form
– Complaint categories: emergent, urgent and
routine
– Office telephone assessment form
– After-hours/On-call Telephone Contact
– Patient Care Phone Call Record Pad
Introduction
• Patients call their ophthalmologist to report
problems and seek advice
• Physicians rely upon their office staff to
screen these calls and schedule
appointments
• After hours:
– ophthalmologists themselves field many of these
calls
– cover other physicians’ patients as well as for the
Emergency Department
The “Risk” Challenge
• The health care team does not have access to
information obtained from face-to-face
contact
• Patient may be a poor historian or may not
want to inconvenience the physician
• Patient may be unknown to the
ophthalmologist and medical records may
not be available
3
Roles and Responsibilities
• Practice is made up of physicians, techs,
administrators, front and back office
• Each has specific roles and responsibilities
• Every practice needs written guidelines for
telephone screening
OVERVIEW
• Exercise same care over telephone as you
would during office visit
1. Gather information
2. Communicate assessment and plan to the
patient
3. Document the encounter and decision
making process
OVERVIEW
• Safely enlist your staff’s assistance in
gathering information
1. Develop and implement written protocols for
telephone screening (approved by physician)
2. All delegated duties are part of employee’s
written job description
3. Should be specific to your patient population,
subspecialty and staff
4
Polling Question – Show of Hands
• Do you have a written protocol for telephone
screening?
• Yes
• No
• I don’t know
OVERVIEW
• Physician and Administrators must
supervise staff members who screen calls
1. Train and verify competency
2. Staff must feel authorized to consult with an
ophthalmologist as needed
3. Ideally, daily review of telephone calls by
physician
4. Periodic review of the screening protocols
themselves. When you update guidelines, note
the new revised date, and keep a copy
Practice of Medicine
• Do not delegate tasks that require
independent medical judgment
• Practice of medicine is defined by state law in
Medical Practice Acts
• Only physicians can
– diagnose mental and physical conditions
– use drugs in or upon human beings
– sever or penetrate tissues of human beings
– use other methods in treatment of diseases
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Scope of Practice
• All medical diagnoses must be made by the
ophthalmologist to promote patient safety
and avoid allegations of practicing medicine
without a license
• You should respect staff members scope of
practice and service
• If in doubt what services can be delegated to
non-physicians, contact your state licensing
boards
Screening Training
ROLE OF STAFF
• Staff members are limited to gathering
information and the assignment of an
appointment category
• Important:
– All contact forms must be filed in the patient’s
medical record. (Ideally) The physician will initial
and date forms.
– No independent decision making can be made by
your staff
Instruct Staff
• Medical advice should only come from a
physician
• Instruct non-physician staff members not to
give their opinion.
• When properly trained, staff can
communicate instructions and information to
the patient
EXAMPLE:
“Instruct patient on how to rinse eye with sterile
saline solution”
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Instruct Staff
• Staff should not minimize patient complaints
or provide false reassurance
• Juries are not sympathetic when a
receptionist tells a patient that nothing is
wrong
Screening Training
• Non-physicians follow written policies and
procedures under the supervision of an
ophthalmologist
• Written guidelines should be in place that
prompt your staff to ask questions
• Staff ask questions and follows these written
guidelines to ascertain the patient’s level of
distress
Polling Question
• Do you have a written guidelines in place that
prompt staff to ask questions?
• Yes
• No
• I don’t know
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Instruct Staff
• Post the guidelines by the phones of all staff
members who answer calls
• Staff members may be concerned about the
amount of time required to screen calls
• Not every phone call will require asking every
question. The patient’s complaint will
determine how many questions should be
asked
• Important: Time spent carefully screening calls is
time well spent if it preserves a patient’s vision
Categories of Complaint
• Vision Loss Vision Changes
• Pain Flashes/Floaters
• Burn Foreign Body
• Trauma (Injury) Redness/Discharge
• Other Eye Complaints
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Categories of Complaint
• If patient falls into one or more category,
always consider assigning the category
where the patient will be seen soonest
• Important: If the patient has any complaint
that falls into the emergent category, give
him/her an emergent appointment
Polling Question
• Do you have staff training reviewing category
of complaints?
• Yes
• No
• I don’t know
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Interrupting Physician
• Your protocol should indicate if your
physicians want to be notified of emergent
appointments or other situations
• Staff should be instructed what to do if the
patient requests to speak with the physician
Patient “same day” requests
• Ask staff to inform physician when a patient’s
request to be seen the same day can’t be
accomplished
• If physician cannot see the patient when the
patient wants to be seen, it is best to speak to
the patient personally (physician)
• Suggest alternative sources of care
• Important: Emergency departments may not
be equipped to carefully evaluate ophthalmic
complaints; direct patient to source of care
that is likely to be beneficial
New Patients
• Does practice accept new patients
– Step 1: Ask caller if current patient
– Step 2: If no, inform caller that practice does
not accept new patients
– Step 3: Offer caller names of ophthalmologists
in the area or the state/local ophthalmology
society
– Caution: staff should not discuss caller’s
condition or complaint if ophthalmologist is
not available to treat caller
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When Staff Have Questions
• Staff should be encouraged to consult with
the physician at anytime
• EXAMPLES
– Complaints that are not listed on the
screening guide
– Those that fall into more than one
appointment category
– Routine patients that want to be seen that
day
Staff Qualifications
• Authorize only staff members with the
necessary language and communication
skills to screen ophthalmic problems over
the phone
• SKILLS
– Patience
– Cheerfulness
– Compassion
– Clarity of enunciation
– Professionalism
– Ability to abide by guidelines
Office Telephone Assessment Form
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Prescription Refill Protocols
• OPHTHALMOLOGIST (documentation)
– Name
– Dosage
– Route
– Frequency of medication
– Number of refills
– Date for follow-up appointment
Prescription Refill Protocols
• PATIENT OR PHARMACY REQUESTS
– Instruct staff to verify if patient is
authorized to have the prescription refill by
reviewing Medication Summary Sheet or
Progress Notes form
Prescription Refill Protocols
• VERIFICATION
– Staff verifies date of last office visit. If
greater than one year, instruct staff to tell
patient needs to be seen by physician
– Document this activity by dating and
initialing form
– Staff member notes time and date of call
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Prescription Refill Protocols
• ACCEPT – DENIAL OF REFILL
– Staff gives request and patient’s record to
ophthalmologist for approval
– Staff contacts pharmacy with request
– Staff notes include date, time of call and
the physician’s initials indicating
authorization
Postoperative Contact Protocols
• Postoperative patients play a significant role
in malpractice claims
• Important: Always treat a postoperative
patient as a high risk contact
Postoperative Contact Protocols
• Proactive written instructions
– Medications
– Activity
– Wound care instructions
– Date of follow-up appointment
– State symptoms that should be reported and
consequence of not reporting them
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Postoperative Contact Protocols
• STAFF ISSUES
– Ask patient if they are postop, and if so,
date and type of procedure
– Ask patient if they still have the written postop
instructions
– Staff should categorize the patient’s status
• Urgent or Emergent
– Postoperative patients must be documented by
staff and reviewed by the physician on a daily
basis
CASE STUDY
Risk Management Issues
• Patient abandonment following surgery
• Handling of complaints of postoperative
patient
• Patient handoffs to on-call partner
• Management of postoperative
complications of increased IOP and vision
changes
14
Case Summary
• 53 year old male referred to retina specialist for
vitreo-retinal evaluation. Diagnosed with lattice
degeneration superotemporally OD. Very
prominent posterior vitreous separation.
• Patient warned of possible retinal detachment,
told to call if those symptoms developed.
• 2 ½ months later, Pt complained of spots OD
and was diagnosed with retinal detachment and
giant tear.
Case Summary
• Had microscopic pars plana vitrectomy, retinal re-
attachment surgery, internal fluid gas exchange &
endophotocoagulation. Postoperative IOP 27,
doing well.
• Two days after surgery, called insured, who was
in his car. “Eye felt different.” Denied upset
stomach, nausea, vomiting.
• Patient instructed to increase medication to every
8 instead of 12 hours.
• Patient informed that physician was going out of
town and that partner was covering.
Case Summary
• Patient called covering MD next day complaining of feeling pressure, seeing black
• Partner not concerned since patient had gas bubble three days prior, was on steroids and IOP lowering agents.
• Told patient to come in next day (Monday).
• During office visit, Pt complained of nausea and vomiting during the night.
• NLP, mild swelling of lids, IOP 60. Lens and iris shoved against cornea. Decompressed eye.
15
Case Summary
• Treated eye with gas withdrawal, decompression, injection of fluid and air over next 3 days. IOP remained high; NLP.
• Patient had pars plana lensectomy and vitrectomy, with removal of retinal blood.
• Next day, IOP 7. Laser surgery attempted, unsuccessful.
• Eventual outcome: LP, phthisical eye, needed prosthesis. OS developed retinal tear.
Legal Issues
ABANDONMENT
• Occurs when a physician fails to provide for necessary medical care to a current patient without adequate justification
• Includes providing “coverage” for patients when the physician is ill, on vacation, when treating other patients, etc.
• If care provided by covering MD is inadequate, and the original physician did not exercise due care in selecting the covering physician, could be liable for harm to patient.
Claims Analysis
• Significant damages: lost right eye,
required prosthesis, left eye vision
continued to deteriorate
• Damages evaluation • Health care needs of plaintiff
• Income loss
• Age of patient
• Presence/absence of damage caps in state law
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Claims Analysis
• Factors affecting decision
• Reviews by OMIC Claims Committee, and
experts retained by defense attorney
• Level of support for standard of care
• Level of supporting documentation
• Credibility and witness quality of plaintiff
• Credibility and witness quality of defendant
Claims Analysis
• Credibility issue since no documentation of
phone calls or of decision-making process that
led to phone treatment versus examination
• No support for standard of care for either
physician, but especially telephone treatment by
covering ophthalmologist when pt complained of
“seeing black” and delayed treatment of
increased IOP.
Polling Question
• What do you think is a reasonable amount to
pay the plaintiff to settle the lawsuit
• $75,000
• $500,000
• $1 million
• > $1 million
17
Risk Management Issues
Patient “Hand-Offs”
• When covering for another physician...
– Identify high-risk patients
• Recent surgeries or procedures
• Unstable patients
• Patients who have already called to report
problems
– Clarify when you will go off-call
Risk Management Issues
Patient “Hand-Offs”
• Document -
• Documentation promotes continuity and
defensibility of care.
• Keep after-hours and on-call contact forms
with you (see sample).
• Document each patient contact.
• Document your decision-making process.
• Document the patient hand-off.
Risk Management Issues
Patient “Hand-Offs”
• When going off-call...
• Contact physician for whom you were covering
• Identify patients who called
• Fax contact form
• Keep original copy of contact form in “On-call
Patient Contact” file
18
After Hours Documentation
• WHEN GOING OFF CALL
– Once you return to the office, place or tape the
contact form in your patient’s medical record
– When providing on call coverage for a physician in
another practice, tell the physician when you go
off call and fax a copy of the contact form and
other records, retain the original in a file
designated “On-call coverage contacts”
Patient Care Phone Call Record Pad
Email: [email protected]
for booklet
19
Handout Material
• “Telephone Screening of Ophthalmic
Problems” at www.omic.com for:
– Sample screening guidelines
– Patient Telephone Screening Form
– Complaint categories: emergent, urgent and
routine
– After-hours/On-call Telephone Contact
Thank You!
Steven R. Robinson, FASOA, COE
Steven Robinson is currently an independent senior consultant with Advantage Administration of Dallas Texas, consulting with medical offices around the country on human resource issues, operations and financial management and optical operations. He was formerly vice president and chief operations officer of Professional Eye Associates, Inc. in Dalton, Georgia, where he served in this capacity for 18 years. He received his education from the University of Tennessee at Chattanooga in Business management and the United States Army Professional Development Institute in the field of logistics. He is a graduate of the prestigious Wharton Professional Management program for ophthalmic administrators, and he has also completed the New York University, Wagner School of Business series of courses in ophthalmic medical practice planning and financial management. He is one of only 220 persons currently holding the Certified Ophthalmic Executive credentials and he also holds an Ophthalmic Coding Specialist designation. He has lectured extensively to medical administrator and physician groups around the country. He is a regular course presenter at the American Society of Ophthalmic Administrator National Congress, The Southeastern Congress of Optometry and the American Society of Ophthalmic Executives. He has written numerous articles for medical management periodicals, and he is a contributing writer to a book on the management of Ambulatory Surgery Centers. He is a past president and vice president of the American Society of Ophthalmic Administrators and served on the board of directors of this 2,000 member international organization for 8 years. Steve is a retired reserve army officer who was decorated 26 times during his career and served his last tour of duty as a logistics advisor on the senior staff of the commanding general of army forces during Operations Desert Shield and Desert Storm. He has held officer positions in the North Georgia Medical Managers Association, the Retired Officer Association, he presently serves on an advisory team for Lake Forest Ranch, a camp ministry for children in central Mississippi, also served on the board of directors of a non-profit speech and hearing Center, and the National Board of Certified Ophthalmic Executives. Steve and his wife Ruby reside near Chattanooga Tennessee. He is an avid computer enthusiast and also has a passion for the outdoors with interests in hunting, fishing and backpacking.
1
Organizational Management
Steve Robinson, FASOA, COE
Senior Consultant
Steve Robinson is a paid consultant
and provides management consulting
services to physician practices and
has some financial interest in the
material presented
BORING……
Organizational
Management
101
2
Why
organizational
management ?
Types of Management
H. R. Management
Financial Management
Facilities Management
Security Management
Information Management
Types of Management
Tyranny of the Urgent
Baby Sitting Management
Anger Management
Crisis Management
Drama Management
3
Isn’t this where it
all breaks down ?
What is your
Vision ?
1950’s
Made in Japan…..
Cheap, Shoddy,
Imitation,
Worthless
4
We will create products that become pervasive
around the world.…. We will be the first
Japanese company to go into the U.S. market
and distribute directly.… We will succeed
with innovations that U.S. companies have
failed at - such as the transistor radio.…
Fifty years from now, our brand name will be as
well known as any in the world…and will signify
innovation and quality that rival the most
innovative companies anywhere.… “Made in Japan” will mean something fine, not
something shoddy
Sony - 1950’s
Intentionally left blank
5
What does this
tell you ?
The story of Microsoft’s lost decade could serve as a
business-school case study on the pitfalls of success.
For what began as a lean competition machine led by
young visionaries of unparalleled talent has mutated
into something bloated and bureaucracy-laden, with an
internal culture that unintentionally rewards managers
who strangle innovative ideas that might threaten the
established order of things.
Excerpt from article in Vanity Fair Magazine
Microsoft’s Lost Decade By Kurt Eichenwald
By the dawn of the millennium, the hallways at Microsoft
were no longer home to barefoot programmers in
Hawaiian shirts working through nights and weekends
toward a common goal of excellence; instead, life behind
the thick corporate walls had become staid and brutish.
Fiefdoms had taken root, and a mastery of internal
politics emerged as key to career success.
In those years Microsoft had stepped up its efforts to
cripple competitors, but—because of a series of
astonishingly foolish management decisions—the
competitors being crippled were often co-workers at
Microsoft, instead of other companies.
6
Staffers were rewarded not just for doing well but for
making sure that their colleagues failed. As a result, the
company was consumed by an endless series of internal
knife fights. Potential market-busting businesses—such
as e-book and smartphone technology—were killed,
derailed, or delayed amid bickering and power plays.
That is the portrait of Microsoft depicted in interviews
with dozens of current and former executives, as well as
in thousands of pages of internal documents and legal
records.
NOTE:
In the quarter ending March 31,
2012, just the iPhone had sales of
$22.7 billion for Apple;
the entire Microsoft Corporation,
$17.4 billion
“They used to point their finger at IBM and laugh,”
said Bill Hill, a former Microsoft manager. “Now
they’ve become the thing they despised.”
#1 problem
listed in
administrator
survey
7
I never seem to
have enough time
to accomplish all
that is expected
Why organizational
management ?
Number 1 problem in
administrator survey ?
Why organizational
management ?
Number 1 problem in
administrator survey ?
WHY ? WHY ? Will I remember any of
this ?
Organizational
Management
8
4 Distinct
Elements
P O C C
C C
P LAN O
C C
RGANIZE
OORDINATE ONTROL
9
Planning
Identifying Goals & Objectives
Stating Premises & Assumptions
Developing Specific Details
Identifying Goals & Objectives
Stating Premises & Assumptions
Planning
Types of Planning
Short Term Planning
Long Term Planning
Strategic Planning
Disaster Planning
????? Planning
Short Term Planning
Long Term Planning
Strategic Planning
Disaster Planning
????? Planning
Organization
Breaking work down
into components Group related work
activities and units
Breaking work down
into components Group related work
activities and units
10
Organization
Developing
organization chart Developing position
descriptions
Developing
organization chart
Organization
Developing
organization chart
Developing
organization chart
11
Why do we need an
Organizational
Chart?
Coordinate
Communicating
objectives
Leading members
to objectives
Communicating
objectives
12
Coordinate
Training & Supervising
Integrating Individuals
into organization
Training & Supervising
Why do we lose
Great People ?
Control
Measuring
accomplishments
against stated goals
Correcting deviations
from goals
Measuring
accomplishments
against stated goals
Correcting deviations
from goals
13
Control
Developing feedback
mechanisms
Developing feedback
mechanisms
Adjusting for
variation
Adjusting for
variation
Control
Assessment,
Acquisition, Assembly
And Commitment of
Resources to
Accomplish the Plans
PLAN
ORGANIZE
COORDINATE
CONTROL
14
PLAN
ORGANIZE
COORDINATE
CONTROL
PLAN
ORGANIZE
COORDINATE
CONTROL
Achieving the Objective
PLAN
ORGANIZE
COORDINATE
CONTROL
15
P LAN O
C C
RGANIZE
OORDINATE ONTROL
Achieving the Objective
P LAN
O RGANIZE
16
COORDINATE
COORDINATE
!
Doctor Administrator
17
P LAN O
C C
RGANIZE
OORDINATE ONTROL
Achieving the Objective
If I don’t have enough
time to get everything
done, when am I going to plan ?
If I don’t have enough
time to get everything
done,
Unless something
changes…..you won’t !
18
Sometimes, it is extremely difficult to
keep your objective in perspective!
Organizational
Management
Try re-evaluating your
priorities and see if
following some of these
steps won’t produce
different results
19
P LAN O
C C
RGANIZE
OORDINATE ONTROL
Achieving the Objective
Organizational
Management
Intentionally left blank
20
Management Organizational
Steve Robinson, FASOA, COE
Senior Consultant
This program has been sponsored by the:
Florida Society of Ophthalmology
6816 Southpoint Parkway, Suite 1000 Jacksonville, FL 32216
Phone: 904-998-0819 Fax: 904-998-0855 www.mdeye.org