June 2016

JUNE | 2016
A Newsletter of Mutual Interests
SVMIC Offering Live Webinar
Regarding New Overtime Regulations
July 15, 2016 (10 am CDT)
The U.S. Department of Labor has published significant changes to the overtime rules under the Fair
Labor Standards Act that will take effect on December 1, 2016. Employees earning $47,476 a year
($913 per week) or less will now be subject to being paid overtime for any hours worked over 40 in a
work week.
This will impact many medical practices by requiring the tracking of hours worked, adjusting of payrelated benefits, the disallowance of compensatory time and paying of overtime.
SVMIC policyholders and their staff are invited to join Scott Hickman, JD, for this free, informative
webinar to help you understand these changes and the financial impact it will have on your practice.
Please register early; space is limited. Recorded webinars are available on our website for future
reference or for those unable to attend a live session.
Register at www.svmic.com/webinars.
SVMIC Live Risk Education Seminar Schedule
June 23
Little Rock, AR
August 3
Little Rock, AR
August 31
Louisville, KY
June 28
Chattanooga, TN
August 9-10
Nashville, TN
September 15
Murfreesboro, TN
June 29
Cleveland, TN
August 17-18
Knoxville, TN
September 21
Jackson, TN
July 12
Johnson City, TN
August 23
Hot Springs, AR
October 12
Kingsport, TN
July 13
Kingsport, TN
August 24
Little Rock, AR
October 13
Johnson City, TN
July 26
Jackson, TN
August 25
Jonesboro, AR
October 24
Gatlinburg, TN
August 2-3
Memphis, TN
August 30
Lexington, KY
October 27
Franklin, TN
Specialty
Spotlight
Anesthesiology
by Rochelle “Shelly” Weatherly, JD
A review of SVMIC hospital-based
anesthesiology claims from 2008 – 2015, where
a loss was paid on behalf of an insured, reveals
three basic areas (excluding errors in medical
judgment) that contributed to the determined
indefensibility of such claims. These reasons
are illustrated in the graph at the right.
Documentation
Issues
Maintaining a well-documented
medical record, from both a patient
care and a risk management
standpoint, is crucial. As the graph
above illustrates, documentation
issues were a factor in 59% of claims
paid in Anesthesiology. Of those,
71% were found to have inadequate
documentation which can negatively
impact the ability to defend the care
provided to a patient.
Pre-Anesthesia Evaluation: In
one case, a 350 pound, 50-yearold male, with a known history of
difficult intubation underwent an
outpatient umbilical hernia repair.
A laryngeal mask airway was used.
Shortly after the procedure began, the
patient’s oxygen saturation decreased.
Intubation was unsuccessful and
an emergency tracheostomy was
performed. The patient became
hypoxic and remains in a vegetative
state. A lawsuit was filed alleging
2
improper management of the
patient’s airway during the procedure.
A review of the medical record
revealed several critical omissions in
the pre-anesthesia documentation.
These omissions included: airway
assessment; evaluation of neck
extension; inquiry into the history of
prior difficult intubation; evaluation
for the presence or absence of
obstructive sleep apnea and evidence
of dental assessment. The failure
to document a thorough pre-op
anesthesia evaluation allowed the
plaintiff to successfully argue that
the anesthesia team lacked vital
information about their patient,
causing them to be ill prepared for the
possibility of airway difficulties and
that using an LMA and performing
the procedure in the ambulatory
setting was a departure from the
standard of care.
Anesthesia Record: In addition to
documentation issues with the preanesthesia record, our claims review
revealed a number of inadequate
documentation issues within the
anesthesia record. Examples of
information that was missing include:
• Details about emergency
response/interventions: The lack of
documentation that cardiac activity
ceased during a crisis, as well as major
inconsistencies with the operative
record, allowed the plaintiff to allege
careless and improper emergency
response.
• Maneuvers utilized for managing
a difficult airway: The failure to
document the events that unfolded in
these cases, or the maneuvers utilized,
paved the road for the plaintiff to
allege negligent treatment and lack of
attention to detail.
• Anesthesiologist’s presence during
induction/emergence: The failure to
document such led to allegations of
improper CRNA oversight in a number
of claims.
• Positioning and padding: In
cases where the patient suffered
nerve damage leading to permanent
disabilities following a procedure,
insufficient notes hampered the
defense.
PACU Documentation:
Documentation of patient status
when handing off to PACU nurses
was lacking in several cases where
the patient suffered a complication
post-procedure. This made it easy
for the plaintiffs to argue that
there was negligent post-anesthetic
transfer of care. Also lacking in the
cases reviewed was documentation
reflecting proper assessment of
the patient status prior to PACU
discharge, which, in turn, led to
allegations of discharging the patient
too early and without anesthesiologist
oversight.
Informed Consent: In the majority
of the cases reviewed, lack of informed
consent was asserted by the plaintiff.
Most often, the only documentation
associated with the consent process
was a boiler plate hospital surgical
consent form which did not reflect the
details of the discussion during which
the anesthesia providers outlined
the anesthesia risks. That made it
difficult for the defense to argue that
the particular anesthesia complication
had been explained to, and was
understood by, the patient prior to the
procedure.
Communication
Issues
Effective communication is essential
in establishing trust and building
good patient rapport, which in turn
plays a role in a patient’s perception of
the quality of care received and helps
ensure compliance. Anesthesiologists
have very little time for personal
patient engagement, so it’s
important to take advantage of every
opportunity. In 32% of the claims
reviewed, communication breakdowns
were noted. Case examples include:
Physician-to-physician
breakdowns: Hand-off issues
between anesthesia providers was a
common theme in this category of
cases. A tragic example involved a
50-year-old who underwent a Nissen
fundoplication. An epidural was
placed for post-op pain management.
The anesthesiologist who placed
the epidural left on vacation
without advising his partner of such
placement. Without this information,
or the benefit of a note in the chart
reflecting the epidural placement,
the covering anesthesiologist did
not include a neurological evaluation
during any of the post-op visits. On
the third post-op day the patient
complained of leg numbness and
developed cauda equina syndrome.
Physician-to-CRNA breakdowns:
Another frequent communication
breakdown observed in the
case analysis was between the
anesthesiologist and CRNA. In one
case an anesthesiologist prepared
a morphine bolus to be given to an
11-month-old patient by epidural
catheter for post-op pain control. The
anesthesiologist was then called out of
the room leaving the CRNA to oversee
the infusion without specifically
discussing the infusion plan. When he
returned to the room, he discovered
that the timing on the pump had
been set inaccurately resulting in the
patient receiving an excessive volume
of morphine which caused lower
extremity paralysis.
Physician-to-patient: As stated
earlier, in a majority of cases reviewed,
lack of informed consent was alleged
by the plaintiffs. Certainly there is
a legal obligation on the part of the
anesthesiology provider to provide
patients sufficient information about
the proposed anesthesia plan with
which they may make an informed
health care decision. But what is
often overlooked is the opportunity
this discussion affords for the
anesthesiologist to establish a rapport
with patients, which makes it a
valuable risk management tool.
Medication
Issues
Medication errors were present in
26% of the reviewed cases. The types
of errors that occurred follow:
Adverse Reaction: Patient with a
prior penicillin reaction experienced
an anaphylactic reaction after
cephalosporin was administered. A
delay in diagnosis and treatment
interventions contributed to the
patient’s death.
Contraindicated medication:
CRNA failed to review the patient’s
history which reflected known renal
disease before ordering Toradol for
perioperative pain relief. It was
alleged that such medication caused
the patient’s progressive renal failure
and eventual hemodialysis.
Wrong dose: Patient received 10
times the intended dose of NeoSynephrine due to improper dilution
and usage of the wrong syringe size.
Wrong Medication: A paralytic
was inadvertently administered by
anesthesiologist who intended to give
lidocaine. Patient became apneic and
required resuscitation.
3
¾¾ Conduct all important patient
communication before preoperative medications are
administered.
¾¾ Clearly and timely
communicate/document
information about patients
with anticipated problems to
covering anesthesiologists.
¾¾ Insist on seeing complicated
patients before the day of
surgery.
4
¾¾ Engage in a full and clear
discussion with patients about
the anesthesia plan and the
associated risks, benefits,
alternatives, and expected
outcomes. Be sure these
discussions are documented
in a separate Anesthesia
Consent Form rather than
relying on a generic hospital
surgical consent form which
typically does not include
the information specific to
anesthesia management.
¾¾ To ensure good communication
between the anesthesiologist
and the CRNA: communicate
clearly regarding the
anesthesia plan; ensure
that the anesthesiologist
is present in the OR upon
induction, during key portions
of the procedure, as well as
emergencies and be sure this
is documented; and insist that
CRNAs communicate with the
anesthesiologist regarding all
unusual events and readings.
The anesthesiologist needs to
be approachable; have written
protocols delineating the
responsibilities and duties of
the CRNA; consider having an
emergency manual or “crisis
checklist” available at each OR
anesthesia station; and practice
emergency response with mock
crisis situations. ¾¾ To help prevent medication
errors: review patient
history before ordering or
administering medication; use
standardized concentrations,
prepared by the pharmacy
when possible, in ready-to-use
syringes with standardized
labels; identify medications
before drawing up and/or
administering them and verify
with a second source (second
person or barcode reader
linked to medical records);
keep medication drawers
and workspace organized
(i.e. separate look-alike/
sound-alike drugs; standard
positioning of syringes and
ampules). For a comprehensive
listing of medication safety
recommendations, please refer
to http://apsf.org/newsletters/
pdf/spring_2010. pdf and
https://www.ismp.org/
newsletters/acutecare/
showarticle.aspx?id=123.
¾¾ For additional information
about ways to improve
patient safety and reduce
your liability exposure, we
encourage you to visit SVMIC.
com and complete the selfstudy “Liability Exposure in
Anesthesiology”.
by Elizabeth Woodcock, MBA, FACMPE, CPC
The Centers for Medicare & Medicaid Services (CMS)
packed a double punch in the 2016 Final Rule that is just
now coming to light.
In the statement accompanying the rule, CMS issued two
clarifications to the incident to rules. The first was a nobrainer – that the practitioners being supervised must be
legally allowed to perform the services they render.
The second part of the rule clarification, however, is giving
some physicians pause. Explaining that it was simply
illuminating its previous regulations, CMS stated that
“the physician (or other practitioner) directly supervising
the auxiliary personnel need not be the same physician
(or other practitioner) that is treating the patient more
broadly…” Good so far. The “punch,” however, is what
comes next: “…only the physician (or other practitioner)
that supervises the auxiliary personnel that provide
incident to services may bill Medicare Part B for those
incident to services.”
The challenge that this language will bring to some
practices is that the ordering physician is often the
“default” physician whose name is placed on the claim
form, not the physician who is actually present when
by Julie Loomis, RN, JD
¾¾ Clearly and completely
document the pre-operative
anesthesia evaluation,
including classification of
airway, evaluation of neck
extension, prior anesthesia
difficulty, inquiry into the
presence or absence of
obstructive sleep apnea as
well as dental assessment.
Additionally, there should
be detailed documentation
reflecting the intra-operative
anesthesia management and
patient monitoring including
emergency response and
interventions; maneuvers
utilized for managing a difficult
airway; position and padding;
time outs; and the presence
of an anesthesiologist during
key portions of the procedure.
Lastly, include detailed
documentation of the patient’s
status when transferring to
the PACU, to include times and
oxygenation status.
New Incident To Services Clarification May Give
Some Physicians Pause
Risk Pearls
LESSONS LEARNED
the service is rendered. CMS explains that while the
physician or practitioner ordering the service or referring
the beneficiary certainly has a connection to the services,
“the physician or other practitioner directly supervising
the incident to service assumes responsibility and
accountability for the care of the patient that is provided
by auxiliary personnel.” It is important to recognize the
implications of this clarification. When billing “incident
to,” the name of the physician supervising the service
(generally the physician on site during the time of service)
should be recorded on the claim, even if that is not the
same physician who ordered the service.
For years, questions had circled around the interpretation
of this portion of the incident to rules. Now, for better
or worse, there is clarification. This elucidation by CMS
may require that practices alter their workflow related to
capturing, finalizing and reconciling charges. If practices
must take steps to implement this additional tracking and
accounting, then take heart; according to CMS, it’s all part
of assuring that physicians bill appropriately for services
furnished incident to their professional services.
Read more about this latest incident-to rule clarification by
CMS in the Federal Register.
After hours calls should be handled and documented with the same level of
importance as in-person visits. These telephone conversations are particularly
tricky because they occur without the benefit of observing or examining the
patient, and often
when the medical record is
unavailable, which
poses a major liability risk.
Whether
treating
your own patients or providing
coverage for other
physicians, taking patient
phone calls outside
of the office is the same as
treating patients in
the office. Documenting after
hours calls is crucial.
SVMIC provides patient phone
call record pads at
no cost to policyholders in
order to encourage both the consistency and defensibility of after hours
telephone care.
To order phone record pads visit www.svmic.com.
5
Tale of Two Practices
by Rana McSpadden, FACMPE, CPC
“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of
foolishness.”1 There was a practice with a social media plan (Practice-1); there was a practice without a
social media plan (Practice-2). In both practices, the use of social media ran rampant.
One practice was successful and the other…not so much. This is their tale.2
Websites
Practice-1 has a well-designed website. On the Home
page, patients can easily find the address and contact
information, business hours, and a link to the Notice of
Privacy Practices. It includes the mission of the practice
as well as a brief history. There is a page with a brief
biography of each provider. New patients can easily access
registration paperwork to complete and bring in to their
first appointment. The website links to all other social
media platforms being used by the practice.
Practice-2 has a website, but it is not easily navigable. The
list of providers is not current. Several physicians and
advanced practice providers have joined or left the practice
since the website was last updated. There is no contact
information or address shown on the site, so patients
must rely on other methods to get the phone number.
New patients have to look through several pages to find
the initial paperwork because it is buried in the site. The
Notice of Privacy Practices is included in the paperwork,
but no link is on the Home page nor has it been updated to
include the 2013 requirements. Because the introductory
paperwork for new patients is outdated, they have to
complete different paperwork when they arrive for their
appointment.
Why are websites important? Patients often research their providers though the internet long before they
actually make an appointment. A website is usually the first impression a practice can make on a patient and
having a substandard website is worse than not having one at all. If the site is not professional looking, easy
to navigate, and accurate, patients may perceive this as a lack of competence and care. Additionally, practices
must have their Notice of Privacy Practices prominently displayed on all websites maintained by the practicewhich includes social media platforms. This can be accomplished by posting a link that leads directly to their
Notice.
1
2
6
Tale of Two Cities, Charles Dickens 1865
This is a compilation of various issues medical practices have had surrounding the use of social media.
Social Media
Practice-1 has two employees in charge of updating
Facebook and Twitter. Physicians regularly post to their
blog health articles relevant to their specialty and patients.
Additionally, the practice has a LinkedIn page where they
follow several medical societies as well as other healthcare
related professional pages. The practice uses Facebook and
Twitter to update patients on appointment openings, events
the practice is hosting, and newsworthy events such as new
providers or services. Whenever a provider posts an article
to the blog, a link is also posted through Facebook and
Twitter. The practice is very careful not to post any patient
photos or data. When pictures are taken in the practice,
they ensure no patient data is in the background of the
picture. Should a patient’s photo or information be used, the
office manager obtains a written patient authorization prior
to posting. If patients post personal health information to
the practice’s Facebook page, the office manager calls the
patient directly to have the post removed. If patients post
a negative review, the office manager personally calls the
patient to discuss and resolve the situation and politely asks
the negative review to be removed. All staff members are
asked to review and sign the practice’s social media policy
annually.
Practice-2 allows any employee to post to the practice
Facebook page which has resulted in the posting of
inappropriate content. This is the only platform used by
the practice. Several employees have posted complaints
about patients, both to the company page as well as their
personal pages. Even though the posts may not name a
patient directly, it has caused patients to react negatively.
The inappropriate posts to both company and personal
pages have increasingly damaged the practice’s reputation.
Some employees have also posted pictures of patients to
their own personal pages without patient authorization.
At least once, a picture was posted with patient data in the
background and that patient’s identity was stolen as a result.
When patients post personal health information or negative
reviews to the company Facebook page, the staff or providers
respond directly through Facebook which is visible to others.
The practice does not have a social media policy for staff.
So where did Practice-2 go wrong? Many of their problems could have been avoided by having a proper social
media policy in place and ensuring all employees understood it. Had the practice restricted who was allowed
to post to the company page and outlined what type of content could be posted, their reputation would not
have been damaged as much. While a practice cannot completely control what their employees post to their
personal pages, they can outline what is not acceptable from a practice and patient standpoint.
Additionally, the practice allowed employees to post pictures of patients without authorization - a blatant
violation of patients’ HIPAA rights. In most cases, photos can be considered Protected Health Information
(PHI), so practices must have patients sign a HIPAA compliant authorization prior to using the information.
Staff should receive proper HIPAA training on when it is not appropriate to access and use patient
information and know what rights patients have regarding their information.
What else did the practice do wrong? The staff members were engaging patients through Facebook, which
should never happen. This type of conversation needs to be taken off-line immediately and discussed by
phone or in person. Call the patient directly to discuss his or her concern. Good reputation management
starts with taking these types of responses off-line and speaking directly with the patient.
Social media can be an excellent tool to promote your practice if used wisely with appropriate guidelines.
SVMIC has several resources available on the Practice Management Resources section of our website,
including a sample Social Media Policy, guidelines on using e-mail, as well as other policies. This year’s Risk
Education series, “Practicing in the Age of Electronic Communication,” goes into further detail regarding the
use of social media in your practice. Please contact SVMIC for questions on the proper use of social media in
your practice.
7
Closed Claim Review:
No Good Deed Goes Unpunished ...
By Ken Rucker, JD
Or Not?
A physician, even if approaching a situation with the best of intentions, must be careful
not to go outside the bounds of his/her training and expertise.
Samantha Smith1 had struggled with back pain and muscle
spasms through her teenage years due to the development
of extremely large breasts. This led to problems with selfesteem, depression, and had a negative impact on her overall
quality of life. Samantha had sought care from several medical
providers, but none were willing or in a position to provide her
with any treatment options.
An ENT physician practicing in the town where Samantha
lived began expanding his practice to include various cosmetic
procedures involving the face and neck. Seeing that the
physician offered cosmetic services, Samantha obtained an
appointment with this physician. At this initial appointment,
Samantha explained how she suffered from chronic back
pain caused by her large breasts that resulted in her being
in constant pain, resulting in severe depression and even
thoughts of suicide at times. She explained that she did not
have the financial resources to pay for breast reduction surgery
and set forth that she had been turned down by several other
physicians when she sought treatment. The physician initially
declined to perform the surgery, stating that he was not a
plastic surgeon and that he was not experienced in breast
reduction surgery. Ultimately, the physician agreed to perform
the surgery if the procedure was approved by the patient’s
insurance carrier as being medically necessary. The insurer
approved the procedure, and the surgery was scheduled.
Since the physician was not credentialed for breast reduction
surgery in any surgery center or hospital, the decision was
made to perform the procedure in the office setting with
the use of conscious sedation. The patient understood and
agreed to have the procedure performed in the office, as she
was desperate for the relief the procedure would provide. The
breast reduction went forward as planned with the physician
removing just over three pounds of tissue from each breast.
Initially, Samantha felt much better following the procedure
and expressed great appreciation for the relief the physician
provided through the breast reduction surgery. However,
her attitude changed quickly once she developed wound
1
8
Names have been changed.
infections in both breasts. Wound care continued over
the next 7 months which included multiple procedures for
debridement of the wounds and a scar revision surgery. At
the end of this treatment, the infection had cleared and the
wounds had healed, but Samantha was left with deformities
in both breasts that would require further surgical treatment.
As would be expected, Samantha consulted with an attorney,
and a lawsuit was filed. This lawsuit alleged multiple bases
for negligence including lack of training and qualifications for
the procedure; failure to obtain adequate informed consent;
improper performance of the extensive procedure in an office
setting; improperly performing the procedure under conscious
sedation; and overall mismanagement of the care. Further,
the attorney for the plaintiff asserted that the procedure was
not done with a proper motive and was instead done for the
pecuniary benefit of the physician.
Even assuming that the physician’s motive was pure, which
was a disputed fact, a physician must recognize the limitations
of his/her training and not succumb to pressure to perform a
treatment or procedure outside of the physician’s training or
skill set. In this case, the decision to perform the procedure
in an office setting may very well have violated the rules and
regulations established by the licensing board for office-based
surgeries, making the case very difficult to defend and resulting
in questions as to whether insurance coverage applied to the
physician’s actions. Experts who reviewed the case, while
acknowledging that these complications could happen in
the best of circumstances, were unwilling to look past the
physician’s lack of training for this procedure. Additionally,
the experts felt that the technique (such as the type of
incisions utilized) was not what would normally be utilized in
this type of procedure for the best cosmetic outcome, and the
type of incisions increased the risk of healing difficulties.
This physician expressed surprise upon receipt of the lawsuit.
In his mind, he had provided a medical service for the patient
that was needed and which he had agreed to perform to give
her a better quality of life. But a “good deed” is only really good
if it is actually in the best interests of the patient.
Medical Professional Liability Insurance What Does It Cover?
by James E. Smith, CPCU
In the practice of medicine, unexpected or undesired outcomes occur, and sometimes incidents involving
actual malpractice occur—any of which often result in a claim or lawsuit by the patient or patient’s family.
Whether such claims or lawsuits are merited or unmerited, they can be devastating to the involved medical
professional—both financially and emotionally.
The most common method of “treating” the financial risk of loss resulting from medical professional liability
(“MPL”) claims or lawsuits is to transfer that risk to an insurance company by purchasing MPL insurance.
The following is a brief overview of MPL insurance.
MPL insurance is a contract (called a “policy”) between an insurance company and the policyholder whereby
the policyholder pays an amount of money (called a “premium”) to the insurance company in order to
transfer the financial risk of loss to the insurance company. The insurance company in turn agrees to defend
and indemnify (pay on behalf of) the insured person(s)/organization(s) related to incidents falling under
the coverage for all sums that the insured becomes legally obligated to pay, subject to the terms, limitations,
exclusions, and conditions that will be detailed in the insurance policy.
SVMIC’s MPL insurance covers claims and/or lawsuits resulting from the rendering of medical professional
services—generally defined as providing medical services, including medical treatment, making medical
diagnoses, and rendering medical opinions or medical advice.
In addition, it covers claims/lawsuits resulting from participation in formal peer review activities, including
the reviewing of professional standards, utilization of professional services, evaluating or improving quality
of care, and reviewing the qualifications, credentials, or competence of any health care provider.
As with any insurance policy, SVMIC’s policy has certain terms, limitations, exclusions and conditions—
all of which anyone insured under the policy should review and understand. For example, SVMIC’s
obligation to indemnify as described above is limited by the amount of the liability limits purchased by the
policyholder. Generally, the exclusions have to do with liability of the insured that goes beyond what SVMIC
intended to cover under an individual or corporate policy or from conduct that one would normally not
expect to be covered by insurance. For example, SVMIC’s policy excludes liability resulting from unlawful
or criminal activity, liability arising from sexual conduct or from any act or omission of the insured that
occurs while the insured’s license to practice has expired or has been suspended, revoked or voluntarily
surrendered. Finally, in general, the conditions have to do with the insured’s obligations under the policy,
such as paying the premium when due, reporting medical incidents (as defined in the policy) as soon as
practicable, otherwise cooperating with SVMIC in the investigation and defense of claims or lawsuits, and
other conditions having to do with cancellation, renewal or changes to the policy.
The above is intended to provide an overview of the coverage provided by SVMIC’s MPL insurance policy as a
service to the reader. It is not intended to represent an exhaustive review or as an alternative to reading the
actual policy form itself. As always, call SVMIC’s Underwriting Department with any questions about the
coverage provided or regarding any of the terms, limitations, exclusions or conditions.
9
Stock, Huddle, Sweep:
Avoid the Vicious Cycle of Inefficiency
by Elizabeth Woodcock, MBA, FACMPE, CPC
Organization is the key to effective patient flow, yet many practices don’t embrace this hallmark of efficiency.
Citing a lack of time, practices that focus on a reactionary approach to patient flow find themselves in a vicious
cycle of inefficiency. It requires a new mindset, but you can break this dangerous sequence by taking a few
simple steps – and encourage those around you to do the same.
Stock your exam rooms. Determine what,
where and how many supplies need to be
stocked in each exam room. Use a label
maker to mark the location and inventory level of
each supply. Take a picture of the supply and tape it to
the shelf, drawer, etc. Create a master list of supplies,
and delegate responsibility for room stocking.
Someone - a medical assistant or nurse - should be
assigned to stock each exam room with all supplies
you need at the start of the day and in between
patient visits, as appropriate. (This may be a rotating
job, or the assignment of specific exam rooms to
designated employees; whatever method you choose,
put it in writing.) Treat equipment in a similar
fashion, to include wall hooks that are labeled. Most
importantly, ensure that the location of supplies and
equipment is consistent in every room, with the goal
of standardization. A consistent approach to stocking
rooms means that physicians, advanced practice
providers, and clinical support staff can walk into any
room, reach for a certain supply on a shelf or open a
drawer, and find it there regardless of the exam room.
Supplies and equipment should be in the same place
in each exam room so you never have to slow down to
search the room for a needed item. This
recommendation extends to all rooms within the
practice.
Preview your charts. Assign the
responsibility of previewing patient charts
for the next day (or perhaps two days in
advance) to the clinical assistant. Make sure he or she
10
includes everything the provider needs to complete
the visit, for example: lab results, radiologic
interpretations, referring physician correspondence,
operative reports, etc. This is also an opportunity to
focus on identifying gaps in care, such as
immunizations, tests or other service that may be
recommended based on the patient’s age, gender,
condition, and so forth.
Huddle and sweep. These may sound like
terms more applicable to a sports team, but
daily huddles and sweeps can exact positive
consequences to every practice. Before each morning
and afternoon clinic, hold a three- to five-minute
“huddle” - an informal chat – with the clinical team to
review the appointment schedule for that day. Decide
if there are issues that can be resolved immediately.
For example, if three new patients were accidentally
booked for the same slot, determine which patient(s)
can be rescheduled, and prepare accordingly. Use this
time to anticipate challenges that otherwise throw off
the whole day - like a mom who schedules an
appointment for one child but always asks you to
examine his brother, too, “as long as he’s here.” Invite
your scheduler to the huddle to improve
communication. Hold a sweep in the afternoon, this
time focusing on the next business day. Identify any
slots that have opened due to cancellations, search for
any anomalies in the schedule, and confer about any
special instructions. The huddle and the sweep allow
you to keep a constant pulse on your practice, and fill
every minute of every day with productive time.
Deploy time-savers. Use biometric
authentication to log into your information
systems, in contrast to keying a lengthy
series of digits. With the systems constantly “timing
out” due to efforts to protect health information, this
switch has significant implications on your efficiency.
Hang convex mirrors to “see” around corners instead
of walking back and forth; install clocks so that
employees and providers can know what time it is.
This will, ideally, allow employees and providers to not
only know what time it is, but to also keep track of it.
Take the chart rack in the front office down, and
instead use an electronic patient tracking board to
determine if a patient has arrived and has been
registered. Use a “workstations on wheels” – a WOW
– to keep your work close to you. Add a small, but
handy, printer on the bottom shelf along with any
other equipment that might be needed to prevent you
from having to walk around to locate the resource.
“Hire” your patient by deploying technology that
allows the patient to register and complete his or her
medical history from the comfort of home; interface
this data into your information systems. At a
minimum, accept information from the pharmacy,
hospital or other sources of data about the patient’s
care.
Don’t take efficiency for granted; take steps to ensure that the
infrastructure of your practice supports your success.
ALERT!
MEANINGFUL USE
DEADLINE
JULY 1, 2016
July 1, 2016 is the deadline for the hardship
exception for the EHR Incentive Program. This
applies to all practices who did not report their
meaningful use criteria in 2015. Investing 10
minutes to complete the application will prevent
the payment adjustments being applied in 2017
to all of your Medicare reimbursements.
Tired of Getting
“Snail Mail”?
The SVMIC Sentinel is available by
email!
Choosing the email version will
ensure you get the newsletter in
the most cost effective, efficient
fashion.
Please go to www.svmic.com to
update your communications
preferences.
See the Practice Management Resources section
of www.svmic.com for link to more information.
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About Our Authors
Julie Loomis is Assistant Vice President of Risk Education for SVMIC where she develops educational programs and assists policyholders and staff
with risk management issues. Ms. Loomis is a member of the Tennessee Bar Association, Medical Group Management Association, and American
Society of Healthcare Risk Managers (ASHRM). She recently contributed to ASHRM’s Medication Safety Pearls. She serves on the Risk Management
Committee of the Physician Insurers Association of America. Ms. Loomis is a speaker on risk management and professional liability topics at medical
professional association meetings, medical schools and residency programs, and industry seminars.
Rana McSpadden is is a Medical Practice Consultant and Analyst with the Medical Practice Services Department at SVMIC. Her background
includes almost 20 years in medical office experience, including physician practice administration. She obtained a Bachelor’s degree in Organizational
Leadership from Tennessee Tech University. She is a Board Certified Medical Practice Executive, a Fellow in the American College of Medical Practice
Executives and a Certified Professional Coder. She is currently the ACMPE Forum Rep for the Tennessee MGMA.
Kenneth W. Rucker is Vice President, Claims for SVMIC. Mr. Rucker graduated from David Lipscomb University with a degree in Business
Management. Following his undergraduate studies, Mr. Rucker attended the University of Memphis, Cecil C. Humphreys School of Law where he
attained his law degree. After law school, Mr. Rucker practiced law with the Tennessee Attorney General’s Office and with the law firm of Manier &
Herod in Nashville, Tennessee before joining SVMIC. Mr. Rucker has been with SVMIC since 1999 in various roles in SVMIC’s Claims Department.
Jim Smith is Senior Vice President of SVMIC. He received a Bachelor of Science degree from Jacksonville State University in 1975 and earned the CPCU
designation from the Society of Chartered Property and Casualty Underwriters in 1989. Jim’s career began as a claims adjuster with Liberty Mutual Insurance
Company. In 1991, Jim was recruited by SVMIC as Vice President of Underwriting, where he has been since. He was promoted to Senior Vice President in
2012. Mr. Smith served as a member of the Underwriting Section of the Physician Insurers Association of America (PIAA) from 1990 to 2009, and was its
chairman from 1993 to 2001. He is a member of the Professional Liability Underwriting Society (PLUS), and briefly served on its Industry Review Panel.
Shelly Weatherly is Vice President, Risk Education and Evaluation Services for SVMIC. Ms. Weatherly graduated from the University of Tennessee
School of Law, is a member of the Nashville and Tennessee Bar Associations, and has been with SVMIC for 26 years. Prior to joining SVMIC, Ms.
Weatherly served as Law Clerk on the Tennessee Court of Appeals for the Honorable William C. Koch, as well as on the U.S. District Court for the
Middle District of Tennessee under the Honorable Charles Neese. Ms. Weatherly leads SVMIC’s Risk Education and Evaluation Services. Prior to
2015, she developed and administered the company’s Risk Evaluation Services and earlier served as a Claims Attorney. She is a frequent speaker on
risk management, liability assessment, and professional liability topics at medical professional association meetings, medical schools and residency
programs, and industry seminars.
Elizabeth Woodcock is the founder and principal of Woodcock & Associates. She has focused on medical group operations and revenue cycle
management for more than 20 years and has led educational sessions for the Medical Group Management Association, the American Congress of
Obstetricians & Gynecologists, and the American Medical Association. She has authored and co-authored many books. She is frequently published
and quoted in national publications including The Wall Street Journal, Family Practice Management, MGMA Connexion, and American Medical
News. Elizabeth is a Fellow in the American College of Medical Practice Executives and a Certified Professional Coder. In addition to a Bachelor of Arts
from Duke University, she completed a Master of Business Administration in healthcare management from The Wharton School of Business of the
University of Pennsylvania.
GET IN TOUCH
By Phone
800.342.2239
By Email
ContactSVMIC@svmic.com
By Fax
615.370.1343
By Mail
101 Westpark Drive, Suite 300
Brentwood, TN 37027
SVMIC.com
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