EM Physician Compensation Report 2017

In this year’s compensation report by Medscape EM Physician Compensation Survey, reported in April, accounting for nearly19,200 respondents in over 26 specialties disclosed their income, working hours, career satisfaction, their major rewards and whether they’d choose medicine again and more.

Overall Earning by EM Physicians:

Each physician who participated in the survey were asked to provide their annual compensation for providing patient care.  An annual compensation for employed physicians includes salary, bonus, and profit-sharing contributions.  And for partners, it involves earnings after deducting taxes as well as business expenses before income tax.  This year EM physicians had a compensation of $339,000, ranking them above the middle. Orthopedists were the highest payees at $489,000, whereas pediatricians were at the lowest at $202,000.

Some Specialties Observed Decline:

Cardiologists and Oncologists compensation remained same as 2016 survey.  Only Pediatricians were reported to show a decrease this year by 1%.  All other specialties showed an increase, also EM physicians (5%),with plastic surgeons’ (24%) and allergists’ (16%)are the largest gainers.

Who Earns Big? US Trained Physician or Foreign Trained Physician?

On average, a compensation difference of 3% has been observed in this year’s report, as US-trained EM physicians earn$340,000more than that of their foreign-trained associates i.e. $330,000.  The average compensation earned by the US-trained physicians surveyed is $301,000.  Also, the second highest earners are the Canada-trained physicians with $328,000.

Geographic Income Disparities Persist:

This year, EM physicians in the South Central ($395,000), North Central ($381,000),and Southeast ($354,000) regions were the highest average compensation receivers, whereas the lowest compensation receivers was found in the West ($311,000), Northwest ($312,000), and Mid-Atlantic($313,000) regions.

Welfare received by an EM Physician:

This year high percentages of EM physicians responded positively of receiving welfare:

1. Liability coverage (75%)
2. Employer-subsidized health insurance(62%)
3. Employer-subsidized dental insurance (54%)
4. Employee-matched retirement plans (46%)

Although 14% of EM physicians reported receiving no benefits.

Compensation Satisfaction – Are EM Physicians Fairly Compensated?

Almost 68% of EM physicians reported negatively on being fairly compensated. Of the list, at the bottom most, only 41% of nephrologists feel they are fairly compensated, on contrary 44% of endocrinologists reported dissatisfaction on this subject.

Do EM Physicians think to join MACRA?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), commonly called the permanent “Doc Fix,” came into effect on January 1, 2017.  In this survey when asked if they – the EM physicians think to join MACRA, to which 43% answered positively.

Hours per Week EM Physicians Spent Seeing Patients?

Most of the EM physicians i.e. 80% of the surveyed, spend 45 hours/week or less with patients.

Would EM Physicians choose medicine again if they had to?

Almost 77% of the EM physicians responded positively when asked if they would do over medicine again if they had to.

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References:

1. http://www.medscape.com/slideshow/compensation-2017-emergency-medicine- 6008568

Family Physician Ethics Report – 2017

Doctor’s, in everyday practice, struggle with key ethical decisions related to everything from pain and death to money and romance.  Medscape’s Ethics Survey, 2017, saw more than 7500 physicians responding and sharing their views on the challenges they face ethically.  Given below is the synopsis of the responses by the family physicians, to the various questions asked during the survey.

Should a mistake that would harm a patient be ever covered up or avoid being revealed by a physician?  Is it an acceptable practice?

About a quarter i.e., 24% of family physician’s responded saying it is or might be acceptable to hide a harmful mistake; a response which in 2014 stood at just 9% answering the same.  However, most of the family physicians considered being “honest” and “forthright” in revealing their mistake to all the parties.  A large number did also say it would depend on the situation and the consequences.

Should the annual flu shots be made mandatory for the doctors?

Family physicians are not quite fervid to the notion of mandatory flu shots for physicians; in similarity to the profession altogether (63% v/s 67%).  While a lot of them got infuriated with this “required flu shot” notion; most of them also thought it to be a good idea – if they expect their patients to undergo immunization, they must lead and set an example for them first.

Should Physician-assisted suicide/dying be made for critically ill patients?

There are extremely mixed opinions from the family physicians concerning physician-assisted suicide and they are also less in favor of this practice than doctors in general (47% v/s 57%).  One of the physicians wrote that “Physicians should not be put in the position of hastening death.  This flies in the face of the Hippocratic Oath.   Individuals can commit suicide without the help of a physician.  To use the physician for the provision of a medical benediction diminishes our profession.”   To which another physician countered by adding, “We are far more humane to the pets who share our homes than we are with ourselves.”

Would you ever deny information to a competent patient on family’s request?

When asked in 2014, most of the physicians had responded saying that depending on the situation they might deny the information to the patients; however, that is not the scenario anymore.  The percentage of family physicians who refused to withhold the information from the patient has almost doubled in 2016 i.e., 78%, compared to 39% in 2014.  One of the physicians wrote that “Family members are not my patients. My obligation is only to the patient.”  Another physician wrote saying “Absolutely freaking NOT. I was fired once for doing this exact thing.”

Have you ever failed to report or further investigate a patient whom you had suspected to be a victim of domestic abuse?

18% of family physicians out of the total surveyed, responded saying that they have suspected a patient to be a victim of domestic violence, but failed to report it or further investigate, compared to 12% general physicians who said the same.  One of the physicians protested saying, “Adult women who will not leave their abuser, are at increased risk for death, if we involve law enforcement” to which another supported, claiming that a patient admitted to abuse, but asked the physician not to report it because the patient’s experience with the previous investigation was negative.

Is it ever appropriate to get involved with a patient in a romantic or sexual relationship?

While 70% of physicians generally say that doctor-patient romance is forbidden, 65% of family physicians find the relationship appropriate.  One of the family physician says that it depends on the kind of physician and the type of relationship they share with the patient, to which many contended, noting that such relationships are never acceptable for a psychiatrist.  Some said that it would be okay for a physician practicing in a remote area, on which one of the physicians wrote, “I have worked in rural Maine for 38 years.  I expect that 30% of my patients are also my friends.  I think it is permissible for health providers to become romantically involved with past patients.”

Would you report a colleague who sometimes seemed under the influence of drugs, alcohol or illness?

The vast majority of family physicians (78%) said that they would report an enfeebled colleague, and the percentage is growing.  Many asserted saying they would first warn the friend/colleague of what they are going to do.  Several reported that they have reported before and the end result has been favorable for the colleague—”they got help and are back practicing”— stating that reporting on a colleague “is not fun.”

Would you tell a patient of your ineptness in a particular procedure before you perform it?

50% of the family physicians said that they would accept and tell the patient of their ineptness for a procedure, while some added that they would refer the patient to another physician.  Others, having revealed their inexperience, stressed that they wouldn’t do the procedure if they are not qualified for it.

Should physicians be randomly tested for drug and alcohol abuse?

Family physicians exhibited mixed responses towards the idea of random testing for drug and alcohol abuse, and their viewpoint hasn’t changed much over the span of two years.  Family physicians are almost equally divided over whether testing should be allowed (“absolutely”) or is unacceptable (“A positive ETOH or positive THC test does not distinguish between use and abuse and could lead to great harm.”) Besides 1 out of 5 said that it depends on (“if the problem has been identified or if they are in recovery, only then they should be subjected to the test”).

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References:

1. http://www.medscape.com/features/slideshow/family-physician-ethics-report-2017

Tips on Lowering your Hospital Medical Bills

Jill finally had a smile on her face. Not only because the scars from her cardiac surgery 3 months back had all but disappeared and her skin color was almost indistinguishable, but also because of her recent victory in the law suit against her health care provider.  2 months after having returned home from hospital to recover from her major surgery, Jill almost had a second heart attack on finding that her insurer had disputed several of the charges mentioned in her long form medical bill.  She suddenly found herself in a position where she would have to foot thousands of dollars from her own pocket.

Luckily, Jill, an educated woman who also ran her own brokerage firm, had researched extensively on her laptop about her medical predicament, as she lay in the hospital bed for weeks before being finally discharged.

A quick review of her itemized bill showed glaring discrepancies in the services she had received and the charges levied.  The icing on the cake – the hospital had affected a bogus augmentation charge to a woman who had only received emergency cardiac surgery following a sudden attack at the age of 57.

A quick letter from her lawyer ensued to the hospital within a fortnight.  When the health care provider did not respond satisfactorily, she sued.  Cue one month later and one of the biggest hospitals in Los Angeles had settled the case with a very handsome compensation in favor of Mrs. Jill Hathaway.

Negotiating a Payment Plan, Rebates, Financial Assistance and Crowd Sourcing

If you’ve planned for hospitalization in advance (surgery, pregnancy etc.); it pays to research online to find out how much it could potentially cost you.  Information is power, so compare the costs at your hospital with other health care providers to make the best choice.  Contrary to popular belief, hospitals do negotiate charges in the face of overwhelming evidence against phantom fees.  This is because no reasonable business wants to draw itself out in protracted lawsuits which would cost thousands of dollars additionally in legal fees.  Not to mention the damage to reputation.

If the charges are reasonable but outside your budget, try and negotiate a systematic payment plan with your hospital.  You’ll be surprised at how many hospitals are opting for the same these days. Some tips that will help:

• If you are making payment upfront or all at once, ensure that you get a rebate out of it.
• If you are eligible for hospital financial assistance, don’t forget to avail the same.
• Financially challenged patients can turn to crowd funding websites such as GoFundMe.com to support their medical bills.

The A, B, Cs of Prudent Medical Financial Management

Always, always insist on an itemized bill without fail.  Routine items such as gloves, blankets, lights etc. cannot be charged separately.  They are part of the facility fee. Ensure that double billing does not happen.  Unless a second opinion was garnered, doctor’s readings should only be billed once.  The same goes for anesthesiologists etc.

The In-Network Doctor and Hospital

When you’re inside a hospital for yourself or a relative, ensure that the doctor looking after you participates in your insurance plan along with the hospital.  This is one of the most common reasons behind phantom charges in medical bills as most patients automatically assume that in-network hospitals also provide in-network doctors.  Nothing could be farther away from the truth.  If your physician does not participate in your insurance plan, your chances of getting phantom charges on your bill will be higher.

If however you had already mentioned in writing your preference for an in-network doctor but your hospital could not provide you one, you can later on negotiate the charges levied by the doctor.  The same rule applies when your hospital outsources tests to external labs.  Always ensure that all tests are done by participants in your insurance plan and document the same to your hospital in advance.

The ER Services

If you availed ER services, please note that hospitals charge the same by levels.  Level 1 signifies minor injuries such as nosebleeds etc. and level 5 represents major trauma such as heart attacks etc.  Always ensure you were charged a level appropriate to the services you availed.  Ask for a written explanation if you have to.

ER doctors also charge by levels ranging from 1 to 5.  Ensure that your doctor charges you for the appropriate level.  Hospitals can never charge you for a level higher than that of the doctor so flag the same if it happens.

Medical Billing Advocates and Legal Recourse

Even after taking every precaution, if you are unlucky enough to find yourself at the receiving end of exorbitant charges on your medical bill, don’t lose heart just yet.  You still have a few tricks up your sleeve.

These days, many aggrieved patients are actively seeking the services of medical billing advocates – professionals who will negotiate your bills on your behalf with the health care providers and charge you a percentage on your eventual savings.

Of course, when all else fails, consider hiring an attorney to alleviate your situation in a court of law.

Avoid an ER Trip this Holiday with these 5 Tips

Jenna looked at all the holiday greeting cards spread over her dinner table and sighed.  The advent of Thanksgiving heralded the festivals’ season and soon the house would be abuzz with the noise and clatter of her extended family – her cousins and relatives she was used to seeing only once every year and even then it was one too many.

Contrary to most people who eagerly looked forward to the holiday season, Jenna dreaded this time of the year.  It was one thing to host the gamut of the McKinney family for a whole weekend at their winter retreat in Florida because her father, in addition to being a successful businessman who owned premium beach property, was also the eldest of all the brothers.  Quite another to endure the relentless clamor of uncles who wanted to know which college she was planning to apply to after graduation and aunts who wanted to know the name of the cutest guy at her school.

It all started 5 years ago. An otherwise chirpy and energetic pre-teen at the time, the twelve year old Jenna had pleaded with her dad to cancel the festival reunion that year owing to the deteriorating health of her mother suffering from cancer.  Both her parents had declined the proposal – her father because it was family tradition and her mom because she was convinced it would only serve to lift her spirits.

Sure enough, Jenna found her mom immensely happy in the company of her siblings.  She hadn’t seen her mother this jovial since her diagnosis with the terminal disease 3 years ago.  That weekend, the lady of the house had thrown caution to the wind, disregarded her strict dietary and medical regimen in favor of mirth and merriment, drank and ate freely and danced and sang well into the wee hours of the morning.  After all, how much could a few days of deviation from her routine hurt her?  She would be back on her strict diet before long and it would be like she never digressed at all.

Sadly, that was not to be. After 2 days of irregular or skipped medication, Jenna’s mom took to bed on Sunday afternoon.  Later that evening, she was rushed to the ER.  In the wee hours of the morning the next day, Jenna’s mom passed away.

After that, Jenna had always hated the holidays.  The next year and the years after that, when her cousins came over, she would mostly lock herself up in her room citing unfinished assignments.  The only time her extended family would see her pretty face would be around supper.

But that was so many, many years ago and Jenna could sense a closure in her heart this year.  This is why she insisted with her pleasantly surprised and overjoyed dad that she send out the invitations this year.  As she diligently hand wrote and signed each invitation herself, Jenna sighed that she hadn’t done this sooner.  When you lose a loved one, nothing comforts you more and helps you find inner peace again than the realization that you have an entire family to fall back on.

Holidays, sadly, are one of the busiest times of the year for ER attendants in hospitals.  Here’s what you can do to ensure you and your loved ones stay safe this festive season so that the doctors and the nurses at your local hospitals also get to spend more time with their own families!

Don’t get carried away by the moment

Sure, it’s the holiday season.  If you could ever forgive yourself for your indiscretions, now’s the time.  However, pay heed to your pre-existent conditions.  Make sure you’re allergies are in control.  Do not discontinue regular medication if you have diabetes, asthma or other health related issues that require constant monitoring.

Substance abuse

More alcohol is consumed during the festive season than the whole year around.  The same, unfortunately, is true of harmful drugs and chemicals that can have catastrophic consequences upon your body even in the short run.  If you are young and spending the holidays with your peers you are especially susceptible and vulnerable to substance abuse.

Spend the holidays with your family.  If you are spending it with your friends, make sure you do not partake in any activity that you would not permit yourself any other time of the year.

Overindulgence

The festive season is a time to party non-stop.  However, make sure that you are getting enough sleep in between all the fun and enjoyment.  Also, don’t forget to drink plenty of fluids to keep your-self hydrated. Eat regularly to keep your energy up.

Melancholy

Did you lose a loved one during the festive season?  How about a family member you desperately wanted to spend time with but could not be together?  Are you prone to stress, anxiety and depression?  Holidays can be tough on people who have lost loved ones, living away from family or are generally introverts.  Make sure you exercise, eat, drink and sleep regularly.  Do all those activities that keep you motivated year round.

Injuries

The holidays are Christmas time for all kinds of injuries, big or small.  Do you know how many paper cut victims end up in ER while wrapping or opening presents?  Well, thankfully not that many but hospitals are flooded with broken bones, bloody gashes and dislocated shoulders during the festive season.

Have fun during the holidays but do not forget to listen to your spider senses when they start tingling signaling that something has or is about to go wrong.

Reducing Physician Burnout due to EHRs

Technology is aimed at making our lives easier and simple – however, the transition stages seem to make life more difficult and tough.  A typical example is the Electronic Health Record (EHR) system.  While EHR use has definite benefits for patient safety and quality of care, it is also causing frustration amongst physicians and other medical professionals.

EHR use has found acceptance across the country with 97% of hospitals and 75% of physicians already using it.  Even though EHRs are here to stay, its use seems to be contributing to physician burnout and interfering with patient care.  According to surveys, primary care physicians and emergency physicians feel that their facilities are not effectively addressing physician burnout, with EHR use and time pressures identified as the biggest causes for frustration.

A recently published survey result from The Annals of Internal Medicine, reports that nearly 50% of the office time for physicians is spent working on EHR inputs.  Compare this to a mere 27% that is spent with patients directly.  And this does not end at the office – doctors spend an average of one to two hours at home completing and updating EHRs.  A similar finding by a Medscape survey, reports that 57% of physicians stated that EHR use reduced face-to-face patient interaction while 50% said that EHRs limited the number of patients they could see.

Exacerbating physician burnout; the mounting pressure from frustrated clinicians and management, in turn, is impacting health IT workers’ stress and job satisfaction.  A recent HealthITJobs.com survey found that 55% of health IT workers are stressed with 38% citing high or extremely high stress.  However, healthcare organizations can prevent provider burn out; improve clinical workflow efficiency and job satisfaction by optimizing their EHR and other clinical IT systems.  Organizations can identify and quantify the daily challenges their providers are facing and then through a careful assessment of IT systems and processes, design strategic solutions for high-quality patient care.

Negative repercussions of EHR burnout will likely influence the future of healthcare industry. Some examples of these repercussions could be:

Declining physician pool: According to a survey by Physicians Foundation, almost 50% of physicians plan to cut back on their working hours, retire or opt for non-clinical jobs due to burnout.  This is likely to cause a shortage of physicians and with the aging US population, seems to be heading for a disaster.

New or future physicians: Burned-out medical students are more likely to engage in patient care misconduct and endorse unprofessional behaviour, states a study by the American Medical Association.  Burnt-out medical students, who typically practiced with physician mentors, were also found to hold less altruistic views of their role as physicians in society.

Care quality: Physician burnout may also lead to lower care quality, increasing medical error, risks of malpractice and patient dissatisfaction, which can end up reducing payment under value-based care reimbursement models.

Pessimism: Most medical professionals are pessimistic about the future of their profession, according to the survey, with one-third indicating they wish they had chosen a different career and nearly 50% recommending different career paths to their children.

However, providers are not completely opposed to EHR use and agree that some features do increase satisfaction to combat burnout.  According to a survey of more than 15,000 physicians across 25 care specialties, nearly 62% of physicians deemed e-prescribing as the most useful EHR feature, while 57% ranked easy review of patient information as the second highest,. Standing third at 49% were the ability to share patient records and lab results, conduct drug/allergy checks and incorporate clinical lab test results. The survey also found that 56% of physicians believed that EHR use effectively improved the documentation at their practices with 81% planning on keeping their current EHR system.

EHR usability is one of the main stressors for both health IT staff and end users.  Organizations can implement vendor scorecard metrics on patient-provider interaction time and after-hours documentation and then analyze data to identify excessive EHR-related usage time to improve patient care and physician/patient experience.

More intuitive user interfaces and templates to support efficient clinical workflows and physicians’ natural thought patterns will improve EHR navigation.  Aligning processes with industry best practices for structured-form workflows, and working with vendors for task sequence customizations to fit work habits, will go a long way in helping EHR use.  Documentation requirements and actual end-user entry need to align, focusing on standardization and simplification of only the most meaningful data.

Health IT staff must properly train and transition end users to be comfortable with and invested in the EHR system.  All stakeholders need to feel they are within a culture where they are inspired, valued and vital to the overall organizational goals and enterprise-wide patient care experience.

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References

1. 2016 SURVEY OF AMERICA’S PHYSICIANS. (2016). Retrieved October 24, 2016, from http://www.physiciansfoundation.org: http://www.physiciansfoundation.org/uploads/default/Biennial_Physician_Survey_2016.pdf
2. Kyle Murphy, P. (2016, March 28). Ensuring Physician EHR Use Doesn’t Lead to Physician Burnout. Retrieved October 24, 2016, from http://www.ehrintelligence.com: https://ehrintelligence.com/news/ensuring-physician-ehr-use-doesnt-lead-to-physician-burnout
3. Liselotte N. Dyrbye, M. M., F. Stanford Massie, M., & Anne Eacker, M. (2010, September 15). Relationship Between Burnout and Professional Conduct and Attitudes Among US Medical Students. Retrieved October 24, 2016, from http://www.jamanetwork.com: http://jamanetwork.com/journals/jama/fullarticle/186582
4. Medscape EHR Report 2016. (2016). Retrieved October 24, 2016, from http://www.medscape.com: http://www.medscape.com/features/slideshow/public/ehr2016
5. Stoltenberg, S. (2016, October 07). Tips for Reversing Physician Burnout Caused by EHR Use. Retrieved October 24, 2016, from http://www.ehrintelligence.com: https://ehrintelligence.com/news/tips-for-reversing-physician-burnout-caused-by-ehr-use

 

 

Medical Chart Audits in a Primary Care Setting

Audit – the very word brings visions of men in suits pouring over your records, looking for the slightest evidence of a mistake or wrongdoing.  However, not all audits are external or scary. Internal and self audits are in fact, a rather helpful tool to enhance both the profitability and efficiency of your work.

Handling hundreds of patients can be quite a chore.  To evaluate the efficiency of their performance, identify areas where improvement can be made and measure the quality of care provided; a chart audit is one of the best tools in a primary care’s arsenal.  Helping monitor and measure performance in areas like research, compliance, clinical and administration, a chart audit can serve many purposes.  Any and all aspects of a medical record can be audited through the use of this tool.

Quality improvement initiatives can be easily mapped and monitored through the use of chart audits.  For example, a practice might review charts to see how often a particular vaccine is offered, given or declined. If the audit determines that the vaccine is not being offered or given as recommended, then there is room for improvement.  The same practice could review the panels of individual physicians within the group to see if they differ in performance on this measure and to give focus to their improvement efforts.  Along with patient surveys, billings/claims data, discharge summary reviews, employee feedback and other similar data sources; chart audits are used for quality improvement efforts.

Although there is no fixed linear process to a formal chart audit, there are typical steps that occur in setting one up.  The basic set up for a chart audit consists of:

• Selecting a topic
• Identify and define measurement parameters
• Identify the target group / patient population
• Determine sample size – it should be statistically valid for a chart review
• Create simple audit tools that can be used by non-clinical staff too
• Start collecting data based on your parameters of size and time
• Summarize the results by collating the collected data
• Analyze the collated data and compare the results against set benchmarks
• Plan the next steps if required and put the plan into action

Chart audits can be useful tools in performance improvement and safety efforts.  However, it is essential to define what you want to measure and the criteria by which you will measure it.  Sample sizes can be chosen informally or determined in a statistically valid fashion – remember that too small will not provide enough data and too large a sample size can be overwhelming.  Summarize your data keeping the parameters in focus – after all, you do not wish to lose focus on what you want out of the audit.  Analyze the data to find out problem areas if any, scope for improvement and other areas of concern.  Work out a plan to counter the problems and put the plan into action.  Regular chart audits will certainly make a positive difference to your work, practice and your patient’s welfare and care.

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References

1. Barbara H. Gregory, M. M. (2008, July). Eight Steps to a Chart Audit for Quality. Retrieved October 26, 2016, from http://www.aafp.org: http://www.aafp.org/fpm/2008/0700/pa3.html
2. Chart Audits in Quality Improvement . (2016). Retrieved October 26, 2016, from http://www.patientsafetyed.duhs.duke.edu: http://patientsafetyed.duhs.duke.edu/module_b/quaility_improvement.html
3. Improving Your Office Testing Process. (2016). Retrieved October 26, 2016, from http://www.ahrq.gov: http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/office-testing-toolkit/officetesting-toolkit9.html
4. Managing Data for Performance Improvement. (2016). Retrieved October 26, 2016, from http://www.hrsa.gov: http://www.hrsa.gov/quality/toolbox/methodology/performanceimprovement/part3.html

 

Physician Assistant Compensation Increased 50% Faster than Inflation

Physician assistants have never had it so good – a rapid growth in demand and compensation like never before, according to multiple studies in 2015.  Even with a nationwide shortage of doctors required to treat millions of newly insured Americans, the demand for physician assistants is growing with compensation averaging $100,000 across the U.S.

Nationally certified by the commission and licensed in the states where they practice, a physician assistant generally has a two-year master’s degree, often from a program that runs about two years and includes three years of healthcare training.  They work in doctor’s offices, retail clinics and other locations and their work includes diagnosing illnesses, writing prescriptions and counseling patients on preventive care.  Physician assistants and other allied health professionals like nurse practitioners are increasingly an integral part of value-based care models proliferating across the country like Accountable Care Organizations (ACOs) and patient-centered medical homes that contract with insurers, Medicare and Medicaid programs.

According to a report from the American Academy of PAs (AAPA), physician assistants saw a 3.4 percent increase in median provider compensation between 2014 and 2015.  The study indicates that the increased demand for physician assistants led to increases in their compensation in 2015.  Gathering feedback from about 16,000 respondents, the 2016 AAPA Salary Report revealed rapid growth in the physician assistant workforce, with the profession increasing by more than 33 percent between 2010 and 2015.  Since 1980, this workforce has doubled in size every decade.  The study found that the median annual salary for physician assistants was $97,000 in 2015 and the median hourly wage came to $55, with about 78 percent of physician assistants receiving a salary, 18 percent paid hourly and 3.7 percent receiving compensation based on productivity.  Physician assistants who were more likely to be paid hourly were found to be generally working in urgent care, emergency medicine and convenient care.

 

According to the researchers, the highest paid physician assistants with a $120,000 median base salary were employed in hospital critical access departments, followed by those in industrial facility and work site settings ($114,003) and hospital intensive care and critical care units ($108,000).  The study also stated that provider compensation for some physician assistants included bonuses, with about 49 percent of full-time clinically practicing physician assistants earning a bonus payment in 2015. 50% of those providers reported a bonus of $5,000 or more.  Bonuses were given based on a variety of factors, including milestone achievements, employee performance, practice performance, collections productivity, relative value unit productivity, incentives, and holidays.

The study indicated that physician assistant compensation has consistently risen faster than both the national inflation rate and most other professions, with provider compensation for physician assistants increasing approximately 50 percent faster than the rate of inflation between 2000 and 2015.  The good news is that despite significant growth in workforce and compensation rates, the demand for physician assistants remains high nationwide.  According to The Bureau of Labor Statistics, physician assistant job demand should grow by 30 percent between 2014 and 2024.  The Association of American Medical Colleges projected that the industry will fall short by 61,700 to 94,700 physicians in 2025.

According to another healthcare employment study from Health eCareers, physician assistant compensation grew by 4.3 percent and demand for physician assistants and nurse practitioners increased due to physician shortages.  With payment reforms promoting more access to preventative services and about 54.8 million Americans touching the age of 65 by 2020, healthcare organizations are seeking more providers to add to their staffing rosters.  However, many are finding it difficult to hire and retain providers because of physician shortages.  According to the study, in order to offset a lack of physicians, healthcare organizations have opened new physician assistant and nurse practitioner positions.

According to Jennifer L. Dorn, AAPA CEO, “The growth of the PA profession in terms of size and compensation is just the tip of the iceberg.  PAs are going beyond just healthcare by taking on new leadership roles in health systems around the country.  They are well positioned to drive change as the US healthcare system adapts to a growing and aging population, the shift towards value-based care, and a renewed focus on patient education and prevention. In short, the state of the PA profession has never been stronger.”

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References

1. Belliveau, J. (2016, September 28). Demand for Physician Assistants Led to Increased Pay in 2015. Retrieved October 19, 2016, from http://www.revcycleintelligence.com: http://revcycleintelligence.com/news/demand-for-physician-assistants-led-to-increased-pay-in-2015
2. Grygotis, L. (2016, October 06). National PA Week 2016 honors the profession’s growing influence. Retrieved October 19, 2016, from http://www.clinicaladvisor.com: http://www.clinicaladvisor.com/web-exclusives/national-pa-week-honors-the-professions-growing-impact/article/527450/
3. James Tyll. (2016, September 26). AAPA Exclusive Salary Data Shows Continued Growth in Size of and Demand for the PA Profession. Retrieved October 19, 2016, from http://www.aapa.org: https://www.aapa.org/twocolumn.aspx?id=6442451625
4. Japsen, B. (2016, January 29). Physician Assistant Pay Reaches $100K Annually. Retrieved October 19, 2016, from http://www.forbes.com: http://www.forbes.com/sites/brucejapsen/2016/01/29/physician-assistant-pay-reaches-100k-annually/#6736e1e82bec

Causes of EHR-related Pediatric Malpractice Claims

The days of squinting while trying to read the physician’s prescription are long gone along with the bulky files which stored all our medical records.  The electronic health record (EHR) has replaced the pen and paper documents, resulting in better legibility and documentation of our medical records.  A powerful tool that is helping physicians achieve better care, lower costs per capita and better population health.  But, like all good things, the EHR is also prone to causing errors – errors that can be a source of medical liability.  Let us look at some of the factors that can be the cause for EHR related malpractice claims at a pediatric setting.

Interoperability Issues

Office based pediatricians use of EHR rose from 58% in 2009 to 79% in 2012.  However, interoperability issues caused due to multiple EHR systems and platforms coupled with limited pediatric functionality still prevail.

There is a need for pediatricians to realize that due to these interoperability issues, they do not have access to complete data on hospital admissions, emergency department visits, lab results, subspecialist reports and care provided outside the medical facility.  Serious errors in medical management could result due to these fragmented EHRs, resulting in harm to patients and exposing pediatricians to professional liability through malpractice claims.

Electronic Prescribing

While nearly 50% of pediatric practices are transmitting prescriptions directly to the pharmacies through the electronic prescription programs, the lack of pediatric functionalities in many EHRs can pose significant safety risks to children.  There is a need to verify if the EHR uses pediatric-specific drugs, calculates the correct pediatric dosages, and alerts the provider of dosing errors and potential contraindications.  Another problem area is that the majority of e-prescribing programs do not keep information from providers using a different e-prescription program. This can lead to serious consequences for both the patient and the pediatrician.

Cloning

While copying and pasting information from previous medical records does reduce time and effort to duplicate records – it can also cause tragic results.  Also known as cloning, duplication more often than not, results in over-documentation of the actual findings – for example, when the document cites items that have changed or were not examined in subsequent visits.  This can lead to damaging the credibility of the record in a liability action for the pediatrician.  For the patient, incorrect information from a past visit can lead to incorrect care.

Validating Reports

It is important that electronic reports from labs and consultation are examined by a provider before being incorporated in the EHR.  Incorrect reports or posting the wrong one can lead t serious medical errors and pose a significant malpractice risk.

Transition, Retention, Contracts

While it is good to move with the times, care should be taken when transitioning from paper to electronic charts. Before getting rid of the old paper records, pediatricians need to be sure that they have complied with all federal and state record retention laws.

Before finalizing the provider, all EHR vendor and service contracts should be scrutinized and legal review secured.  Pediatricians need to be aware of where protected health information is stored and the relevant risk of loss of this data.

Coding Issues

Some EHRs may be prone to coding pediatric services at a higher level than warranted due to a feature that automatically calculates CPT codes based on the services documented in the EHR.  Incorrect coding can lead to receiving overpayments, which may lead to liabilities due to fraud and system abuse.

The majority of pediatricians using EHR find the advantages outweigh the disadvantages.  Although, adverse EHR events are rare, they do exist. Becoming aware of and preventing potential and real risks of EHR errors is the best policy.

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Reference

1. Anunta Virapongse, M. M., David W. Bates, M. M., & Ping Shi, M. (2008, November 24). Electronic Health Records and Malpractice Claims in Office Practice. Retrieved from The JAMA Network: http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/414653
2. Graber ML, S. D. (2015, November 6). Electronic health record–related events in medical malpractice claims. Retrieved from PSNet: Patient Safety Network: https://psnet.ahrq.gov/resources/resource/29582/electronic-health-record-related-events-in-medical-malpractice-claims
3. Richard L. Oken, M. F. (2016, August 8). Lessons learned from EHR-related medical malpractice cases. Retrieved from American Academy of Pediatrics: http://www.aappublications.org/news/2016/08/08/Law080816
4. Spooner, S. A. (2007, March). Special Requirements of Electronic Health Record Systems in Pediatrics. Retrieved from American Academy of Pediatrics: http://pediatrics.aappublications.org/content/119/3/631

Statistics on Orthopedic Malpractice Cases

Medical malpractice is a poorly understood and complex phenomenon.  Which patients file claims, why these claims are filed, and under what conditions remain vexing questions.  In 2014, malpractice lawsuits were filed against 18% of orthopedic surgeons by patients and their families.  According to a 2011 study, orthopedics is the fourth most sued specialty, after neurosurgery, cardiothoracic surgery, and general surgery.  There are several aspects of orthopedic malpractice claims that intuitively appear to contribute to malpractice losses.  Among these factors are the nature and quality of the physician/patient relationship, the amount of time physicians spend communicating with patients, and the presence, or at least the appearance, of physician empathy and compassion.

The Doctors Company recently released a closed claims study examining medical malpractice claims against orthopedists.  Covering 1,895 claims against orthopedists that closed between 2007 and 2014, including all claims and lawsuits in which an orthopedist was named a defendant; the study included all cases regardless of the outcome in order to get a broader sense of what motivates a patient to pursue a claim and to gain a better understanding of what led to patient harm and the respective system failures.

According to David B. Troxel, MD, medical director of The Doctors Company in Napa, California, the nation’s largest insurer of physician and surgeon medical liability, “if you practice orthopedic surgery long enough, the odds are good that someone will hit you with some sort of lawsuit.”  The good news is that the rate of lawsuits has been declining across all specialties since 2008, added Dr Troxel. However, according to him, far more liability suits could be prevented if orthopedists took the time to maintain good relationships with their patients.

The study analyzed claims against more than 2100 orthopedists, pinpointed the most common types of claims and, based on these findings, developed recommendations for avoiding them.

Given below are some of the important statistics from the study.

1. 46% of claims came from patients stating their surgery was performed improperly, making this the largest reason for filing claims.  While the allegation was most often made when the outcome of the procedure differed from the patient’s perspective, the findings of expert reviewers showed only a small percentage of injuries were due to substandard care.
2. The procedures that brought the maximum and most frequent allegations of improper care were total knee replacement, total hip replacement, knee arthroscopy, vertebroplasty, open reduction internal fixation, discectomy, exploration and decompression of spinal canal, shoulder arthroscopy and rotator cuff repair.
3. 16% of all claims stemmed from improper management of surgical patients, with patients claiming improper management if they experienced infections, continued pain or mechanical complications of orthopedic devices or mal-union or nonunion of bones.
4. 13% of claims were due to delayed, failed or wrong diagnosis with compartment syndrome, fractures, nonunion of fracture, hematomas, postoperative infections, malignant bone tumors, thromboembolism and dislocations accounting for the most incorrectly diagnosed procedures.

The study also identified several factors that contributed to patient injury.

1. 35% of all patient injury was due to technical performance, although that does not necessarily imply negligence.  While most claims were related to known risks, a “small” portion was due to substandard care.
2. 29% of patient injuries stemmed from patient behavior wherein patients dissatisfied with the care provided sought other providers thus reducing the original physician’s opportunity to address concerns or the unsatisfactory surgical outcomes through follow-up care.

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References

 

1. Harrison, L. (2015, October 7). How Orthopedists Can Get off the List of Most-Sued Doctors. Retrieved from Medscape: http://www.medscape.com/viewarticle/851706_2
2. Oliver, E. (2016, August 11). 10 thoughts and statistics on medical malpractice claims against orthopedists. Retrieved from Becker’s Healthcare: http://www.beckersspine.com/sports-medicine/item/32668-10-thoughts-and-statistics-on-medical-malpractice-claims-against-orthopedists.html
3. Peckham, C., & Grisham, S. (2016, January 22). Medscape Malpractice Report 2015: Why Orthopedists Get Sued. Retrieved from Medscape: http://www.medscape.com/features/slideshow/malpractice-report-2015/orthopedics
4. Sonny Bal, M. M., & Lawrence H. Brenner, J. (2008, April). Surgeon characteristics and medical malpractice: Are orthopedists at risk? Retrieved from Healio Orthopedics Today: http://www.healio.com/orthopedics/business-of-orthopedics/news/print/orthopedics-today/%7Bc033311f-cb7b-4d01-bc35-a69a36c2c5a2%7D/surgeon-characteristics-and-medical-malpractice-are-orthopedists-at-risk

Medscape EM Physician Compensation Report 2016

The Medscape compensation survey 2016 witnessed the responses of emergency medicine (EM) physicians with regards to their compensation, hours of work on a weekly basis, the time spent with each patient, the ways in which healthcare reforms affected their practice, the rewarding parts about their jobs, etc.

For patient-care compensation for employed physicians, which includes profit-sharing contributions, bonus and salary, there exists a wide range of earnings in various specialties.  While orthopedists and cardiologists (including surgical sub-specialists) topped the list with an annual compensation of $443,000 and $410,000 respectively in 2016 (higher than $421,000 and $376,000 as per last year’s compensation report), EM physicians were somewhere in the mid range with compensations of $322,000 on a yearly basis.  A 5% increase in income was in the offing for EM physicians – with the highest earnings being reported in the Southwest ($355,000), Southeast ($360,000) and South Central region ($371,000) – while internists experienced a whopping 12% increase.  However, practitioners of pulmonology and allergy/immunology experienced a decrease in their income (-5% and -11% respectively).

EM physicians in and healthcare organizations ($327,000) and hospitals($329,000) enjoyed the highest income.  Overall, male EM physicians notched $332,000 while their female peers made $279,000 this year ($53,000 less) for full-time positions.  The earnings for self-employed EM physicians (female) were $317,000, which was 85% of that of men ($371,000).  It’s notable that being self-employed or employed had no role to play in this gender disparity with relation to salary.

60% of EM physicians are satisfied with their earnings and feel fairly compensated.  Since
2012, the other physicians who felt duly compensated are dermatologists (66%), pathologists (63%) urologists (42%), and allergists/endocrinologists (both 43%).  This year’s report showed that the physicians who earned more believed that they were fairly paid, rather than those who did not match up with them.  Over 52% of employed EM physicians (male) and 63% of their female counterparts believed that they are compensated fairly, as compared to 24% and 17% of self-employed EM physicians (male and female respectively).

In the 2016 Medscape report, EM physicians (66%) preferred to choose medicine, but a lesser number (44%) wanted to select their own specialty; these figures were close to the survey results of 2011.  Concierge and cash-only practices failed to serve as significant payment models despite a lot of attention being given to these fields.

Over 55% EM physicians have been positively impacted by the Affordable Care Act (ACA) that has paved the way for a large influx of patients.  A year after the implementation of this Act, the physicians who believed that the quality of care provided had worsened, 18% reported no increase in patient load while 21% had higher loads.  As far as the physicians whose patient load had increased are concerned, 78% felt that the quality was the same or improved; with 82% of physicians who experienced no increase showcasing the same experiences.

In the current Medscape report, 11% EM physicians said that it was inappropriate to drop insurers that paid poorly, while the question did not apply to the remaining ones.  As per the report conducted in 2014, more than 58% of physicians had received $100 or less for new-patient office visits by their private insurers.

The report also stated that 67% of EM physicians spent 30-45 hours on a weekly basis seeing patients with only 19% spending more than that. It was also observed that middle-aged physicians worked harder than their older and younger peers.  According to the results of the current year’s Medscape Lifestyle Report, spending many hours at work and bureaucratic tasks happened to be the primary causes of burnout in physicians.

It’s unclear how the income of physicians is affected by ACA as many variables have a role to play in the ultimate results.  When asked about how their income was affected, 72% of EM physicians who participated in last year’s health insurance exchanges reported no changes while 7% acknowledged that it had increased; and 21% experienced a decrease.

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References

1. Peckham, C. (2016, April 1). Medscape Physician Compensation Report 2016. Retrieved September 2, 2016, from MedScape: http://www.medscape.com/features/slideshow/compensation/2016/public/overview