Friday, February 4, 2022

Tips for combatting medical misinformation in the exam room

Medical misinformation is all too common these days, especially as many try to politicize public health recommendations. While doctors are not immune from these narratives, we are still expected to follow evidence-based practices. Even though we try our best to follow best clinical practices, misinformation often creeps up in the course of patient encounters. It is easy to grow frustrated when this happens but it’s important to remember that it often comes from a good place: our patients trust us to give them the real information.

What can be done to handle discussions around medical misinformation?

First, know the facts


Everyone is talking about public health since the pandemic started. It is often hard to know who the real experts are. It is imperative, as the experts that our patients trust, to get the right information. We need to know what the medial authorities, such as the CDC, WHO, and our medical societies are saying. We need to understand the data they are publishing. For example, if they report on studies showing that a vaccine is 95% effective, that is the data we need to share with our patients. If we say they always work, that would be wrong information. If we say some doctor on Instagram says there is a study that shows they don’t work at all, that would be wrong as well. Know the trusted sources and know what they are saying. We can’t share reliable information when we don’t have it.

Follow clinical guidelines from appropriate medical societies


There are many medical societies and groups out there. During our careers, we learn those that we can depend on to get accurate information and serve as a guide for us. For those of us in family practice, the American Academy of Family Practice is such a medical authority on all things family medicine. Each specialty has their own governing society. These societies tend to release clinical guidelines on the treatment and prevention of diseases we may encounter in the course of our medical practice. We should be following these guidelines as appropriate. There are also outlier medical groups publishing conflicting recommendations. When they conflict with the oldest, most-known authorities, then there is a good chance that they are wrong.

Address specific concerns that the patients have


We can give the patient a ton of information but unless we address what they are actually concerned about, we lost them. For example, we can tell a patient that the COVID vaccine is safe but if their only concern is that it may cause infertility, we fail if we don’t reassure them on that point. We need to listen and ask what specific concerns they have



Don’t be condescending


While something may seem ridiculous to us as healthcare providers, it may be completely reasonable to our patients. We need to understand where they are coming from and try to understand why they believe something that may be obviously misinformed. Maybe they heard it from a close family member or a role model they followed all their lives. Ridiculing these others is not going to bring patients closer to the truth. A family member may be trying to keep their loved one from harm. We need to be empathetic and not undermining.

Take time to answer questions


I often hear from patients that the specialists didn’t take time to answer their questions. Patients are not going to follow our advice if they don’t feel confident about that decision. During the pandemic, we’re busier than ever before. However, our patients probably have more questions than ever before. Answering the patients questions about the vaccine may save time down the road when we convince them to get vaccinated rather than treating them when they become infected.

If you don’t know, say so


As a doctor, it is hard to admit when we don’t know something. Yet, we don’t know everything and it is wrong to give patients made-up or half-truthed answers. This may just feed in to mistrust and falling for other misinformation. If we don’t know something, it is OK that we say so and then commit to finding the answer for the patient. Don’t be a source of misinformation.

Don’t say things on social media that you don’t stand by in real life


There are doctors on social media that are the source of much misinformation. It is easy to fall into the political arguments surrounding public health policy. However, it’s always best to assume whatever you say on social media is available to the public eye and patients are following it.

Misinformation has been around for a long time but never more pertinent than it seems these days. It is driving politics and economies. Everyone has an opinion on it. Yet, science is an undisputable truth that doesn’t care what anyone thinks about it. As doctors, we are called to be champions for that truth and for the well-being of our patients. Are you ready to take a stand against misinformation?


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Wednesday, February 2, 2022

CREATES: An approach to employee retention

How many of you have had turnover, Covid and other illnesses, care for family issues, other organization pirating our staff, work from home (WFH) issues, burnout, and employees leaving for hire paying jobs? It seems to be a never-ending battle to deal with employees, turnover, burnout, and related stress. Turnover is expensive. The Society for Human Resource Management estimates turnover costs between 70% and 200% of an annual salary due to recruiting, interviewing, training, and lower productivity rates – you don’t write out a check for that amount, you just use or loose resources. What can be done to retain physicians and knowledge workers?

First is the hope that your hired right! If you are looking to hire, do it right!

An acronym that works for retention is CREATES! The breakdown is as follows.

C is for culture. How has your organization dealt with masks, vaccines, time off, wage and salary adjustments and bonuses? Have you been consistent, effective in communications, and transparent? Is your mission clear, understood, and lived? There is no right or wrong approach, just how your organization has done it.

R is for reward. What has been done for wage adjustments? How about recognition for staying, for a job well done? Recognition is accomplished with money true. But that is a small but necessary part. Customized benefits where you understand the needs of the various generations and so much more, read on.


E is for engagement. Do you listen to employees? Do you recognize their individual contributions to the success of each patient visit? An engaged employee, one who buys into the mission, sees a purpose for their efforts in improving patient care, and achieving a level of personal satisfaction is critical to your success.

A is for attention. Effective communication and transparency. Effective through various means including one on one exchanges, meetings, emails, texts, and the like will get and keep the focus on your mission.

T is for teach. Younger employees are hungry for more knowledge and for personal growth and personal development opportunities. A learning organization focuses on formal training, mentoring and effective coaching.

E is for execute. One of the biggest reasons employees leave is due to poor management. Doing none of the above. Are you a Theory X manager – authoritarian, micro-manager? Or a Theory Y manager – open, delegator? Now is a good time to take a serious look at yourself and how you work to develop managers, supervisors, and lead workers who you work with.

S is for schedule. Flexible time is critical for all. This includes days of or hours away to care for a circumstance outside of the office that is important to the employee. A goal of work life integration, going beyond just balancing.

This all leads to a question of meeting individual, yours, and your staffs, well-being. Gallup defines well-being around five major factors: career, social, financial, physical and community. An effective approach that CREATES a retention strategy will reduce costs, improve patient retention and treatment plan compliance, and well satisfied employees served by your medical practice.


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Tuesday, February 1, 2022

The most common – and costliest – coding mistakes physicians make

A physician’s workday is often segmented into two major jobs: Seeing patients and performing the necessary administrative duties to ensure they are paid for work they have performed.

Burnout is always a significant risk in any medical practice. It’s mostly caused by doctors and other clinicians having to see too many patients in too little time. Their levels of stress and exhaustion are further compounded by dealing with an enormous number of complex but monotonous administrative tasks at the end of the clinical workday.

As a result, by the time most physicians check off all the tasks on their daily clinical and administrative worklists, they just want to go home and get enough rest to be able to tackle the next day’s work.

However, the brutal workloads and the disparate skills required to complete the daily grind of practicing medicine and getting paid for it means many physicians are not wholly engaged in ensuring their practices are run optimally. If your goal is to survive to get to the next day, you are not going to perform a deep dive into how your practice is operating and whether it is the best possible approach.

As a result, medical practices throughout the U.S. systematically engage in suboptimal medical coding for their patient encounters. And as there is no fixed way to code an encounter, it means that task can be performed in a myriad of ways. Add to that the fact commercial insurance and Medicare auditors are always poring over claims data and may demand a payment clawback, and many doctors will they resort to the coding approach they believe is least likely to draw any attention. It may be the safest path, but it is not the most accurate representation of the care provided. In the aggregate, these errors and omissions can lead to a sizable revenue hit for medical practices.

However, out of this chaos emerges patterns, particularly in terms of the most costly coding errors for a medical practice. Among them are:

Inappropriate Coding For Evaluation and Management Services (E/M)


Issues with coding for E/M is often linked to the hectic schedules of physicians and other clinicians, who may see 20 or more patients a day. As a result, the approach often goes in one of two directions: Overly aggressive without proper documentation to back it up, which may trigger an audit; or too low for the documentation provided, which leaves money on the table. And missing E/M codes can make the problem even worse.



Missing E/M Codes


This is often the result of incomplete charting, which again is often due to provider distraction. Many times, these charts remain without follow up and the claim is being sent out late or not billed out at all.

Inaccurate Capturing of Patient Status


While typically a front desk issue, the confusion between whether a patient is new or established can lead to lower payments if not properly resolved.

Missed Administrative Procedure Codes


Providers often miss administrative procedure codes for minor treatments, which can leave money on the table. That includes codes for injections, immunization and immobilization. Giving patients an injection is among the most routine services provided in a primary care or urgent care practice. But one shot includes two codes: a CPT code for the injection, and a separate code for the medication or vaccination that is being provided. Modifier 25 may also be applied if other care is being rendered. A similar oversight can occur when putting a splint on a limb. There is a code for the application, and a separate code for the supply item, whether a splint, cast or other device. Using a single code leaves money on the table.

Inaccurate Utilization of Modifiers


Among the biggest errors coding are how modifiers 25 and 59 are deployed.Either modifier can expand treatment and payments considerably. However, using them appropriately can be tricky, and mistakes can lead to audits and clawbacks. Modifier 25 may be used in conjunction with an E/M encounter when a particular service that is performed – such as an injection – is separately identifiable. The use of modifier 59 is appropriate only in slightly different circumstances to identify procedures other than E/M services that would not normally be reported with such an encounter.

This is not a complete list of the coding errors a physician or their practice can make, but it covers some of the most obvious ones. Using an outside firm that can perform an analysis of your practice’s approach to coding and propose solutions is a potential way to address this issue.


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