Billing patterns for in-office computerized tomography scans of the face/sinus by otolaryngologists.

PURPOSE: To evaluate billing trends, Medicare reimbursement, and practice setting for Medicare-billing otolaryngologists (ORLs) performing in-office face computerized tomography (CT) scans. METHODS: This retrospective study included data on Medicare-billing ORLs from Medicare Part B: Provider Utilization and Payment Datafiles (2012-2018). Number of Medicare-billing ORLs performing in-office CT scans, and total sums and medians for Medicare reimbursements, services performed, and number of patients were gathered along with geographic and practice-type distributions. RESULTS: In 2018, roughly 1 in 7 Medicare-billing ORLs was performing in-office CT scans, an increase from 1 in 10 in 2012 (48.2% growth). From 2012 to 2018, there has been near-linear growth in number of in-office CT scans performed (58.2% growth), and number of Medicare fee-for-service (FFS) patients receiving an in-office CT scan (64.8% growth). However, at the median, the number of in-office CT scans performed and number of Medicare FFS patients receiving an in-office CT, per physician, has remained constant, despite a decline of 42.3% (2012: $227.67; 2018: $131.26) in median Medicare reimbursements. CONCLUSION: Though sharp declines have been seen in Medicare reimbursement, a greater proportion of Medicare-billing ORLs have been performing in-office face CT scans, while median number of in-office CT scans per ORL has remained constant. Although further investigation is certainly warranted, this analysis suggests that ORLs, at least in the case of the Medicare FFS population, are utilizing in-office CT imaging for preoperative planning, pathologic diagnosis, and patient convenience, rather than increased revenue streams. Future studies should focus on observing these billing trends among private insurers.

Prior authorizations in dermatology and impact on patient care: An updated survey of US dermatology providers and staff by the American Academy of Dermatology.

BACKGROUND: Completing prior authorizations (PAs) can be a lengthy process, which can delay access to appropriate care. A 2017 American Academy of Dermatology survey highlighted that PAs are common across many dermatologic medication classes. However, little is known regarding the impact of PAs on patient care and resource use. METHODS: To better characterize the burden of PAs on dermatology practices and their effects on patient care, a survey was conducted in February 2020 among U.S.-based dermatologists (N=3,000) and the Association of Dermatology Administrators/Managers (ADAM) members (N=718). RESULTS: Respondents reported 24% of patients require PAs. Dermatologists and staff spend a mean of 3.3 hours/day on PAs. Sixty percent of dermatologists reported interrupting patient visits for PAs. Sixty-five percent respondents reported PAs were required for clobetasol, 76% for tretinoin, and 42% for 5-fluorouracil. Respondents noted 45% of PA determinations took beyond one week and 17% took beyond two weeks. Respondents reported 12% of PAs resulted in delaying or abandoning treatment and 17% resulted in less appropriate treatment. CONCLUSIONS: Prior authorization burden remains high and consumes substantial clinical resources, which may negatively impact patient care. Additionally, they result in prolonged treatment delays and are associated with delaying treatment, abandoning treatment, or using lesser treatment.

Response of Practicing Chiropractors during the Early Phase of the COVID-19 Pandemic: A Descriptive Report.

OBJECTIVE: The coronavirus disease-2019 (COVID-19) pandemic has strained all levels of healthcare and it is not known how chiropractic practitioners have responded to this crisis. The purpose of this report is to describe responses by a sample of chiropractors during the early stages of the COVID-19 pandemic. METHODS: We used a qualitative-constructivist design to understand chiropractic practice during the COVID-19 pandemic, as described by the participants. A sample of chiropractic practitioners (doctors of chiropractic, chiropractors) from various international locations were invited to participate. Each described the public health response to COVID-19 in their location and the actions that they took in their chiropractic practices from April 20 through May 4, 2020. A summary report was created from their responses and common themes were identified. RESULTS: Eighteen chiropractic practitioners representing 17 locations and 11 countries participated. A variety of practice environments were represented in this sample, including, solo practice, mobile practice, private hospital, US Veterans Administration health care, worksite health center, and group practice. They reported that they recognized and abided by changing governmental regulations. They observed their patients experience increased stress and mental health concerns resulting from the pandemic. They adopted innovative strategies, such as telehealth, to do outreach, communicate with, and provide care for patients. They abided by national and World Health Organization recommendations and they adopted creative strategies to maintain connectivity with patients through a people-centered, integrated, and collaborative approach. CONCLUSION: Although the chiropractors in this sample practiced in different cities and countries, their compliance with local regulations, concern for staff and patient safety, and people-centered responses were consistent. This sample covers all 7 World Federation of Chiropractic regions (ie, African, Asian, Eastern Mediterranean, European, Latin American, North American, and Pacific) and provides insights into measures taken by chiropractors during the early stages of the COVID-19 pandemic. This information may assist the chiropractic profession as it prepares for different scenarios as new evidence about this disease evolves.

Launching a Mohs Surgery Program.

BACKGROUND: There is a paucity of data or publications in the literature on best practices for opening a new Mohs surgery unit. OBJECTIVE: The goal of this article is to be a "how to" guide for starting a Mohs and dermatologic surgery practice. MATERIALS AND METHODS: Two academic Mohs surgeons share their personal experiences and data from the literature. RESULTS: Topics discussed include picking a location and identifying space, equipment, staffing, regulatory practices, policies and procedures, marketing and outreach, patient experience, building culture, clinic efficiency, and vision. CONCLUSION: Although opening a new Mohs surgery unit is challenging, it can be rewarding to have the opportunity to develop best practices and systems that create a wonderful working environment and allow for exceptional care of patients.

Patient Safety in the Traditional and Evolving Nontraditional Office Setting.

Patient safety remains a concern for practice in traditional office settings as well as emerging forms of telehealth. Effective leadership is required to establish a culture of safety in office practice, with all staff undergoing appropriate credentialing and privileging. Key areas of focus for office safety are documentation and follow-up of patient encounters, medication safety, and surgical safety. Medication safety standards include prescribed medications, office administered injections and samples given to patients. Similar rules of patient safety apply to both hospital-based and office-based surgical procedures. Telehealth will present new challenges for maintaining patient safety, for which more study is needed.

Bergamot Aromatherapy for Medical Office-Induced Anxiety Among Children With an Autism Spectrum Disorder: A Randomized, Controlled, Blinded Clinical Trial.

This randomized, blinded clinical trial evaluated the effects of aromatherapy on medical office-induced anxiety in children with an autism spectrum disorder. Patients awaiting office visits were randomized into an aromatherapy group and a control group. After adjusting for baseline scores, there was no significant difference between the 2 groups.

Caring for the patient, caring for the record: an ethnographic study of 'back office' work in upholding quality of care in general practice.

BACKGROUND: The quality of information recorded about patient care is considered key to improving the overall quality, safety and efficiency of patient care. Assigning codes to patients' records is an important aspect of this documentation. Current interest in large datasets in which individual patient data are collated (e.g. proposed NHS care.data project) pays little attention to the details of how 'data' get onto the record. This paper explores the work of summarising and coding records, focusing on 'back office' practices, identifying contributors and barriers to quality of care. METHODS: Ethnographic observation (187 hours) of clinical, management and administrative staff in two UK general practices with contrasting organisational characteristics. This involved observation of working practices, including shadowing, recording detailed field notes, naturalistic interviews and analysis of key documents relating to summarising and coding. Ethnographic analysis drew on key sensitizing concepts to build a 'thick description' of coding practices, drawing these together in a narrative synthesis. RESULTS: Coding and summarising electronic patient records is complex work. It depends crucially on nuanced judgements made by administrators who combine their understanding of: clinical diagnostics; classification systems; how healthcare is organised; particular working practices of individual colleagues; current health policy. Working with imperfect classification systems, diagnostic uncertainty and a range of local practical constraints, they manage a moral tension between their idealised aspiration of a 'gold standard' record and a pragmatic recognition that this is rarely achievable in practice. Adopting a range of practical workarounds, administrators position themselves as both formally accountable to their employers (general practitioners), and informally accountability to individual patients, in a coding process which is shaped not only by the 'facts' of the case, but by ongoing working relationships which are co-constructed alongside the patient's summary. CONCLUSION: Data coding is usually conceptualised as either a technical task, or as mundane, routine work, and usually remains invisible. This study offers a characterisation of coding as a socially complex site of moral work through which new lines of accountability are enacted in the workplace, and casts new light on the meaning of coded data as conceptualised in the 'quality of care' discourse.

Does the year-end decline in injury risk reflect reporting error?

BACKGROUND: Relatively little is known about seasonal patterns in occupational injury risk. Injury risk may vary seasonally due to weather-related factors or changing work exposure. Employer confusion about recordkeeping rules and injury occurrence near year end may also lead to an undercount of year-end injuries. METHODS: Case records from the Bureau of Labor Statistics' Survey of Occupational Injuries and Illnesses and Census of Fatal Occupational Injuries were used to determine seasonality for a variety of injury types. RESULTS: Reported injury rates were higher in summer and lower at year end. Difficult-to-identify injuries showed greater year-end incidence declines. CONCLUSIONS: End-of-year injury declines may have reflected reporting errors for some injury types. The summertime increase in injury risk was broad-based and presumably reflected real seasonal factors.

[Risk assessment of work-related stress: the case of a public administration]. / Valutazione del rischio stress lavoro correlato: il caso di una pubblica amministrazione.

The paper describes a case study of work related stress assessment in a public administration, based on an objective methodology (Romano, 2009). The Ispes1 forms (2010) have been used to perform the assessment. They have been filled during some focus group in which 45 workers have been involved, divided into 7 homogeneous groups relying on their department, back-office vs front-office typology of work and the office collocation. According to the Grounded Theory perspective, through the content analysis three further risk factors arose, comparing to the Ispesl forms, such as: (a) the quality of communication, (b) the relationship among and with leaders and colleagues, (c) the presence of discriminatory behaviours. Hence, on the basis of the results, mostly for a deeper analysis of work related stress assessment in a public administration, we suggest to consider these further risk factors.

Sample policies for your policy and procedure manual.

A policy and procedure manual is a tool to set guidelines and expectations based on the mission and vision of an office. If a manual is not available to set guidelines, the employees may make their own decisions to solve problems, which can often result in confusion, inconsistencies, and mistakes. A well-written policy manual will also benefit the staff by providing them with a quick resource for decision-making. This will increase the quality of service by reducing the risk of potential mistakes that can be made in a busy practice.

Understanding claims-based quality profiles in primary care practice: the role of office system tools and health information technology.

BACKGROUND: Claims-based quality profiles are increasingly used by third-party payers as a means of monitoring and remunerating physician performance. As traditional approaches to assessing performance yield to electronically generated data, identifying practice tools capable of influencing the behavior of these measures becomes essential to effectively managing medical practices. PURPOSE: The aim of this study was to examine the effect of using office system tools (i.e., patient registries, physician reminders, and flow sheets) and health information technology (HIT) on claims-based quality profile scores in primary care practices. METHODOLOGY: We analyzed survey responses from primary care physicians (n = 191) regarding their use of office system tools and HIT. These responses were linked to quality profile scores obtained from a Blue Cross Blue Shield of Texas claims-based data set. FINDINGS: Elevated quality profile scores were associated with physicians who reported higher use of HIT. In addition, the influence of one office system tool, physician reminders, was contingent upon the availability and use of HIT. PRACTICE IMPLICATIONS: Our findings indicate that primary care practices that fail to implement or use HIT appropriately will fare poorly in systems that monitor and reward performance based on measures derived from claims data. Linking prompts or reminders directly to clinical actions that influence quality indicators endorsed by payers should be a component of quality assurance programs.

A comparison of occupational and nonoccupational noise exposures in Sweden.

This study was conducted to evaluate noise exposures and the contributions of occupational and nonoccupational activities among three groups of Swedish workers (office workers, day care workers, and military flight technicians), and to evaluate risk factors for elevated hearing threshold levels. Forty-five subjects were recruited across the three groups. Each subject completed a risk factor questionnaire along with Békésy audiometry at frequencies between 125 and 8000 Hz. Subjects also wore a noise dosimeter continuously for 1 week, and documented their occupational and nonoccupational activities using a time-activity log. Subjects in all groups completed >7400 h of dosimetry, and had weekly exposures between 76 and 81 dBA. Day care workers had the highest daily exposures, and flight technicians had the highest weekly exposures. Most daily and weekly exposures exceeded the 70 dBA exposure limit recommended for prevention of any hearing loss. Subjects' perceptions of their exposures generally agreed well with measured noise levels. Among office workers, exposures were predominately nonoccupational, while among flight technicians nonoccupational and occupational activities contributed roughly equally, and among day care workers occupational exposures were dominant. Extreme exposures and cumulative noise exposure were associated with an increased risk of hearing threshold levels >10 dB hearing level. Effective hearing loss prevention programs may be needed in occupations not historically considered to be at high risk of noise-induced hearing loss (e.g., day care workers). Prevention efforts need to address nonoccupational exposures as well as occupational exposures, as nonoccupational activities may present the dominant risk of noise-induced hearing loss for some workers.

Lessons learned from the restaurant industry: what outstanding waiters and waitresses can teach the medical profession.

All doctors and office staff go to restaurants and have men and women take our orders and deliver our food. These waiters and waitresses earn minimum wage and depend on tips for their income. Some of the best waiters and waitresses earn substantial incomes. This article will discuss the techniques used by stellar waiters and waitresses to generate more tips and how these techniques might apply to the healthcare profession.

Front-office staff can improve clinical tobacco intervention: health coordinator pilot project.

OBJECTIVE: To learn whether front-line personnel in primary care practices can increase delivery of clinical tobacco interventions and also help smokers address physical inactivity, at-risk alcohol use, and depression. DESIGN: Uncontrolled before-and-after design. SETTING: Vancouver, BC, area (4 practices); northern British Columbia (2 practices). PARTICIPANTS: Six practices, with 1 staff person per practice serving as a "health coordinator" who tracked and, after the baseline period, delivered preventive interventions to all patients who smoked. To assess delivery of preventive interventions, each practice was to sample 300 consecutive patient records, both at baseline and at follow-up 15 months later. INTERVENTIONS: Front-office staff were recruited, trained, paid, and given ongoing support to provide preventive care. Clinicians supplemented this care with advice and guided the use of medication. MAIN OUTCOME MEASURES: Effectiveness of the intervention was based on comparison, at baseline and at follow-up, of the proportion of patients with any of the following 6 proven intervention components documented in their medical records: chart reminder, advice received, self-management plan, target quit date, referral, and follow-up date (as they applied to tobacco, physical inactivity, at-risk alcohol use, and depression). A Tobacco Intervention Flow Sheet cued preventive care, and its data were entered into a spreadsheet (which served as a smokers' registry). Qualitative appraisal data were noted. RESULTS: For tobacco, substantial increases occurred after the intervention period in the proportion of patients with each of the intervention components noted in their charts: chart reminder (20% vs 94%); provision of advice (34% vs 79%); self-management plan (14% vs 57%); target quit date (5% vs 11%); referral (6% vs 11%); and follow-up date (7% vs 42%). Interventions for physical inactivity and depression showed some gains, but there were no gains for at-risk alcohol use. Front-line staff, patients, and clinicians were enthusiastic about the services offered. CONCLUSION: Selected front-office personnel can substantially increase the delivery of evidence-based clinical tobacco intervention and increase patient and staff satisfaction in doing so. How far these findings can be generalized and their population effects require further study.

[Regional classification of office specialists' partial labour market for use in vocational rehabilitation]. / Regionalklassifikation für den beruflichen Teilarbeitsmarkt der Bürofachkräfte zur Anwendung in der beruflichen Rehabilitation.

The core objective of all those involved in vocational rehabilitation is integration into the primary labour market. In order to achieve this effectively and efficiently the disparities of regional and occupational partial labour markets have to be transparent. On the example of vocational retraining centres for adults with disabilities (Berufsförderungswerke) and of office specialists' partial labour market this paper selects relevant labour market indicators, calculates an empirical regional classification using relative niveau data and describes implications. Data base are statistics of the Federal Employment Agency for office specialists (profession ID 781). Cluster analytic results are 6 stable and valid regional clusters.

Specific flexion-related low back pain and sitting: comparison of seated discomfort on two different chairs.

No study has examined the effectiveness of prescribing seating modifications according to the individual clinical presentation of people with low back pain (LBP). A dynamic, forward-inclined chair ('Back App') can reduce seated paraspinal muscle activation among pain-free participants. This study examined 21 participants whose LBP was specifically aggravated by prolonged sitting and was eased by standing. Low back discomfort (LBD) and overall body discomfort (OBD) were assessed every 15 min while participants sat for 1 h on both the dynamic, forward-inclined chair and a standard office chair. LBD increased significantly more (p = 0.005) on the standard office chair, with no significant difference (p = 0.178) in OBD between the chairs. The results demonstrate that, in a specific flexion-related subgroup of people with LBP, increased LBD during sitting can be minimised through modifying chair design. Mechanisms that minimise seated discomfort may be of relevance in LBP management, as part of a biopsychosocial management plan. PRACTITIONER SUMMARY: This study examined low back discomfort (LBD) during a typing task among people with low back pain (LBP). Sitting on a dynamic, forward-inclined chair resulted in less seated LBD than sitting on a standard office chair. Further research is required to examine the long-term effectiveness of ergonomics interventions in LBP.

Steve Jobs provides lessons for any medical practice.

Steve Jobs is inarguably the greatest inventor and creative genius since Thomas Edison. He provided technology that enhances communication on a global level. Jobs also provided ideas and suggestions that could work in any medical practice regardless of the size of the practice, the location of the practice, or the employment model. His advice can be transferred from a high-tech business that employs thousands to a high-touch medical practice that has only a few employees. This article will list a few of Jobs leadership characteristics and how they might apply to physicians, their teams, and their practices. Wouldn't you like to be the Steve Jobs of healthcare? If so, read on!