Reminder to self: Use more office reminders
Don’t let tests, procedures fall through the cracks
If you’re a pet owner, your veterinarian probably sends you a reminder card when it’s time for your pet’s shots and checkup. Don’t your patients deserve the same kind of reminders and follow-ups that your dog or cat receives?
"Patients greatly appreciate the fact that somebody cares enough to follow up and see if they have a test. It increases confidence and reduces liability. It’s a no-lose situation. It’s easy to set up. We have to wonder why we aren’t doing that," says William F. Jessee, MD, president and CEO of the Medical Group Management Association (MGMA) in Englewood, CO.
The MGMA conducted an informal poll of members last year, asking them to identify what they perceived to be the risks in an office-based practice. Of the 200 people who responded, 57% said that the greatest risk was lost diagnostic or lab testing.
"A lot of times, things fall through the cracks. We weren’t surprised that was perceived as a common risk, but we were surprised that it was the biggest risk," Jessee says.
Their perceptions are backed up by the MGMA’s Center for Research project to improve the effectiveness of early diagnosis and treatment of breast cancer in office-based practices. The study was originally funded by a grant from a Denver malpractice insurance carrier.
When researchers analyzed the last 10 years of claims, they found that delays in the diagnosis of breast cancer was the second biggest cause of liability claims, Jessee says.
"We have worked with oncologists to do a closed claim analysis to see if common system breakdowns lead to delay. It’s not a matter of a knowledge gap. We know that early diagnosis is important, and when that doesn’t happen, something broke," he says.
Researchers found that in the vast majority of cases, the system broke down. For instance, the patient may have been referred for a routine mammogram and there was no evidence that the patient had a mammogram or no evidence that the report came back to the doctor, or if it did come back, no evidence that it was reviewed.
"These kind of issues are fairly well solved by putting protocols in place," Jessee says.
As a result of their study on breast cancer, the MGMA’s Center for Research has developed a CD/ROM-based training program for office staff and protocol for management of women at risk and women with a self-diagnosed lump. The center is in the second phase of testing the protocol among patients in 30 medical groups in Colorado. "If it works, we plan to shift into high gear," Jessee says.
Follow up with patients
An integral part of every physician’s practice should be a plan to follow up when patients have a procedure, or when they should come in for routine tests, says Fay Rozovsky, JD, MPH, senior vice president of Marsh Inc., a Philadelphia firm specializing in insurance and risk advisory services, and practice leader for the company’s Pro-ject MindShare in Richmond, VA.
She advises practices to develop a tickler file to remind patients of routine tests such as mammograms. Practices should have a system in place to ensure that when a physician prescribes a laboratory test or procedure, these actions take place:
• The patient has it done.
• The physician sees the results.
• The information is noted in the chart.
"These [systems] enhance patient safety but they also enhance patient satisfaction," Jessee says.
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