Joseph S. Eastern, MD

 

By now, you are probably aware that the Centers for Medicare and Medicaid Services has begun the process of switching out old Medicare cards (and numbers) for new ones. The new, completely random number-letter combinations – dubbed Medicare Beneficiary Identifiers (MBI) – replace the old Social Security number–based Health Insurance Claim Numbers (HICN). The idea is to make citizens’ private information less vulnerable to identity thieves and other nefarious parties.

The switch began on April 1, and is expected to take about a year as the CMS processes about half a dozen states at a time. As I write this (at the beginning of May), the CMS is mailing out the first group of new cards to patients in Pennsylvania, Virginia, West Virginia, Maryland, Delaware, and the District of Columbia. But regardless of where you practice, you can expect to start seeing MBIs in your office soon – if you haven’t already – because people enrolling in Medicare for the first time are also receiving the new cards, no matter where they live.

Unlike the abrupt switch in 2015 from ICD-9 coding to ICD-10, this changeover has a transition period: Both HICNs and MBIs can be used on all billing and Medicare transactions from now until the end of 2019; after that, only claims with MBIs will be accepted. The last day of 2019 may sound like a long way off, but the time to get up to speed on everything MBI is now. That way, you can begin processing MBIs as soon as you start receiving them, and you will have time to solve any processing glitches well before the deadline.

First, you’ll need to make sure that your electronic health records and claims processing software will accept the new format, and that your electronic clearinghouse, if you use one, is geared up to accept and transmit the data on the new cards. Not all of them are. Some have been seduced by the year-and-a-half buffer – during which time HICNs can still be used – into dragging their feet on the MBI issue. Now is the time to find out if a vendor’s software is hard-wired to accept a maximum of 10 digits (MBIs have 11), not when your claims start bouncing.

Second, you will need to educate your front desk staff, so they will be able to recognize the new cards at a glance. Unfortunately, it looks a lot like the current card, though it is slightly smaller. It has the traditional red and blue colors with black printing, but there is no birthday or gender designation – again, in the interest of protecting patients’ identities. Knowing the difference will become particularly important after your state has been processed, when all of your Medicare patients should have the new card. Those who don’t will need to be identified and urged to get one before the December 2019 deadline.

Centers for Medicare & Medicaid Services

Finally, once your staff and vendors are up to speed, you can begin educating your patients. Inevitably, some will not receive a new card, especially if they have moved and have not notified the CMS of the change; and some who are not expecting a new card will believe it is a duplicate, and throw it away. The CMS will be airing public service announcements and mailing education pieces to Medicare recipients, but a substantial portion of the education burden will fall on doctors and hospitals.

Have your front office staff remind patients to be sure their addresses are updated online with Medicare (www.Medicare.gov) or the Social Security Administration (www.ssa.gov). Encourage them to take advantage of the free resources available at www.cms.gov. These include both downloadable options and printed materials that illustrate what the new card will look like, explain how to update a mailing address with the Social Security Administration, and remind seniors to keep an eye out for their cards in the mail.

 

For the many Medicare-age patients who are not particularly computer savvy, the CMS has free resources for physicians as well. You will need to open an account at the agency’s Product Ordering website (productordering.cms.hhs.gov), which in turn needs to be approved by an administrator. The posters and other free literature can be displayed in your waiting room, exam rooms, and other “patient flow” areas. There is also a 1-minute video, downloadable from YouTube (https://youtu.be/DusRmgzQnLY), which can be looped in your waiting area.

When patients do bring in their new cards, remind them to destroy their old ones, and caution them to beware of unsolicited contacts from anyone who asks about their new card, demands their new number or other personal information, or insists that they must pay a fee before their new card can be used.
 

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

 

By now, you are probably aware that the Centers for Medicare and Medicaid Services has begun the process of switching out old Medicare cards (and numbers) for new ones. The new, completely random number-letter combinations – dubbed Medicare Beneficiary Identifiers (MBI) – replace the old Social Security number–based Health Insurance Claim Numbers (HICN). The idea is to make citizens’ private information less vulnerable to identity thieves and other nefarious parties.

The switch began on April 1, and is expected to take about a year as the CMS processes about half a dozen states at a time. As I write this (at the beginning of May), the CMS is mailing out the first group of new cards to patients in Pennsylvania, Virginia, West Virginia, Maryland, Delaware, and the District of Columbia. But regardless of where you practice, you can expect to start seeing MBIs in your office soon – if you haven’t already – because people enrolling in Medicare for the first time are also receiving the new cards, no matter where they live.

Unlike the abrupt switch in 2015 from ICD-9 coding to ICD-10, this changeover has a transition period: Both HICNs and MBIs can be used on all billing and Medicare transactions from now until the end of 2019; after that, only claims with MBIs will be accepted. The last day of 2019 may sound like a long way off, but the time to get up to speed on everything MBI is now. That way, you can begin processing MBIs as soon as you start receiving them, and you will have time to solve any processing glitches well before the deadline.

First, you’ll need to make sure that your electronic health records and claims processing software will accept the new format, and that your electronic clearinghouse, if you use one, is geared up to accept and transmit the data on the new cards. Not all of them are. Some have been seduced by the year-and-a-half buffer – during which time HICNs can still be used – into dragging their feet on the MBI issue. Now is the time to find out if a vendor’s software is hard-wired to accept a maximum of 10 digits (MBIs have 11), not when your claims start bouncing.

Second, you will need to educate your front desk staff, so they will be able to recognize the new cards at a glance. Unfortunately, it looks a lot like the current card, though it is slightly smaller. It has the traditional red and blue colors with black printing, but there is no birthday or gender designation – again, in the interest of protecting patients’ identities. Knowing the difference will become particularly important after your state has been processed, when all of your Medicare patients should have the new card. Those who don’t will need to be identified and urged to get one before the December 2019 deadline.

Centers for Medicare & Medicaid Services

Finally, once your staff and vendors are up to speed, you can begin educating your patients. Inevitably, some will not receive a new card, especially if they have moved and have not notified the CMS of the change; and some who are not expecting a new card will believe it is a duplicate, and throw it away. The CMS will be airing public service announcements and mailing education pieces to Medicare recipients, but a substantial portion of the education burden will fall on doctors and hospitals.

Have your front office staff remind patients to be sure their addresses are updated online with Medicare (www.Medicare.gov) or the Social Security Administration (www.ssa.gov). Encourage them to take advantage of the free resources available at www.cms.gov. These include both downloadable options and printed materials that illustrate what the new card will look like, explain how to update a mailing address with the Social Security Administration, and remind seniors to keep an eye out for their cards in the mail.

 

For the many Medicare-age patients who are not particularly computer savvy, the CMS has free resources for physicians as well. You will need to open an account at the agency’s Product Ordering website (productordering.cms.hhs.gov), which in turn needs to be approved by an administrator. The posters and other free literature can be displayed in your waiting room, exam rooms, and other “patient flow” areas. There is also a 1-minute video, downloadable from YouTube (https://youtu.be/DusRmgzQnLY), which can be looped in your waiting area.

When patients do bring in their new cards, remind them to destroy their old ones, and caution them to beware of unsolicited contacts from anyone who asks about their new card, demands their new number or other personal information, or insists that they must pay a fee before their new card can be used.
 

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

 

By now, you are probably aware that the Centers for Medicare and Medicaid Services has begun the process of switching out old Medicare cards (and numbers) for new ones. The new, completely random number-letter combinations – dubbed Medicare Beneficiary Identifiers (MBI) – replace the old Social Security number–based Health Insurance Claim Numbers (HICN). The idea is to make citizens’ private information less vulnerable to identity thieves and other nefarious parties.

The switch began on April 1, and is expected to take about a year as the CMS processes about half a dozen states at a time. As I write this (at the beginning of May), the CMS is mailing out the first group of new cards to patients in Pennsylvania, Virginia, West Virginia, Maryland, Delaware, and the District of Columbia. But regardless of where you practice, you can expect to start seeing MBIs in your office soon – if you haven’t already – because people enrolling in Medicare for the first time are also receiving the new cards, no matter where they live.

Unlike the abrupt switch in 2015 from ICD-9 coding to ICD-10, this changeover has a transition period: Both HICNs and MBIs can be used on all billing and Medicare transactions from now until the end of 2019; after that, only claims with MBIs will be accepted. The last day of 2019 may sound like a long way off, but the time to get up to speed on everything MBI is now. That way, you can begin processing MBIs as soon as you start receiving them, and you will have time to solve any processing glitches well before the deadline.

First, you’ll need to make sure that your electronic health records and claims processing software will accept the new format, and that your electronic clearinghouse, if you use one, is geared up to accept and transmit the data on the new cards. Not all of them are. Some have been seduced by the year-and-a-half buffer – during which time HICNs can still be used – into dragging their feet on the MBI issue. Now is the time to find out if a vendor’s software is hard-wired to accept a maximum of 10 digits (MBIs have 11), not when your claims start bouncing.

Second, you will need to educate your front desk staff, so they will be able to recognize the new cards at a glance. Unfortunately, it looks a lot like the current card, though it is slightly smaller. It has the traditional red and blue colors with black printing, but there is no birthday or gender designation – again, in the interest of protecting patients’ identities. Knowing the difference will become particularly important after your state has been processed, when all of your Medicare patients should have the new card. Those who don’t will need to be identified and urged to get one before the December 2019 deadline.

Centers for Medicare & Medicaid Services

Finally, once your staff and vendors are up to speed, you can begin educating your patients. Inevitably, some will not receive a new card, especially if they have moved and have not notified the CMS of the change; and some who are not expecting a new card will believe it is a duplicate, and throw it away. The CMS will be airing public service announcements and mailing education pieces to Medicare recipients, but a substantial portion of the education burden will fall on doctors and hospitals.

Have your front office staff remind patients to be sure their addresses are updated online with Medicare (www.Medicare.gov) or the Social Security Administration (www.ssa.gov). Encourage them to take advantage of the free resources available at www.cms.gov. These include both downloadable options and printed materials that illustrate what the new card will look like, explain how to update a mailing address with the Social Security Administration, and remind seniors to keep an eye out for their cards in the mail.

 

For the many Medicare-age patients who are not particularly computer savvy, the CMS has free resources for physicians as well. You will need to open an account at the agency’s Product Ordering website (productordering.cms.hhs.gov), which in turn needs to be approved by an administrator. The posters and other free literature can be displayed in your waiting room, exam rooms, and other “patient flow” areas. There is also a 1-minute video, downloadable from YouTube (https://youtu.be/DusRmgzQnLY), which can be looped in your waiting area.

When patients do bring in their new cards, remind them to destroy their old ones, and caution them to beware of unsolicited contacts from anyone who asks about their new card, demands their new number or other personal information, or insists that they must pay a fee before their new card can be used.
 

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

 

Unless you’ve been hibernating for the past decade, you know how important websites have become to the continued success of private practices. Nowadays, almost half of all Americans (and nearly all millennials) seek out doctors online. But your practice website should be doing a lot more than simply describing your practice. How many visitors to your site actually schedule an appointment? With a few relatively simple but important modifications, you can convert casual website viewers to patients.

Start with a good title, one that not only describes your practice but also anticipates how prospective patients will search for you – usually by specialty plus geographic location. My site’s title, for example, is “Belleville Dermatology Center,” so when someone searches for a dermatologist near Belleville, N.J., my site will invariably rank near the top of their search results.
 

Follow with an understandable URL. Search engines use URLs to determine how well your site, or a portion of it, matches search criteria. URLs also need to make sense to searchers, especially when they link specific areas of expertise (more on that in a minute). For example, a URL like “bellevilledermatology[dot]com/?p=89021” is meaningless to anyone except programmers; but “bellevilledermatology[dot]com/psoriasistreatments” obviously leads to a page about psoriasis treatments. Search engines look for not only the most relevant, but also the most helpful and user-friendly, answers to a user’s query.
Incidentally, if the URL for your site is not your own name, you should register your name as a separate domain name – even if you never use it – to be sure that a trickster or troll, or someone with the same name but a bad reputation, doesn’t get it.

Georgijevic/E+/Getty Images

Continue with a good meta description. That’s the grayish text that follows the title and URL in search results. Searchers will read it to confirm that your site is what they seek, so make sure it describes exactly what you do, including any areas of special expertise. Aggressive marketers will sometimes pad their descriptions with a wide variety of other specialties, services, and locations, hoping to gain inclusion in a larger pool of search results. That tactic – “keyword stuffing” in IT parlance – is not only ineffective, but search engines tend to ignore sites that use it. An accurate, honest description works best.

 

Describe your principal services in detail. You never know which specific service a prospective patient is searching for, so describe everything you offer. Don’t try to summarize everything on a single page; relevance is determined by how deeply a topic is covered, so each principal service should have a detailed description on its own page. Not only will your skills become more visible to search engines, but you can also use the space to enumerate your qualifications and expertise in each area. Whenever possible, write your descriptions in question-and-answer form. Searchers tend to ask questions (“what is the best…?”), particularly in voice searches. Search engines increasingly value sites that ask and answer common questions.

How does your site look on small screens? More than half of all searches are now made on smartphones, so the more “mobile friendly” your site is, the higher it will be ranked. Besides, prospective patients who are forced to scroll forever, or zoom in to tap a link, are likely to become frustrated and move on. Mobile searchers prefer sites that provide the best experience for the least amount of effort, and rankings tend to reflect that preference.

 

Include photos. Especially yours; new patients are more comfortable when they know what you look like. Although some disagree, I feel family photos are also important; they help to present you as a person, as well as a doctor. Photos of your office – professional ones, not casual snapshots – will reassure prospective patients that they will be visiting a clean, modern, professional facility.

Testimonials are essential. Amazon[dot]com taught us that candid reviews from customers go a long way toward building the trust necessary to buy products and services, and nowhere is that more true than for doctors. According to one study, when it comes to finding a doctor, 88% of people trust online reviews as much as a personal recommendation. Loyal patients will be happy to write you glowing reviews; feature them prominently.

Provide online appointment scheduling. Once searchers make an appointment, they stop searching. If they have to wait until the next day to call your office, they may keep looking – and might find a competitor with online scheduling. You should also have a separate “contact” page, listing all of the ways people can reach you, along with a map. Finally, list which insurance plans you accept as a courtesy to patients and to decrease unnecessary calls for your staff.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

 

Unless you’ve been hibernating for the past decade, you know how important websites have become to the continued success of private practices. Nowadays, almost half of all Americans (and nearly all millennials) seek out doctors online. But your practice website should be doing a lot more than simply describing your practice. How many visitors to your site actually schedule an appointment? With a few relatively simple but important modifications, you can convert casual website viewers to patients.

Start with a good title, one that not only describes your practice but also anticipates how prospective patients will search for you – usually by specialty plus geographic location. My site’s title, for example, is “Belleville Dermatology Center,” so when someone searches for a dermatologist near Belleville, N.J., my site will invariably rank near the top of their search results.
 

Follow with an understandable URL. Search engines use URLs to determine how well your site, or a portion of it, matches search criteria. URLs also need to make sense to searchers, especially when they link specific areas of expertise (more on that in a minute). For example, a URL like “bellevilledermatology[dot]com/?p=89021” is meaningless to anyone except programmers; but “bellevilledermatology[dot]com/psoriasistreatments” obviously leads to a page about psoriasis treatments. Search engines look for not only the most relevant, but also the most helpful and user-friendly, answers to a user’s query.
Incidentally, if the URL for your site is not your own name, you should register your name as a separate domain name – even if you never use it – to be sure that a trickster or troll, or someone with the same name but a bad reputation, doesn’t get it.

Georgijevic/E+/Getty Images

Continue with a good meta description. That’s the grayish text that follows the title and URL in search results. Searchers will read it to confirm that your site is what they seek, so make sure it describes exactly what you do, including any areas of special expertise. Aggressive marketers will sometimes pad their descriptions with a wide variety of other specialties, services, and locations, hoping to gain inclusion in a larger pool of search results. That tactic – “keyword stuffing” in IT parlance – is not only ineffective, but search engines tend to ignore sites that use it. An accurate, honest description works best.

 

Describe your principal services in detail. You never know which specific service a prospective patient is searching for, so describe everything you offer. Don’t try to summarize everything on a single page; relevance is determined by how deeply a topic is covered, so each principal service should have a detailed description on its own page. Not only will your skills become more visible to search engines, but you can also use the space to enumerate your qualifications and expertise in each area. Whenever possible, write your descriptions in question-and-answer form. Searchers tend to ask questions (“what is the best…?”), particularly in voice searches. Search engines increasingly value sites that ask and answer common questions.

How does your site look on small screens? More than half of all searches are now made on smartphones, so the more “mobile friendly” your site is, the higher it will be ranked. Besides, prospective patients who are forced to scroll forever, or zoom in to tap a link, are likely to become frustrated and move on. Mobile searchers prefer sites that provide the best experience for the least amount of effort, and rankings tend to reflect that preference.

 

Include photos. Especially yours; new patients are more comfortable when they know what you look like. Although some disagree, I feel family photos are also important; they help to present you as a person, as well as a doctor. Photos of your office – professional ones, not casual snapshots – will reassure prospective patients that they will be visiting a clean, modern, professional facility.

Testimonials are essential. Amazon[dot]com taught us that candid reviews from customers go a long way toward building the trust necessary to buy products and services, and nowhere is that more true than for doctors. According to one study, when it comes to finding a doctor, 88% of people trust online reviews as much as a personal recommendation. Loyal patients will be happy to write you glowing reviews; feature them prominently.

Provide online appointment scheduling. Once searchers make an appointment, they stop searching. If they have to wait until the next day to call your office, they may keep looking – and might find a competitor with online scheduling. You should also have a separate “contact” page, listing all of the ways people can reach you, along with a map. Finally, list which insurance plans you accept as a courtesy to patients and to decrease unnecessary calls for your staff.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

 

Unless you’ve been hibernating for the past decade, you know how important websites have become to the continued success of private practices. Nowadays, almost half of all Americans (and nearly all millennials) seek out doctors online. But your practice website should be doing a lot more than simply describing your practice. How many visitors to your site actually schedule an appointment? With a few relatively simple but important modifications, you can convert casual website viewers to patients.

Start with a good title, one that not only describes your practice but also anticipates how prospective patients will search for you – usually by specialty plus geographic location. My site’s title, for example, is “Belleville Dermatology Center,” so when someone searches for a dermatologist near Belleville, N.J., my site will invariably rank near the top of their search results.
 

Follow with an understandable URL. Search engines use URLs to determine how well your site, or a portion of it, matches search criteria. URLs also need to make sense to searchers, especially when they link specific areas of expertise (more on that in a minute). For example, a URL like “bellevilledermatology[dot]com/?p=89021” is meaningless to anyone except programmers; but “bellevilledermatology[dot]com/psoriasistreatments” obviously leads to a page about psoriasis treatments. Search engines look for not only the most relevant, but also the most helpful and user-friendly, answers to a user’s query.
Incidentally, if the URL for your site is not your own name, you should register your name as a separate domain name – even if you never use it – to be sure that a trickster or troll, or someone with the same name but a bad reputation, doesn’t get it.

Georgijevic/E+/Getty Images

Continue with a good meta description. That’s the grayish text that follows the title and URL in search results. Searchers will read it to confirm that your site is what they seek, so make sure it describes exactly what you do, including any areas of special expertise. Aggressive marketers will sometimes pad their descriptions with a wide variety of other specialties, services, and locations, hoping to gain inclusion in a larger pool of search results. That tactic – “keyword stuffing” in IT parlance – is not only ineffective, but search engines tend to ignore sites that use it. An accurate, honest description works best.

 

Describe your principal services in detail. You never know which specific service a prospective patient is searching for, so describe everything you offer. Don’t try to summarize everything on a single page; relevance is determined by how deeply a topic is covered, so each principal service should have a detailed description on its own page. Not only will your skills become more visible to search engines, but you can also use the space to enumerate your qualifications and expertise in each area. Whenever possible, write your descriptions in question-and-answer form. Searchers tend to ask questions (“what is the best…?”), particularly in voice searches. Search engines increasingly value sites that ask and answer common questions.

How does your site look on small screens? More than half of all searches are now made on smartphones, so the more “mobile friendly” your site is, the higher it will be ranked. Besides, prospective patients who are forced to scroll forever, or zoom in to tap a link, are likely to become frustrated and move on. Mobile searchers prefer sites that provide the best experience for the least amount of effort, and rankings tend to reflect that preference.

 

Include photos. Especially yours; new patients are more comfortable when they know what you look like. Although some disagree, I feel family photos are also important; they help to present you as a person, as well as a doctor. Photos of your office – professional ones, not casual snapshots – will reassure prospective patients that they will be visiting a clean, modern, professional facility.

Testimonials are essential. Amazon[dot]com taught us that candid reviews from customers go a long way toward building the trust necessary to buy products and services, and nowhere is that more true than for doctors. According to one study, when it comes to finding a doctor, 88% of people trust online reviews as much as a personal recommendation. Loyal patients will be happy to write you glowing reviews; feature them prominently.

Provide online appointment scheduling. Once searchers make an appointment, they stop searching. If they have to wait until the next day to call your office, they may keep looking – and might find a competitor with online scheduling. You should also have a separate “contact” page, listing all of the ways people can reach you, along with a map. Finally, list which insurance plans you accept as a courtesy to patients and to decrease unnecessary calls for your staff.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

 

As I stepped from an exam room one recent busy morning, my office manager pulled me aside. “Someone from the county courthouse is on the phone and needs to talk to you,” she whispered.

“You know better than that,” I said. “While I’m seeing patients, I don’t take calls from anyone except colleagues and immediate family.”

artisteer/Thinkstock

“He says he has a warrant for your arrest.”

I took the call.

“You failed to appear for jury duty,” the official-sounding voice said. “That’s a violation of state law, as you were warned when you received your summons. You’ll have to come down here and surrender yourself immediately, or else we’ll have to send deputies to your office. I don’t think you’ll want to be led through your waiting room in handcuffs.”

“Wait a minute,” I replied nervously. “I haven’t received a jury summons for 2 years, at least. There must be some mistake.”

“Perhaps we’ve confused you with a citizen with the same or a similar name,” he said. “Let me have your Social Security number and birth date.”

Alarm bells! “You should have that information already,” I replied. “Why don’t you read me what you have?”

A short silence, and then … click.

I immediately called the courthouse. “Citizens who fail to appear receive a warning letter and a new questionnaire, not a phone call,” said the jury manager. “And we use driver license numbers to keep track of jurors.”

The phone company traced the call, which dead-ended at a VoIP circuit, to no one’s surprise. The downside of VoIP (Voice over Internet Protocol) and similar technologies is that unscrupulous individuals can use them to appear to be calling you from a legitimate business when they are not.

Like most other supposedly affluent professionals, doctors have always been popular targets for scam artists and con men. Those of us of a certain age remember phony office calls offering great deals on supplies or waiting room magazine subscriptions. Those capers eventually disappeared; but scam artists are endlessly creative. This is especially true since the Internet took over, well, everything. There’s a real dark side to the information age.

The jury duty scheme, I learned, is an increasingly popular one. Others involve calls or e-mails from the “fraud department” of your bank, claiming to be investigating a breach of your account, or one of your credit or debit cards. Another purports to be a “Customs official” informing you that you owe a big duty payment on an overseas shipment. Victims of power outages due to natural disasters are hearing from crooks claiming to be from the local power company; the power won’t be restored, they say, without an advance payment.

 

In most cases, the common denominator – and the biggest red flag – is a request for a social security number, a birth date, a credit card number, or other private information that could be used to steal your identity or empty your accounts.

You may think you would never be fooled by any of these schemes, but trust me: These guys are good. They sound very authentic – particularly when they surprise you in the midst of your office hours.

Here’s a summary of what my recent experience taught (or reminded) me:

• Never give out a bank account, social security, or credit card number online or over the telephone if you didn’t initiate the contact, no matter how legitimate the caller sounds. This is true of anyone claiming to be from a bank, a service company, or a government office, as well as anyone trying to sell you anything.
• No federal or state court will call to say you’ve missed jury duty – or that they are assembling jury pools and need to “prescreen” those who might be selected to serve on them. The jury manager I spoke with said she knew of no reason why anyone in my state would ever be called about jury service before mailing back a completed questionnaire, and even then, such a call would be extraordinary.
• Never send anyone a “commission” or “finder’s fee” as a condition of receiving funds. In legitimate transactions, such fees are merely deducted from the money being paid out.
• Examine your credit card and bank account statements each month. Immediately challenge any charges you don’t recognize.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

 

As I stepped from an exam room one recent busy morning, my office manager pulled me aside. “Someone from the county courthouse is on the phone and needs to talk to you,” she whispered.

“You know better than that,” I said. “While I’m seeing patients, I don’t take calls from anyone except colleagues and immediate family.”

artisteer/Thinkstock

“He says he has a warrant for your arrest.”

I took the call.

“You failed to appear for jury duty,” the official-sounding voice said. “That’s a violation of state law, as you were warned when you received your summons. You’ll have to come down here and surrender yourself immediately, or else we’ll have to send deputies to your office. I don’t think you’ll want to be led through your waiting room in handcuffs.”

“Wait a minute,” I replied nervously. “I haven’t received a jury summons for 2 years, at least. There must be some mistake.”

“Perhaps we’ve confused you with a citizen with the same or a similar name,” he said. “Let me have your Social Security number and birth date.”

Alarm bells! “You should have that information already,” I replied. “Why don’t you read me what you have?”

A short silence, and then … click.

I immediately called the courthouse. “Citizens who fail to appear receive a warning letter and a new questionnaire, not a phone call,” said the jury manager. “And we use driver license numbers to keep track of jurors.”

The phone company traced the call, which dead-ended at a VoIP circuit, to no one’s surprise. The downside of VoIP (Voice over Internet Protocol) and similar technologies is that unscrupulous individuals can use them to appear to be calling you from a legitimate business when they are not.

Like most other supposedly affluent professionals, doctors have always been popular targets for scam artists and con men. Those of us of a certain age remember phony office calls offering great deals on supplies or waiting room magazine subscriptions. Those capers eventually disappeared; but scam artists are endlessly creative. This is especially true since the Internet took over, well, everything. There’s a real dark side to the information age.

The jury duty scheme, I learned, is an increasingly popular one. Others involve calls or e-mails from the “fraud department” of your bank, claiming to be investigating a breach of your account, or one of your credit or debit cards. Another purports to be a “Customs official” informing you that you owe a big duty payment on an overseas shipment. Victims of power outages due to natural disasters are hearing from crooks claiming to be from the local power company; the power won’t be restored, they say, without an advance payment.

 

In most cases, the common denominator – and the biggest red flag – is a request for a social security number, a birth date, a credit card number, or other private information that could be used to steal your identity or empty your accounts.

You may think you would never be fooled by any of these schemes, but trust me: These guys are good. They sound very authentic – particularly when they surprise you in the midst of your office hours.

Here’s a summary of what my recent experience taught (or reminded) me:

• Never give out a bank account, social security, or credit card number online or over the telephone if you didn’t initiate the contact, no matter how legitimate the caller sounds. This is true of anyone claiming to be from a bank, a service company, or a government office, as well as anyone trying to sell you anything.
• No federal or state court will call to say you’ve missed jury duty – or that they are assembling jury pools and need to “prescreen” those who might be selected to serve on them. The jury manager I spoke with said she knew of no reason why anyone in my state would ever be called about jury service before mailing back a completed questionnaire, and even then, such a call would be extraordinary.
• Never send anyone a “commission” or “finder’s fee” as a condition of receiving funds. In legitimate transactions, such fees are merely deducted from the money being paid out.
• Examine your credit card and bank account statements each month. Immediately challenge any charges you don’t recognize.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

 

As I stepped from an exam room one recent busy morning, my office manager pulled me aside. “Someone from the county courthouse is on the phone and needs to talk to you,” she whispered.

“You know better than that,” I said. “While I’m seeing patients, I don’t take calls from anyone except colleagues and immediate family.”

artisteer/Thinkstock

“He says he has a warrant for your arrest.”

I took the call.

“You failed to appear for jury duty,” the official-sounding voice said. “That’s a violation of state law, as you were warned when you received your summons. You’ll have to come down here and surrender yourself immediately, or else we’ll have to send deputies to your office. I don’t think you’ll want to be led through your waiting room in handcuffs.”

“Wait a minute,” I replied nervously. “I haven’t received a jury summons for 2 years, at least. There must be some mistake.”

“Perhaps we’ve confused you with a citizen with the same or a similar name,” he said. “Let me have your Social Security number and birth date.”

Alarm bells! “You should have that information already,” I replied. “Why don’t you read me what you have?”

A short silence, and then … click.

I immediately called the courthouse. “Citizens who fail to appear receive a warning letter and a new questionnaire, not a phone call,” said the jury manager. “And we use driver license numbers to keep track of jurors.”

The phone company traced the call, which dead-ended at a VoIP circuit, to no one’s surprise. The downside of VoIP (Voice over Internet Protocol) and similar technologies is that unscrupulous individuals can use them to appear to be calling you from a legitimate business when they are not.

Like most other supposedly affluent professionals, doctors have always been popular targets for scam artists and con men. Those of us of a certain age remember phony office calls offering great deals on supplies or waiting room magazine subscriptions. Those capers eventually disappeared; but scam artists are endlessly creative. This is especially true since the Internet took over, well, everything. There’s a real dark side to the information age.

The jury duty scheme, I learned, is an increasingly popular one. Others involve calls or e-mails from the “fraud department” of your bank, claiming to be investigating a breach of your account, or one of your credit or debit cards. Another purports to be a “Customs official” informing you that you owe a big duty payment on an overseas shipment. Victims of power outages due to natural disasters are hearing from crooks claiming to be from the local power company; the power won’t be restored, they say, without an advance payment.

 

In most cases, the common denominator – and the biggest red flag – is a request for a social security number, a birth date, a credit card number, or other private information that could be used to steal your identity or empty your accounts.

You may think you would never be fooled by any of these schemes, but trust me: These guys are good. They sound very authentic – particularly when they surprise you in the midst of your office hours.

Here’s a summary of what my recent experience taught (or reminded) me:

• Never give out a bank account, social security, or credit card number online or over the telephone if you didn’t initiate the contact, no matter how legitimate the caller sounds. This is true of anyone claiming to be from a bank, a service company, or a government office, as well as anyone trying to sell you anything.
• No federal or state court will call to say you’ve missed jury duty – or that they are assembling jury pools and need to “prescreen” those who might be selected to serve on them. The jury manager I spoke with said she knew of no reason why anyone in my state would ever be called about jury service before mailing back a completed questionnaire, and even then, such a call would be extraordinary.
• Never send anyone a “commission” or “finder’s fee” as a condition of receiving funds. In legitimate transactions, such fees are merely deducted from the money being paid out.
• Examine your credit card and bank account statements each month. Immediately challenge any charges you don’t recognize.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

 

Few movies have universal appeal these days, but one that comes close is Bill Murray’s 1993 classic, “Groundhog Day,” in which Murray’s character is trapped in a time loop, living the same day over and over until he finally “gets it right.”

One reason that this film resonates with so many, I think, is that we are all, in essence, similarly trapped. Not in a same-day loop, of course; but each week seems eerily similar to the last, as does each month, each year – on and on, ad infinitum. That’s why it is so important, every so often, to step out of the “loop” and reassess the bigger picture.

I write this reminder every couple of years because it’s so easy to lose sight of the overall landscape among the pressures of our daily routines. Sooner or later, no matter how dedicated we are, the grind gets to all of us, leading to fatigue, irritability, and a progressive decline in motivation. And we are too busy to sit down and think about what we might do to break that vicious cycle. This is detrimental to our own well-being, as well as that of our patients.

There are many ways to maintain your intellectual and emotional health, but here’s how I do it: I take individual days off (average of 1 a month) to catch up on journals or taking a CME course; or to try something new – something I’ve been thinking about doing “someday, when there is time” – such as a guitar, bass, or sailing lesson, or a long weekend away with my wife. And we take longer vacations, without fail, each year.

I know how some of you feel about “wasting” a day – or, God forbid, a week. Patients might go elsewhere while you’re gone, and every day the office is idle you “lose money.” That whole paradigm is wrong. You bring in a given amount of revenue per year – more on some days, less on other days, none on weekends and vacations. It all averages out in the end.

Besides, this is much more important than money: This is breaking the routine, clearing the cobwebs, living your life. And trust me, your practice will still be there when you return.

Dr. Joseph S. Eastern

Recently, my wife and I packed our carry-ons and left for a 2-week trip to Antarctica. As we crossed the Drake Passage, and then explored the Antarctic Peninsula’s spectacular glaciers, icebergs, and vast penguin colonies, I didn’t have the time – or the slightest inclination – to worry about the office. But I did accumulate some great ideas – practical, medical, and literary. Original thoughts are hard to chase down during the daily grind, but in a refreshing environment, they will seek you out. When our trip was over, I returned ready to take on the world, and my practice, anew.

More than once I’ve recounted the story of K. Alexander Müller, PhD, and J. Georg Bednorz, PhD, the Swiss Nobel laureates whose superconductivity research ground to a halt in 1986. The harder they pressed, the more elusive progress became. So Dr. Müller decided to take a break to read a new book on ceramics – a subject that had always interested him.

Nothing could have been less relevant to his work, of course; ceramics are among the poorest conductors known. But in that lower-pressure environment, Dr. Müller realized that a unique property of ceramics might apply to their project.

Back in the lab, the team created a ceramic compound that became the first successful “high-temperature” superconductor, which in turn triggered an explosion of research leading to breakthroughs in computing, electricity transmission, magnetically-elevated trains, and many applications yet to be realized.

Sharpening your saw may not change the world, but it will change you. Any nudge out of your comfort zone will give you fresh ideas and help you look at seemingly insoluble problems in completely new ways.

And to those who still can’t bear the thought of taking time off, remember the dying words that no one has spoken, ever: “I wish I had spent more time in my office!”


 

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

 

Few movies have universal appeal these days, but one that comes close is Bill Murray’s 1993 classic, “Groundhog Day,” in which Murray’s character is trapped in a time loop, living the same day over and over until he finally “gets it right.”

One reason that this film resonates with so many, I think, is that we are all, in essence, similarly trapped. Not in a same-day loop, of course; but each week seems eerily similar to the last, as does each month, each year – on and on, ad infinitum. That’s why it is so important, every so often, to step out of the “loop” and reassess the bigger picture.

I write this reminder every couple of years because it’s so easy to lose sight of the overall landscape among the pressures of our daily routines. Sooner or later, no matter how dedicated we are, the grind gets to all of us, leading to fatigue, irritability, and a progressive decline in motivation. And we are too busy to sit down and think about what we might do to break that vicious cycle. This is detrimental to our own well-being, as well as that of our patients.

There are many ways to maintain your intellectual and emotional health, but here’s how I do it: I take individual days off (average of 1 a month) to catch up on journals or taking a CME course; or to try something new – something I’ve been thinking about doing “someday, when there is time” – such as a guitar, bass, or sailing lesson, or a long weekend away with my wife. And we take longer vacations, without fail, each year.

I know how some of you feel about “wasting” a day – or, God forbid, a week. Patients might go elsewhere while you’re gone, and every day the office is idle you “lose money.” That whole paradigm is wrong. You bring in a given amount of revenue per year – more on some days, less on other days, none on weekends and vacations. It all averages out in the end.

Besides, this is much more important than money: This is breaking the routine, clearing the cobwebs, living your life. And trust me, your practice will still be there when you return.

Dr. Joseph S. Eastern

Recently, my wife and I packed our carry-ons and left for a 2-week trip to Antarctica. As we crossed the Drake Passage, and then explored the Antarctic Peninsula’s spectacular glaciers, icebergs, and vast penguin colonies, I didn’t have the time – or the slightest inclination – to worry about the office. But I did accumulate some great ideas – practical, medical, and literary. Original thoughts are hard to chase down during the daily grind, but in a refreshing environment, they will seek you out. When our trip was over, I returned ready to take on the world, and my practice, anew.

More than once I’ve recounted the story of K. Alexander Müller, PhD, and J. Georg Bednorz, PhD, the Swiss Nobel laureates whose superconductivity research ground to a halt in 1986. The harder they pressed, the more elusive progress became. So Dr. Müller decided to take a break to read a new book on ceramics – a subject that had always interested him.

Nothing could have been less relevant to his work, of course; ceramics are among the poorest conductors known. But in that lower-pressure environment, Dr. Müller realized that a unique property of ceramics might apply to their project.

Back in the lab, the team created a ceramic compound that became the first successful “high-temperature” superconductor, which in turn triggered an explosion of research leading to breakthroughs in computing, electricity transmission, magnetically-elevated trains, and many applications yet to be realized.

Sharpening your saw may not change the world, but it will change you. Any nudge out of your comfort zone will give you fresh ideas and help you look at seemingly insoluble problems in completely new ways.

And to those who still can’t bear the thought of taking time off, remember the dying words that no one has spoken, ever: “I wish I had spent more time in my office!”


 

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

 

Few movies have universal appeal these days, but one that comes close is Bill Murray’s 1993 classic, “Groundhog Day,” in which Murray’s character is trapped in a time loop, living the same day over and over until he finally “gets it right.”

One reason that this film resonates with so many, I think, is that we are all, in essence, similarly trapped. Not in a same-day loop, of course; but each week seems eerily similar to the last, as does each month, each year – on and on, ad infinitum. That’s why it is so important, every so often, to step out of the “loop” and reassess the bigger picture.

I write this reminder every couple of years because it’s so easy to lose sight of the overall landscape among the pressures of our daily routines. Sooner or later, no matter how dedicated we are, the grind gets to all of us, leading to fatigue, irritability, and a progressive decline in motivation. And we are too busy to sit down and think about what we might do to break that vicious cycle. This is detrimental to our own well-being, as well as that of our patients.

There are many ways to maintain your intellectual and emotional health, but here’s how I do it: I take individual days off (average of 1 a month) to catch up on journals or taking a CME course; or to try something new – something I’ve been thinking about doing “someday, when there is time” – such as a guitar, bass, or sailing lesson, or a long weekend away with my wife. And we take longer vacations, without fail, each year.

I know how some of you feel about “wasting” a day – or, God forbid, a week. Patients might go elsewhere while you’re gone, and every day the office is idle you “lose money.” That whole paradigm is wrong. You bring in a given amount of revenue per year – more on some days, less on other days, none on weekends and vacations. It all averages out in the end.

Besides, this is much more important than money: This is breaking the routine, clearing the cobwebs, living your life. And trust me, your practice will still be there when you return.

Dr. Joseph S. Eastern

Recently, my wife and I packed our carry-ons and left for a 2-week trip to Antarctica. As we crossed the Drake Passage, and then explored the Antarctic Peninsula’s spectacular glaciers, icebergs, and vast penguin colonies, I didn’t have the time – or the slightest inclination – to worry about the office. But I did accumulate some great ideas – practical, medical, and literary. Original thoughts are hard to chase down during the daily grind, but in a refreshing environment, they will seek you out. When our trip was over, I returned ready to take on the world, and my practice, anew.

More than once I’ve recounted the story of K. Alexander Müller, PhD, and J. Georg Bednorz, PhD, the Swiss Nobel laureates whose superconductivity research ground to a halt in 1986. The harder they pressed, the more elusive progress became. So Dr. Müller decided to take a break to read a new book on ceramics – a subject that had always interested him.

Nothing could have been less relevant to his work, of course; ceramics are among the poorest conductors known. But in that lower-pressure environment, Dr. Müller realized that a unique property of ceramics might apply to their project.

Back in the lab, the team created a ceramic compound that became the first successful “high-temperature” superconductor, which in turn triggered an explosion of research leading to breakthroughs in computing, electricity transmission, magnetically-elevated trains, and many applications yet to be realized.

Sharpening your saw may not change the world, but it will change you. Any nudge out of your comfort zone will give you fresh ideas and help you look at seemingly insoluble problems in completely new ways.

And to those who still can’t bear the thought of taking time off, remember the dying words that no one has spoken, ever: “I wish I had spent more time in my office!”


 

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

 

In my last column, I reviewed the reasons why RSS news feeds can be a useful tool for keeping abreast on frequently updated information, including blog entries, news headlines, audio, and video, without having to check multiple Web pages every day.

In this month’s column, I will provide pointers on how to set up your own RSS feed. This can help increase readership on your website, publicize a podcast, or keep your patients up to date on the latest treatments and procedures in your practice. And if your name appears in news or gossip sites, you will be alerted immediately.

Several options are available, depending on your budget and how involved you want to be in the process: For a monthly fee, many Web hosting services can automatically create and update a feed for you; so, if your website is professionally hosted, check to see if your host offers that service. If not, Web services such as Feedity and RapidFeeds allow you to manage multiple feeds, with automatic updates so that you will not need to manually update your feed each time you update your website content. Feedity’s software can even generate an RSS file without your having to input each item. Other popular options include Web Hosting Hub, Arvixe, MyHosting, and BlueHost. (As always, I have no financial interest in any service I mention here.)

Alternatively, many organizations that publish their own articles and news stories use a content management system (CMS) to organize, store, and publish their material, including RSS feeds. Examples include Drupal and Plone, which are both free, open source programs. Stand-alone RSS creation programs also exist; one popular example is RSS Builder, also a free and open source.

Disadvantages of free systems include advertisements (which can sometimes be removed for a monthly fee) and little or no technical support – and you will probably be limited to a single feed. You’ll also have to add and update headlines, links, and descriptive text manually. Your free feed can become quite expensive if you or staffers are forced to spend an inordinate amount of time maintaining it. Paid RSS editors like FeedForAll and NewzAlert Composer allow easier and less time-consuming content creation and maintenance.

Once you have picked a service or application, you can create your first feed, a process that will be different from program to program. But all feeds will need some basic data: a name (which should be the same as your practice or website); the URL for your website, to help viewers link back to your home page; and a description – a sentence or two describing the general content on the feed.

The next step is to populate the feed with content. Enter the title of each article, blog post, podcast episode, etc.; the URL that links directly to that content; and the publishing date. Each entry should have its own short, interesting description, which is what potential readers will see before they choose to click your entry in their RSS readers, and a global unique identifier (GUID), which the RSS readers use to detect changes or updates.

When all of your content is entered, all that remains is to export your feed to an extensible markup language (XML) file, which will allow visitors to subscribe to it. Upload the XML file to your website, place it on your home page, and click the “publish feed” button.

Once your feed is live, you’ll want to list it on some of the many RSS feed directories to maximize its visibility on search engines. There are literally hundreds of such directories; look for medically oriented ones that do not charge fees, and do not require a reciprocal link back to their website. Add each directory’s URL to your XML file.

Addendum: In my December 2017 column (“Your Online Reputation”), I suggested encouraging your most devoted patients to post favorable reviews about you on the “rating” websites. Several readers (including a practice consultant) have suggested making a laptop or tablet available in your office for that purpose. While that sounds like a great idea, most rating portals track incoming IP addresses, and automatically reject multiple reviews originating from the same computer.
 

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News.
 

 

In my last column, I reviewed the reasons why RSS news feeds can be a useful tool for keeping abreast on frequently updated information, including blog entries, news headlines, audio, and video, without having to check multiple Web pages every day.

In this month’s column, I will provide pointers on how to set up your own RSS feed. This can help increase readership on your website, publicize a podcast, or keep your patients up to date on the latest treatments and procedures in your practice. And if your name appears in news or gossip sites, you will be alerted immediately.

Several options are available, depending on your budget and how involved you want to be in the process: For a monthly fee, many Web hosting services can automatically create and update a feed for you; so, if your website is professionally hosted, check to see if your host offers that service. If not, Web services such as Feedity and RapidFeeds allow you to manage multiple feeds, with automatic updates so that you will not need to manually update your feed each time you update your website content. Feedity’s software can even generate an RSS file without your having to input each item. Other popular options include Web Hosting Hub, Arvixe, MyHosting, and BlueHost. (As always, I have no financial interest in any service I mention here.)

Alternatively, many organizations that publish their own articles and news stories use a content management system (CMS) to organize, store, and publish their material, including RSS feeds. Examples include Drupal and Plone, which are both free, open source programs. Stand-alone RSS creation programs also exist; one popular example is RSS Builder, also a free and open source.

Disadvantages of free systems include advertisements (which can sometimes be removed for a monthly fee) and little or no technical support – and you will probably be limited to a single feed. You’ll also have to add and update headlines, links, and descriptive text manually. Your free feed can become quite expensive if you or staffers are forced to spend an inordinate amount of time maintaining it. Paid RSS editors like FeedForAll and NewzAlert Composer allow easier and less time-consuming content creation and maintenance.

Once you have picked a service or application, you can create your first feed, a process that will be different from program to program. But all feeds will need some basic data: a name (which should be the same as your practice or website); the URL for your website, to help viewers link back to your home page; and a description – a sentence or two describing the general content on the feed.

The next step is to populate the feed with content. Enter the title of each article, blog post, podcast episode, etc.; the URL that links directly to that content; and the publishing date. Each entry should have its own short, interesting description, which is what potential readers will see before they choose to click your entry in their RSS readers, and a global unique identifier (GUID), which the RSS readers use to detect changes or updates.

When all of your content is entered, all that remains is to export your feed to an extensible markup language (XML) file, which will allow visitors to subscribe to it. Upload the XML file to your website, place it on your home page, and click the “publish feed” button.

Once your feed is live, you’ll want to list it on some of the many RSS feed directories to maximize its visibility on search engines. There are literally hundreds of such directories; look for medically oriented ones that do not charge fees, and do not require a reciprocal link back to their website. Add each directory’s URL to your XML file.

Addendum: In my December 2017 column (“Your Online Reputation”), I suggested encouraging your most devoted patients to post favorable reviews about you on the “rating” websites. Several readers (including a practice consultant) have suggested making a laptop or tablet available in your office for that purpose. While that sounds like a great idea, most rating portals track incoming IP addresses, and automatically reject multiple reviews originating from the same computer.
 

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News.
 

 

In my last column, I reviewed the reasons why RSS news feeds can be a useful tool for keeping abreast on frequently updated information, including blog entries, news headlines, audio, and video, without having to check multiple Web pages every day.

In this month’s column, I will provide pointers on how to set up your own RSS feed. This can help increase readership on your website, publicize a podcast, or keep your patients up to date on the latest treatments and procedures in your practice. And if your name appears in news or gossip sites, you will be alerted immediately.

Several options are available, depending on your budget and how involved you want to be in the process: For a monthly fee, many Web hosting services can automatically create and update a feed for you; so, if your website is professionally hosted, check to see if your host offers that service. If not, Web services such as Feedity and RapidFeeds allow you to manage multiple feeds, with automatic updates so that you will not need to manually update your feed each time you update your website content. Feedity’s software can even generate an RSS file without your having to input each item. Other popular options include Web Hosting Hub, Arvixe, MyHosting, and BlueHost. (As always, I have no financial interest in any service I mention here.)

Alternatively, many organizations that publish their own articles and news stories use a content management system (CMS) to organize, store, and publish their material, including RSS feeds. Examples include Drupal and Plone, which are both free, open source programs. Stand-alone RSS creation programs also exist; one popular example is RSS Builder, also a free and open source.

Disadvantages of free systems include advertisements (which can sometimes be removed for a monthly fee) and little or no technical support – and you will probably be limited to a single feed. You’ll also have to add and update headlines, links, and descriptive text manually. Your free feed can become quite expensive if you or staffers are forced to spend an inordinate amount of time maintaining it. Paid RSS editors like FeedForAll and NewzAlert Composer allow easier and less time-consuming content creation and maintenance.

Once you have picked a service or application, you can create your first feed, a process that will be different from program to program. But all feeds will need some basic data: a name (which should be the same as your practice or website); the URL for your website, to help viewers link back to your home page; and a description – a sentence or two describing the general content on the feed.

The next step is to populate the feed with content. Enter the title of each article, blog post, podcast episode, etc.; the URL that links directly to that content; and the publishing date. Each entry should have its own short, interesting description, which is what potential readers will see before they choose to click your entry in their RSS readers, and a global unique identifier (GUID), which the RSS readers use to detect changes or updates.

When all of your content is entered, all that remains is to export your feed to an extensible markup language (XML) file, which will allow visitors to subscribe to it. Upload the XML file to your website, place it on your home page, and click the “publish feed” button.

Once your feed is live, you’ll want to list it on some of the many RSS feed directories to maximize its visibility on search engines. There are literally hundreds of such directories; look for medically oriented ones that do not charge fees, and do not require a reciprocal link back to their website. Add each directory’s URL to your XML file.

Addendum: In my December 2017 column (“Your Online Reputation”), I suggested encouraging your most devoted patients to post favorable reviews about you on the “rating” websites. Several readers (including a practice consultant) have suggested making a laptop or tablet available in your office for that purpose. While that sounds like a great idea, most rating portals track incoming IP addresses, and automatically reject multiple reviews originating from the same computer.
 

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News.
 

 

Recently I mentioned RSS news feeds as a useful, versatile online tool, but because it has been a while since I’ve discussed RSS feeds, an update is certainly in order.

The sheer volume of information on the web makes quick and efficient searching an indispensable skill, but once you have become quick and efficient at finding the information you need, a new problem arises: The information changes! All the good medical, news, and other information-based websites change and update their content on a regular, but unpredictable basis. And checking each one for new information can be very tedious, if you can remember to do it at all.

Many sites offer an e-mail service to notify you of new content, but multiple e-mail subscriptions clutter your inbox and often can’t select out the information you’re really interested in. RSS feeds are a more efficient and increasingly popular method of staying current on all the subjects that interest you – medical and otherwise. RSS (which stands for “Rich Site Summary” or “Really Simple Syndication,” depending on whom you ask) is a file format, and websites use that format (or a similar one called Atom) to produce a summary file, or “feed,” of new content, along with links to full versions of that content. When you subscribe to a given website’s feed, you’ll receive a summary of new content each time the website is updated.

Thousands of websites now offer RSS feeds, including most of the large medical information services, all the major news organizations, and many web logs.

FotoMaximum/Thinkstock

To subscribe to feeds, you must download a program called a “feed reader,” which basically is just a browser specializing in RSS and Atom files. Dozens of readers (also known as “aggregators”) are available. Some can be accessed through browsers, others are integrated into e-mail programs, and still others run as standalone applications. With the rise of cloud computing, some cloud-based services offer feed aggregation.

Many readers are free, but those with the most advanced features usually charge a fee of some sort. (As always, I have no financial interest in any enterprise discussed in this column.) A comprehensive and more or less up-to-date list of available readers can be found in the Wikipedia article “Comparison of feed aggregators.”

It’s not always easy to find out whether a particular website offers a feed, because there is no universally recognized method of indicating its existence. Look for a link to “RSS” or “Syndicate This,” or an orange rectangle with the letters “RSS,” or “XML” (don’t ask). These links are not always on the home page. You may need to consult the site map to find a link to a page explaining available feeds, and how to find them.

Some of the major sites have multiple feeds to choose from. For example, you can generate a feed of current stories related to the page that you are following on Google News by clicking the RSS link on any Google News page.

Once you know the URL of the RSS feed you want, you provide it to your reader program, which will monitor the feed for you. (Many RSS aggregators come preconfigured with a list of feed URLs for popular news websites.)

In addition to notifying you of important news headlines, changes to your favorite websites, and new developments in any medical (or other) field of interest to you, RSS feeds have many other uses. Some will notify you of new products in a store or catalog, new newsletter issues (including e-mail newsletters), weather and other changing-condition alerts, and the addition of new items to a database – or new members to a group.

It can work the other way as well: If you want readers of your website, blog, or podcast to receive the latest news about your practice, such as new treatments and procedures you’re offering – or if you want to know immediately anytime your name pops up in news or gossip sites – you can create your own RSS feed. Next month, I’ll explain exactly how to do that.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected]

 

Recently I mentioned RSS news feeds as a useful, versatile online tool, but because it has been a while since I’ve discussed RSS feeds, an update is certainly in order.

The sheer volume of information on the web makes quick and efficient searching an indispensable skill, but once you have become quick and efficient at finding the information you need, a new problem arises: The information changes! All the good medical, news, and other information-based websites change and update their content on a regular, but unpredictable basis. And checking each one for new information can be very tedious, if you can remember to do it at all.

Many sites offer an e-mail service to notify you of new content, but multiple e-mail subscriptions clutter your inbox and often can’t select out the information you’re really interested in. RSS feeds are a more efficient and increasingly popular method of staying current on all the subjects that interest you – medical and otherwise. RSS (which stands for “Rich Site Summary” or “Really Simple Syndication,” depending on whom you ask) is a file format, and websites use that format (or a similar one called Atom) to produce a summary file, or “feed,” of new content, along with links to full versions of that content. When you subscribe to a given website’s feed, you’ll receive a summary of new content each time the website is updated.

Thousands of websites now offer RSS feeds, including most of the large medical information services, all the major news organizations, and many web logs.

FotoMaximum/Thinkstock

To subscribe to feeds, you must download a program called a “feed reader,” which basically is just a browser specializing in RSS and Atom files. Dozens of readers (also known as “aggregators”) are available. Some can be accessed through browsers, others are integrated into e-mail programs, and still others run as standalone applications. With the rise of cloud computing, some cloud-based services offer feed aggregation.

Many readers are free, but those with the most advanced features usually charge a fee of some sort. (As always, I have no financial interest in any enterprise discussed in this column.) A comprehensive and more or less up-to-date list of available readers can be found in the Wikipedia article “Comparison of feed aggregators.”

It’s not always easy to find out whether a particular website offers a feed, because there is no universally recognized method of indicating its existence. Look for a link to “RSS” or “Syndicate This,” or an orange rectangle with the letters “RSS,” or “XML” (don’t ask). These links are not always on the home page. You may need to consult the site map to find a link to a page explaining available feeds, and how to find them.

Some of the major sites have multiple feeds to choose from. For example, you can generate a feed of current stories related to the page that you are following on Google News by clicking the RSS link on any Google News page.

Once you know the URL of the RSS feed you want, you provide it to your reader program, which will monitor the feed for you. (Many RSS aggregators come preconfigured with a list of feed URLs for popular news websites.)

In addition to notifying you of important news headlines, changes to your favorite websites, and new developments in any medical (or other) field of interest to you, RSS feeds have many other uses. Some will notify you of new products in a store or catalog, new newsletter issues (including e-mail newsletters), weather and other changing-condition alerts, and the addition of new items to a database – or new members to a group.

It can work the other way as well: If you want readers of your website, blog, or podcast to receive the latest news about your practice, such as new treatments and procedures you’re offering – or if you want to know immediately anytime your name pops up in news or gossip sites – you can create your own RSS feed. Next month, I’ll explain exactly how to do that.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected]

 

Recently I mentioned RSS news feeds as a useful, versatile online tool, but because it has been a while since I’ve discussed RSS feeds, an update is certainly in order.

The sheer volume of information on the web makes quick and efficient searching an indispensable skill, but once you have become quick and efficient at finding the information you need, a new problem arises: The information changes! All the good medical, news, and other information-based websites change and update their content on a regular, but unpredictable basis. And checking each one for new information can be very tedious, if you can remember to do it at all.

Many sites offer an e-mail service to notify you of new content, but multiple e-mail subscriptions clutter your inbox and often can’t select out the information you’re really interested in. RSS feeds are a more efficient and increasingly popular method of staying current on all the subjects that interest you – medical and otherwise. RSS (which stands for “Rich Site Summary” or “Really Simple Syndication,” depending on whom you ask) is a file format, and websites use that format (or a similar one called Atom) to produce a summary file, or “feed,” of new content, along with links to full versions of that content. When you subscribe to a given website’s feed, you’ll receive a summary of new content each time the website is updated.

Thousands of websites now offer RSS feeds, including most of the large medical information services, all the major news organizations, and many web logs.

FotoMaximum/Thinkstock

To subscribe to feeds, you must download a program called a “feed reader,” which basically is just a browser specializing in RSS and Atom files. Dozens of readers (also known as “aggregators”) are available. Some can be accessed through browsers, others are integrated into e-mail programs, and still others run as standalone applications. With the rise of cloud computing, some cloud-based services offer feed aggregation.

Many readers are free, but those with the most advanced features usually charge a fee of some sort. (As always, I have no financial interest in any enterprise discussed in this column.) A comprehensive and more or less up-to-date list of available readers can be found in the Wikipedia article “Comparison of feed aggregators.”

It’s not always easy to find out whether a particular website offers a feed, because there is no universally recognized method of indicating its existence. Look for a link to “RSS” or “Syndicate This,” or an orange rectangle with the letters “RSS,” or “XML” (don’t ask). These links are not always on the home page. You may need to consult the site map to find a link to a page explaining available feeds, and how to find them.

Some of the major sites have multiple feeds to choose from. For example, you can generate a feed of current stories related to the page that you are following on Google News by clicking the RSS link on any Google News page.

Once you know the URL of the RSS feed you want, you provide it to your reader program, which will monitor the feed for you. (Many RSS aggregators come preconfigured with a list of feed URLs for popular news websites.)

In addition to notifying you of important news headlines, changes to your favorite websites, and new developments in any medical (or other) field of interest to you, RSS feeds have many other uses. Some will notify you of new products in a store or catalog, new newsletter issues (including e-mail newsletters), weather and other changing-condition alerts, and the addition of new items to a database – or new members to a group.

It can work the other way as well: If you want readers of your website, blog, or podcast to receive the latest news about your practice, such as new treatments and procedures you’re offering – or if you want to know immediately anytime your name pops up in news or gossip sites – you can create your own RSS feed. Next month, I’ll explain exactly how to do that.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected]

Have you ever run across an unfair or even malicious comment about you or your practice on one of those “doctor-rating” web sites? Some curmudgeon, angry about something totally irrelevant to your clinical skills, decided to publicly trash you; and the site, of course, made no effort to authenticate the writer or fact-check the complaint.

What to do? You could hire one of the many companies in the rapidly burgeoning field of online reputation management; but that can cost hundreds to thousands of dollars per month for monitoring and intervention, and there are no guarantees of success.

A better long-range solution is to generate your own search results – positive ones – that will overwhelm any negative comments that search engines might find. The key to that is a well-designed and maintained web site. Even if you’re an IT wiz, a professionally designed site will be far more attractive and polished than anything you could build yourself. Furthermore, an experienced designer will employ search engine optimization (SEO), meaning that content will be created in a way that is readily visible to search engine users.

Leave design and SEO to the pros, but don’t delegate the content itself; as captain of the ship you are responsible for all the facts and opinions on your site. And remember that, once it’s online, it’s online forever; consider the ramifications of anything you post on any site – yours or others – before hitting the “send” button. “The most damaging item about you,” one consultant told me, “could well be something you posted yourself.” Just ask any of several prominent politicians who have famously sabotaged their own careers online.

That said, don’t be shy about creating content. Patients appreciate factual information, but they value your opinions too. Add a blog to your web site and write about subjects – medical and otherwise – that interest you. If you have expertise in a particular field, be sure to write about that.

Incidentally, if the URL for your web site is not your own name, you should register your name as a separate domain name – even if you never use it – to be sure that a trickster or troll, or someone with the same name but a bad reputation, doesn’t get it.

A web site is a powerful resource, but not the only one. Take advantage of Google’s free profiling tool at https://profiles.google.com/me, where you can create a sterling bio, complete with links to URLs, photos, and anything else that shows you in the best possible light. Your Google profile will, of course, be at or near the top of any Google search.

Wikipedia articles also go to the top of most searches, so if you’re notable enough to merit mention in one – or to have one of your own – see that it is done and updated regularly. Remember that Wikipedia’s conflict of interest rules forbid adding or editing content about yourself, so someone with a theoretically “neutral point of view” will have to do it for you.

Other useful resources are the social networking sites. Whatever your opinion of online networks, the reality is that personal pages on Facebook, LinkedIn, and Twitter rank very high on major search engines. (Some consultants say a favorable LinkedIn profile is particularly helpful because of that site’s reputation as a “professional” network.) Make your (noncontroversial) opinions known on these portals. Your community activities, charitable work, interesting hobbies – anything that casts you in a favorable light – also need to be mentioned prominently.

Set up an RSS news feed for yourself (directions to follow in the next two columns), so you’ll know immediately if your name pops up in news or gossip sites, or on blogs. If something untrue is posted about you, take action. Reputable news sites and blogs have their own reputations to protect and can usually be persuaded to correct anything that is demonstrably false. Try to get the error removed entirely or corrected within the original article. An erratum on the last page of the next edition will be ignored and will leave the false information online, intact.

Doctor-rating sites typically refuse to remove unfair comments unless they are blatantly libelous or a case of mistaken identity; but there is nothing wrong with encouraging happy patients to post favorable reviews on those sites. Sauce for the goose, and all that.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

Have you ever run across an unfair or even malicious comment about you or your practice on one of those “doctor-rating” web sites? Some curmudgeon, angry about something totally irrelevant to your clinical skills, decided to publicly trash you; and the site, of course, made no effort to authenticate the writer or fact-check the complaint.

What to do? You could hire one of the many companies in the rapidly burgeoning field of online reputation management; but that can cost hundreds to thousands of dollars per month for monitoring and intervention, and there are no guarantees of success.

A better long-range solution is to generate your own search results – positive ones – that will overwhelm any negative comments that search engines might find. The key to that is a well-designed and maintained web site. Even if you’re an IT wiz, a professionally designed site will be far more attractive and polished than anything you could build yourself. Furthermore, an experienced designer will employ search engine optimization (SEO), meaning that content will be created in a way that is readily visible to search engine users.

Leave design and SEO to the pros, but don’t delegate the content itself; as captain of the ship you are responsible for all the facts and opinions on your site. And remember that, once it’s online, it’s online forever; consider the ramifications of anything you post on any site – yours or others – before hitting the “send” button. “The most damaging item about you,” one consultant told me, “could well be something you posted yourself.” Just ask any of several prominent politicians who have famously sabotaged their own careers online.

That said, don’t be shy about creating content. Patients appreciate factual information, but they value your opinions too. Add a blog to your web site and write about subjects – medical and otherwise – that interest you. If you have expertise in a particular field, be sure to write about that.

Incidentally, if the URL for your web site is not your own name, you should register your name as a separate domain name – even if you never use it – to be sure that a trickster or troll, or someone with the same name but a bad reputation, doesn’t get it.

A web site is a powerful resource, but not the only one. Take advantage of Google’s free profiling tool at https://profiles.google.com/me, where you can create a sterling bio, complete with links to URLs, photos, and anything else that shows you in the best possible light. Your Google profile will, of course, be at or near the top of any Google search.

Wikipedia articles also go to the top of most searches, so if you’re notable enough to merit mention in one – or to have one of your own – see that it is done and updated regularly. Remember that Wikipedia’s conflict of interest rules forbid adding or editing content about yourself, so someone with a theoretically “neutral point of view” will have to do it for you.

Other useful resources are the social networking sites. Whatever your opinion of online networks, the reality is that personal pages on Facebook, LinkedIn, and Twitter rank very high on major search engines. (Some consultants say a favorable LinkedIn profile is particularly helpful because of that site’s reputation as a “professional” network.) Make your (noncontroversial) opinions known on these portals. Your community activities, charitable work, interesting hobbies – anything that casts you in a favorable light – also need to be mentioned prominently.

Set up an RSS news feed for yourself (directions to follow in the next two columns), so you’ll know immediately if your name pops up in news or gossip sites, or on blogs. If something untrue is posted about you, take action. Reputable news sites and blogs have their own reputations to protect and can usually be persuaded to correct anything that is demonstrably false. Try to get the error removed entirely or corrected within the original article. An erratum on the last page of the next edition will be ignored and will leave the false information online, intact.

Doctor-rating sites typically refuse to remove unfair comments unless they are blatantly libelous or a case of mistaken identity; but there is nothing wrong with encouraging happy patients to post favorable reviews on those sites. Sauce for the goose, and all that.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

Have you ever run across an unfair or even malicious comment about you or your practice on one of those “doctor-rating” web sites? Some curmudgeon, angry about something totally irrelevant to your clinical skills, decided to publicly trash you; and the site, of course, made no effort to authenticate the writer or fact-check the complaint.

What to do? You could hire one of the many companies in the rapidly burgeoning field of online reputation management; but that can cost hundreds to thousands of dollars per month for monitoring and intervention, and there are no guarantees of success.

A better long-range solution is to generate your own search results – positive ones – that will overwhelm any negative comments that search engines might find. The key to that is a well-designed and maintained web site. Even if you’re an IT wiz, a professionally designed site will be far more attractive and polished than anything you could build yourself. Furthermore, an experienced designer will employ search engine optimization (SEO), meaning that content will be created in a way that is readily visible to search engine users.

Leave design and SEO to the pros, but don’t delegate the content itself; as captain of the ship you are responsible for all the facts and opinions on your site. And remember that, once it’s online, it’s online forever; consider the ramifications of anything you post on any site – yours or others – before hitting the “send” button. “The most damaging item about you,” one consultant told me, “could well be something you posted yourself.” Just ask any of several prominent politicians who have famously sabotaged their own careers online.

That said, don’t be shy about creating content. Patients appreciate factual information, but they value your opinions too. Add a blog to your web site and write about subjects – medical and otherwise – that interest you. If you have expertise in a particular field, be sure to write about that.

Incidentally, if the URL for your web site is not your own name, you should register your name as a separate domain name – even if you never use it – to be sure that a trickster or troll, or someone with the same name but a bad reputation, doesn’t get it.

A web site is a powerful resource, but not the only one. Take advantage of Google’s free profiling tool at https://profiles.google.com/me, where you can create a sterling bio, complete with links to URLs, photos, and anything else that shows you in the best possible light. Your Google profile will, of course, be at or near the top of any Google search.

Wikipedia articles also go to the top of most searches, so if you’re notable enough to merit mention in one – or to have one of your own – see that it is done and updated regularly. Remember that Wikipedia’s conflict of interest rules forbid adding or editing content about yourself, so someone with a theoretically “neutral point of view” will have to do it for you.

Other useful resources are the social networking sites. Whatever your opinion of online networks, the reality is that personal pages on Facebook, LinkedIn, and Twitter rank very high on major search engines. (Some consultants say a favorable LinkedIn profile is particularly helpful because of that site’s reputation as a “professional” network.) Make your (noncontroversial) opinions known on these portals. Your community activities, charitable work, interesting hobbies – anything that casts you in a favorable light – also need to be mentioned prominently.

Set up an RSS news feed for yourself (directions to follow in the next two columns), so you’ll know immediately if your name pops up in news or gossip sites, or on blogs. If something untrue is posted about you, take action. Reputable news sites and blogs have their own reputations to protect and can usually be persuaded to correct anything that is demonstrably false. Try to get the error removed entirely or corrected within the original article. An erratum on the last page of the next edition will be ignored and will leave the false information online, intact.

Doctor-rating sites typically refuse to remove unfair comments unless they are blatantly libelous or a case of mistaken identity; but there is nothing wrong with encouraging happy patients to post favorable reviews on those sites. Sauce for the goose, and all that.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

 

Much has been written over the past year about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and its primary vehicle, the Merit-Based Incentive System (MIPS); but many small practices seem reluctant to take it seriously, despite the fact that it puts yet another significant percentage of our Medicare reimbursements at risk.

Those much-publicized attempts to “repeal and replace” the Affordable Care Act earlier this year undoubtedly contributed to the apathy; but the ACA is apparently here to stay, and the first MIPS “performance period” ends on Dec. 31, so now would be an excellent time to get up to speed. Herewith, the basics:

MACRA consolidates three existing quality reporting programs, all of which I have discussed in previous columns: the Physician Quality Reporting System (PQRS); the Value-Based Payment Modifier (VBM), and Meaningful Use (MU), and it adds a “new” program called Clinical Practice Improvement Activities (CPIA), which is actually just another iteration of Maintenance of Certification (MOC). While the new system won’t be implemented until 2019, performance reporting began in January, and your 2017 reporting will affect your 2019 reimbursements.

Each practice must choose between two payment tracks: either MIPS or one of the so-called Alternate Payment Models (APM). The MIPS track will use the four reporting programs just mentioned to compile a composite score between 0 and 100 each year for every practitioner, based on four performance metrics: quality measures listed in Qualified Clinical Data Registries (QCDRs), such as Approved Quality Improvement (AQI); total resources used by each practitioner, as measured by VBM; “improvement activities” (MOC); and MU, in some new, as-yet-undefined form. You can earn a bonus of 4% of reimbursement in 2019, rising to 5% in 2020, 7% in 2021, and 9% in 2022 – or you can be penalized those amounts (“negative adjustments”) if your performance doesn’t measure up.

The final MACRA regulations, issued last October, allow a more gradual MIPS implementation that should decrease the penalty burden for small practices, at least initially. For example, you can avoid a penalty in 2019 – but not qualify for a bonus – by reporting your performance in only one quality-of-care or practice-improvement category by the end of this year. A decrease in penalties, however, means a smaller pot for bonuses – and reprieves will be temporary.

The alternative, APM, is difficult to discuss, as very few models have been presented – or even defined – to date. Only Accountable Care Organizations (ACOs) have been introduced in any quantity, and most of those have failed miserably in real-world settings. The Episode of Care (EOC) model, which pays providers a fixed amount for all services rendered in a bundle (“episode”) of care, has been discussed at some length, but this remains untested and in the end may turn out to be just another variant of capitation.

So, which to choose? Long term, I strongly suggest that everyone prepare for the APM track as soon as APMs that are better and more efficient become available, as it appears that there will be more financial security there, with less risk of penalties; but you will probably need to start in the MIPS program, since most projections indicate that the great majority of practitioners, particularly those in smaller operations, will do so.

While some may be prompted to join a larger organization or network to decrease their risk of MIPS penalties and gain quicker access to the APM track – which may well be one of the Center for Medicare & Medicaid Services’ surreptitious goals in introducing MACRA in the first place – there are steps that those individuals and small groups who choose to remain independent can take now to maximize their chances of landing on the bonus side of the MIPS ledger.

First, make sure your practice data is accurate on the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) – where CMS will gather data for the VBM and Physician Feedback Reports. Study the quality benchmarks, and review your Quality Resource and Use Report (QRUR), which gathers information about each practice’s quality and performance rates for the VBM. (Both PECOS and QRUR can be downloaded at CMS.gov).

If the alphabet soup above has your head swimming, join the club – you’re far from alone; but don’t be discouraged. CMS has indicated its willingness to make changes aimed at decreasing the administrative burden and, in its words, “making the transition to MACRA as simple and as flexible as possible.”
 

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

 

Much has been written over the past year about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and its primary vehicle, the Merit-Based Incentive System (MIPS); but many small practices seem reluctant to take it seriously, despite the fact that it puts yet another significant percentage of our Medicare reimbursements at risk.

Those much-publicized attempts to “repeal and replace” the Affordable Care Act earlier this year undoubtedly contributed to the apathy; but the ACA is apparently here to stay, and the first MIPS “performance period” ends on Dec. 31, so now would be an excellent time to get up to speed. Herewith, the basics:

MACRA consolidates three existing quality reporting programs, all of which I have discussed in previous columns: the Physician Quality Reporting System (PQRS); the Value-Based Payment Modifier (VBM), and Meaningful Use (MU), and it adds a “new” program called Clinical Practice Improvement Activities (CPIA), which is actually just another iteration of Maintenance of Certification (MOC). While the new system won’t be implemented until 2019, performance reporting began in January, and your 2017 reporting will affect your 2019 reimbursements.

Each practice must choose between two payment tracks: either MIPS or one of the so-called Alternate Payment Models (APM). The MIPS track will use the four reporting programs just mentioned to compile a composite score between 0 and 100 each year for every practitioner, based on four performance metrics: quality measures listed in Qualified Clinical Data Registries (QCDRs), such as Approved Quality Improvement (AQI); total resources used by each practitioner, as measured by VBM; “improvement activities” (MOC); and MU, in some new, as-yet-undefined form. You can earn a bonus of 4% of reimbursement in 2019, rising to 5% in 2020, 7% in 2021, and 9% in 2022 – or you can be penalized those amounts (“negative adjustments”) if your performance doesn’t measure up.

The final MACRA regulations, issued last October, allow a more gradual MIPS implementation that should decrease the penalty burden for small practices, at least initially. For example, you can avoid a penalty in 2019 – but not qualify for a bonus – by reporting your performance in only one quality-of-care or practice-improvement category by the end of this year. A decrease in penalties, however, means a smaller pot for bonuses – and reprieves will be temporary.

The alternative, APM, is difficult to discuss, as very few models have been presented – or even defined – to date. Only Accountable Care Organizations (ACOs) have been introduced in any quantity, and most of those have failed miserably in real-world settings. The Episode of Care (EOC) model, which pays providers a fixed amount for all services rendered in a bundle (“episode”) of care, has been discussed at some length, but this remains untested and in the end may turn out to be just another variant of capitation.

So, which to choose? Long term, I strongly suggest that everyone prepare for the APM track as soon as APMs that are better and more efficient become available, as it appears that there will be more financial security there, with less risk of penalties; but you will probably need to start in the MIPS program, since most projections indicate that the great majority of practitioners, particularly those in smaller operations, will do so.

While some may be prompted to join a larger organization or network to decrease their risk of MIPS penalties and gain quicker access to the APM track – which may well be one of the Center for Medicare & Medicaid Services’ surreptitious goals in introducing MACRA in the first place – there are steps that those individuals and small groups who choose to remain independent can take now to maximize their chances of landing on the bonus side of the MIPS ledger.

First, make sure your practice data is accurate on the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) – where CMS will gather data for the VBM and Physician Feedback Reports. Study the quality benchmarks, and review your Quality Resource and Use Report (QRUR), which gathers information about each practice’s quality and performance rates for the VBM. (Both PECOS and QRUR can be downloaded at CMS.gov).

If the alphabet soup above has your head swimming, join the club – you’re far from alone; but don’t be discouraged. CMS has indicated its willingness to make changes aimed at decreasing the administrative burden and, in its words, “making the transition to MACRA as simple and as flexible as possible.”
 

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

 

Much has been written over the past year about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and its primary vehicle, the Merit-Based Incentive System (MIPS); but many small practices seem reluctant to take it seriously, despite the fact that it puts yet another significant percentage of our Medicare reimbursements at risk.

Those much-publicized attempts to “repeal and replace” the Affordable Care Act earlier this year undoubtedly contributed to the apathy; but the ACA is apparently here to stay, and the first MIPS “performance period” ends on Dec. 31, so now would be an excellent time to get up to speed. Herewith, the basics:

MACRA consolidates three existing quality reporting programs, all of which I have discussed in previous columns: the Physician Quality Reporting System (PQRS); the Value-Based Payment Modifier (VBM), and Meaningful Use (MU), and it adds a “new” program called Clinical Practice Improvement Activities (CPIA), which is actually just another iteration of Maintenance of Certification (MOC). While the new system won’t be implemented until 2019, performance reporting began in January, and your 2017 reporting will affect your 2019 reimbursements.

Each practice must choose between two payment tracks: either MIPS or one of the so-called Alternate Payment Models (APM). The MIPS track will use the four reporting programs just mentioned to compile a composite score between 0 and 100 each year for every practitioner, based on four performance metrics: quality measures listed in Qualified Clinical Data Registries (QCDRs), such as Approved Quality Improvement (AQI); total resources used by each practitioner, as measured by VBM; “improvement activities” (MOC); and MU, in some new, as-yet-undefined form. You can earn a bonus of 4% of reimbursement in 2019, rising to 5% in 2020, 7% in 2021, and 9% in 2022 – or you can be penalized those amounts (“negative adjustments”) if your performance doesn’t measure up.

The final MACRA regulations, issued last October, allow a more gradual MIPS implementation that should decrease the penalty burden for small practices, at least initially. For example, you can avoid a penalty in 2019 – but not qualify for a bonus – by reporting your performance in only one quality-of-care or practice-improvement category by the end of this year. A decrease in penalties, however, means a smaller pot for bonuses – and reprieves will be temporary.

The alternative, APM, is difficult to discuss, as very few models have been presented – or even defined – to date. Only Accountable Care Organizations (ACOs) have been introduced in any quantity, and most of those have failed miserably in real-world settings. The Episode of Care (EOC) model, which pays providers a fixed amount for all services rendered in a bundle (“episode”) of care, has been discussed at some length, but this remains untested and in the end may turn out to be just another variant of capitation.

So, which to choose? Long term, I strongly suggest that everyone prepare for the APM track as soon as APMs that are better and more efficient become available, as it appears that there will be more financial security there, with less risk of penalties; but you will probably need to start in the MIPS program, since most projections indicate that the great majority of practitioners, particularly those in smaller operations, will do so.

While some may be prompted to join a larger organization or network to decrease their risk of MIPS penalties and gain quicker access to the APM track – which may well be one of the Center for Medicare & Medicaid Services’ surreptitious goals in introducing MACRA in the first place – there are steps that those individuals and small groups who choose to remain independent can take now to maximize their chances of landing on the bonus side of the MIPS ledger.

First, make sure your practice data is accurate on the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) – where CMS will gather data for the VBM and Physician Feedback Reports. Study the quality benchmarks, and review your Quality Resource and Use Report (QRUR), which gathers information about each practice’s quality and performance rates for the VBM. (Both PECOS and QRUR can be downloaded at CMS.gov).

If the alphabet soup above has your head swimming, join the club – you’re far from alone; but don’t be discouraged. CMS has indicated its willingness to make changes aimed at decreasing the administrative burden and, in its words, “making the transition to MACRA as simple and as flexible as possible.”
 

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

 

Recently I received a lengthy email from a woman who claimed to have once been a patient, though her name did not come up in my EHR system. She asked numerous questions about a self-diagnosed skin disorder.

I was undecided on how to reply – or even whether to reply at all – so I queried several dozen dermatology colleagues around the country, as well as a few physician friends and acquaintances in other specialties.

Responses varied all over the map – from “I never answer patient emails” to “What harm could it do, she’s better off getting correct answers from you than incorrect answers from some ‘advocacy’ web site” – and everything in between. I decided to look at what has been published on the subject.

[polldaddy:{"method":"iframe","type":"survey","src":"//newspolls2017.polldaddy.com/s/do-you-answer-patient-emails-take-our-poll?iframe=1"}]It turns out that as early as 1998, a group of investigators asked this same question and designed a study to address it (JAMA. 1998 Oct 21;280[15]:1333-5). Posing as a fictitious patient, they sent emails to random dermatologists describing an acute dermatological problem, tallied the responses they received, and followed up with a questionnaire to responders and nonresponders alike.

As with my informal survey, the authors found what they termed “a striking lack of consensus” on how to deal with this situation: 50% responded to the fictitious patient’s email; of those, 31% refused to give advice without seeing the patient, but 59% offered a diagnosis, and a third of that group went on to provide specific advice about therapy. In response to the questionnaire, 28% said that they tended not to answer any patient emails, 24% said they usually replied with a standard message, and 24% said they answered each request individually. The authors concluded that “standards for physician response to unsolicited patient e-mail are needed.”

Indeed. But my own unscientific survey suggests that, almost 20 years later, there is still nothing resembling a consensus on this issue. In the interim, several groups, including the American Medical Informatics Association, Medem, and the American Medical Association have proposed guidelines; but none have been generally accepted. Until such time as that happens, it seems prudent for each individual practice to adopt its own. For ideas, take a look at the proposals from the groups I mentioned, plus any others you can find. When you’re done, consider running your list past your lawyer to make sure you haven’t forgotten anything, and that there are no unique requirements in your state.

Your guidelines may be very simple (if you decide never to answer any queries) or very complex, depending on your situation and personal philosophy; but all guidelines should cover such issues as authentication of correspondents, informed consent, licensing jurisdiction (if you receive e-mails from states in which you are not licensed), and of course, confidentiality.

Contrary to popular belief, the Health Insurance Portability and Accountability Act (HIPAA) does not prohibit email communication with patients, nor does it require that it be encrypted. The HIPAA website specifically says, “Patients may initiate communications with a provider using e-mail. If this situation occurs, the health care provider can assume (unless the patient has explicitly stated otherwise) that e-mail communications are acceptable to the individual.”

Still, if you are not comfortable with unencrypted communication, encryption software can be added to your practice’s email system. Enli, Sigaba, Tumbleweed, Zix, and many other vendors sell encryption packages. (As always, I have no financial interest in any product or enterprise mentioned in this column.)

Another option is web-based messaging: Patients enter your website and send a message using an electronic template that you design. A designated staffer will be notified by regular email when messages are received, and can post a reply on a page that can only be accessed by the patient. Besides enhancing privacy and security, you can state your guidelines in plain English to preclude any misunderstanding of what you will and will not address online.

Web-based messaging services can be freestanding or incorporated into existing secure web sites. Medfusion and RelayHealth are among the leading vendors of secure messaging services.

As for the email query that triggered all this: I responded, but I told the woman I could not answer questions about a condition that had never been professionally evaluated, and encouraged her to phone the office for an appointment.

And now, I’m writing my guidelines.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

 

Recently I received a lengthy email from a woman who claimed to have once been a patient, though her name did not come up in my EHR system. She asked numerous questions about a self-diagnosed skin disorder.

I was undecided on how to reply – or even whether to reply at all – so I queried several dozen dermatology colleagues around the country, as well as a few physician friends and acquaintances in other specialties.

Responses varied all over the map – from “I never answer patient emails” to “What harm could it do, she’s better off getting correct answers from you than incorrect answers from some ‘advocacy’ web site” – and everything in between. I decided to look at what has been published on the subject.

[polldaddy:{"method":"iframe","type":"survey","src":"//newspolls2017.polldaddy.com/s/do-you-answer-patient-emails-take-our-poll?iframe=1"}]It turns out that as early as 1998, a group of investigators asked this same question and designed a study to address it (JAMA. 1998 Oct 21;280[15]:1333-5). Posing as a fictitious patient, they sent emails to random dermatologists describing an acute dermatological problem, tallied the responses they received, and followed up with a questionnaire to responders and nonresponders alike.

As with my informal survey, the authors found what they termed “a striking lack of consensus” on how to deal with this situation: 50% responded to the fictitious patient’s email; of those, 31% refused to give advice without seeing the patient, but 59% offered a diagnosis, and a third of that group went on to provide specific advice about therapy. In response to the questionnaire, 28% said that they tended not to answer any patient emails, 24% said they usually replied with a standard message, and 24% said they answered each request individually. The authors concluded that “standards for physician response to unsolicited patient e-mail are needed.”

Indeed. But my own unscientific survey suggests that, almost 20 years later, there is still nothing resembling a consensus on this issue. In the interim, several groups, including the American Medical Informatics Association, Medem, and the American Medical Association have proposed guidelines; but none have been generally accepted. Until such time as that happens, it seems prudent for each individual practice to adopt its own. For ideas, take a look at the proposals from the groups I mentioned, plus any others you can find. When you’re done, consider running your list past your lawyer to make sure you haven’t forgotten anything, and that there are no unique requirements in your state.

Your guidelines may be very simple (if you decide never to answer any queries) or very complex, depending on your situation and personal philosophy; but all guidelines should cover such issues as authentication of correspondents, informed consent, licensing jurisdiction (if you receive e-mails from states in which you are not licensed), and of course, confidentiality.

Contrary to popular belief, the Health Insurance Portability and Accountability Act (HIPAA) does not prohibit email communication with patients, nor does it require that it be encrypted. The HIPAA website specifically says, “Patients may initiate communications with a provider using e-mail. If this situation occurs, the health care provider can assume (unless the patient has explicitly stated otherwise) that e-mail communications are acceptable to the individual.”

Still, if you are not comfortable with unencrypted communication, encryption software can be added to your practice’s email system. Enli, Sigaba, Tumbleweed, Zix, and many other vendors sell encryption packages. (As always, I have no financial interest in any product or enterprise mentioned in this column.)

Another option is web-based messaging: Patients enter your website and send a message using an electronic template that you design. A designated staffer will be notified by regular email when messages are received, and can post a reply on a page that can only be accessed by the patient. Besides enhancing privacy and security, you can state your guidelines in plain English to preclude any misunderstanding of what you will and will not address online.

Web-based messaging services can be freestanding or incorporated into existing secure web sites. Medfusion and RelayHealth are among the leading vendors of secure messaging services.

As for the email query that triggered all this: I responded, but I told the woman I could not answer questions about a condition that had never been professionally evaluated, and encouraged her to phone the office for an appointment.

And now, I’m writing my guidelines.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

 

Recently I received a lengthy email from a woman who claimed to have once been a patient, though her name did not come up in my EHR system. She asked numerous questions about a self-diagnosed skin disorder.

I was undecided on how to reply – or even whether to reply at all – so I queried several dozen dermatology colleagues around the country, as well as a few physician friends and acquaintances in other specialties.

Responses varied all over the map – from “I never answer patient emails” to “What harm could it do, she’s better off getting correct answers from you than incorrect answers from some ‘advocacy’ web site” – and everything in between. I decided to look at what has been published on the subject.

[polldaddy:{"method":"iframe","type":"survey","src":"//newspolls2017.polldaddy.com/s/do-you-answer-patient-emails-take-our-poll?iframe=1"}]It turns out that as early as 1998, a group of investigators asked this same question and designed a study to address it (JAMA. 1998 Oct 21;280[15]:1333-5). Posing as a fictitious patient, they sent emails to random dermatologists describing an acute dermatological problem, tallied the responses they received, and followed up with a questionnaire to responders and nonresponders alike.

As with my informal survey, the authors found what they termed “a striking lack of consensus” on how to deal with this situation: 50% responded to the fictitious patient’s email; of those, 31% refused to give advice without seeing the patient, but 59% offered a diagnosis, and a third of that group went on to provide specific advice about therapy. In response to the questionnaire, 28% said that they tended not to answer any patient emails, 24% said they usually replied with a standard message, and 24% said they answered each request individually. The authors concluded that “standards for physician response to unsolicited patient e-mail are needed.”

Indeed. But my own unscientific survey suggests that, almost 20 years later, there is still nothing resembling a consensus on this issue. In the interim, several groups, including the American Medical Informatics Association, Medem, and the American Medical Association have proposed guidelines; but none have been generally accepted. Until such time as that happens, it seems prudent for each individual practice to adopt its own. For ideas, take a look at the proposals from the groups I mentioned, plus any others you can find. When you’re done, consider running your list past your lawyer to make sure you haven’t forgotten anything, and that there are no unique requirements in your state.

Your guidelines may be very simple (if you decide never to answer any queries) or very complex, depending on your situation and personal philosophy; but all guidelines should cover such issues as authentication of correspondents, informed consent, licensing jurisdiction (if you receive e-mails from states in which you are not licensed), and of course, confidentiality.

Contrary to popular belief, the Health Insurance Portability and Accountability Act (HIPAA) does not prohibit email communication with patients, nor does it require that it be encrypted. The HIPAA website specifically says, “Patients may initiate communications with a provider using e-mail. If this situation occurs, the health care provider can assume (unless the patient has explicitly stated otherwise) that e-mail communications are acceptable to the individual.”

Still, if you are not comfortable with unencrypted communication, encryption software can be added to your practice’s email system. Enli, Sigaba, Tumbleweed, Zix, and many other vendors sell encryption packages. (As always, I have no financial interest in any product or enterprise mentioned in this column.)

Another option is web-based messaging: Patients enter your website and send a message using an electronic template that you design. A designated staffer will be notified by regular email when messages are received, and can post a reply on a page that can only be accessed by the patient. Besides enhancing privacy and security, you can state your guidelines in plain English to preclude any misunderstanding of what you will and will not address online.

Web-based messaging services can be freestanding or incorporated into existing secure web sites. Medfusion and RelayHealth are among the leading vendors of secure messaging services.

As for the email query that triggered all this: I responded, but I told the woman I could not answer questions about a condition that had never been professionally evaluated, and encouraged her to phone the office for an appointment.

And now, I’m writing my guidelines.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

 

I can almost hear you saying it now: “Here’s a column I can skip! Embezzlement has never been a problem in this office.” Unfortunately, theft from within is way more common in medical offices than most of us suppose – and it often occurs in full view of physicians who are convinced that it cannot happen to them. Most embezzlers are not particularly skillful, nor very good at covering their tracks. But their transgressions can go undetected for years, simply because no one is watching.

A friend’s experience was all too typical: His bookkeeper wrote sizable checks to herself, disguising them in the ledger as payments to vendors commonly used by his practice. Since she also balanced the checkbook, she got away with it for a long time. “It wasn’t at all clever,” he told me, “and I’m embarrassed to admit that it happened to me.” Is it happening to you, too? You won’t know unless you look.

Detecting fraud is an inexact science; there is no textbook approach that one can follow, but a few simple measures will uncover or prevent a large percentage of dishonest behavior:

• Hire honest employees. Check applicants’ references; find out if they are really as good as they look on paper. And for a few dollars, you can screen prospective employees on one of several public information websites to see if they have a criminal record, or have been sued (or are suing others). My columns on hiring and background checks can be found at http://www.mdedge.com/edermatologynews/managing-your-practice.

• Minimize opportunities for dishonesty. Theft and embezzlement are usually products of opportunity; there are many ways to minimize those opportunities. No one person should be in charge of the entire bookkeeping process. The person who enters charges should be different from the one who enters payments. The employee who writes the checks should not balance the checkbook, and so on. Internal audits should be done on a regular basis, and all employees should know that. Your accountant can help with this.

• Reconcile receipts and cash daily. The most common form of embezzlement is simply taking cash out of the till. In a typical scenario, a patient pays a $15 copay in cash; the receptionist records the payment as $5 and pockets the rest. Make sure a receipt is generated for every cash transaction, and that someone other than the person accepting cash reconciles the receipts and the cash daily.

• Insist on separate accounting duties. Another common scam – the one to which my friend fell victim – is false invoices: You think you are paying for supplies and services, but the money is going to an employee. Once again, separation of duties is the key to prevention. One employee should enter invoices into the data system, another should issue the check or make the electronic transfer, and a third should match invoices to goods and services received.

• Verify expense reports. False expense reports are another common form of fraud. When an employee asks for reimbursement of expenses, make sure they are real.

• Safeguard your computers. A major downside of computerization is the facilitation of embezzlement. Data are usually concentrated in one place, accounts can be accessed from remote workstations or off-premises servers, and a paper trail is often eliminated. Your computer vendor should be aware of this, and should have safeguards built into your system. Ask about them. If they aren’t there, ask why.

• Look for “red flags.” Do you have an employee who refuses to take vacations, because someone else will have to look at the books? Does someone insist on approving or entering expenses that are another employee’s responsibility, “just to be nice”? Is an employee suddenly living beyond his or her means?

• Consider bonding your employees. Dishonesty bonds are relatively inexpensive, and you will be assured of some measure of recovery should your safeguards fail. In addition, the mere knowledge that your staff is bonded will frighten off many dishonest applicants.

• Keep in mind that office personnel are not the only ones susceptible to temptation. A colleague recently told me about a per diem physician in his employ who conspired with a receptionist to keep fees collected for cosmetic neurotoxin and filler procedures “off the books,” then split the proceeds among themselves.
 

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected]

 

I can almost hear you saying it now: “Here’s a column I can skip! Embezzlement has never been a problem in this office.” Unfortunately, theft from within is way more common in medical offices than most of us suppose – and it often occurs in full view of physicians who are convinced that it cannot happen to them. Most embezzlers are not particularly skillful, nor very good at covering their tracks. But their transgressions can go undetected for years, simply because no one is watching.

A friend’s experience was all too typical: His bookkeeper wrote sizable checks to herself, disguising them in the ledger as payments to vendors commonly used by his practice. Since she also balanced the checkbook, she got away with it for a long time. “It wasn’t at all clever,” he told me, “and I’m embarrassed to admit that it happened to me.” Is it happening to you, too? You won’t know unless you look.

Detecting fraud is an inexact science; there is no textbook approach that one can follow, but a few simple measures will uncover or prevent a large percentage of dishonest behavior:

• Hire honest employees. Check applicants’ references; find out if they are really as good as they look on paper. And for a few dollars, you can screen prospective employees on one of several public information websites to see if they have a criminal record, or have been sued (or are suing others). My columns on hiring and background checks can be found at http://www.mdedge.com/edermatologynews/managing-your-practice.

• Minimize opportunities for dishonesty. Theft and embezzlement are usually products of opportunity; there are many ways to minimize those opportunities. No one person should be in charge of the entire bookkeeping process. The person who enters charges should be different from the one who enters payments. The employee who writes the checks should not balance the checkbook, and so on. Internal audits should be done on a regular basis, and all employees should know that. Your accountant can help with this.

• Reconcile receipts and cash daily. The most common form of embezzlement is simply taking cash out of the till. In a typical scenario, a patient pays a $15 copay in cash; the receptionist records the payment as $5 and pockets the rest. Make sure a receipt is generated for every cash transaction, and that someone other than the person accepting cash reconciles the receipts and the cash daily.

• Insist on separate accounting duties. Another common scam – the one to which my friend fell victim – is false invoices: You think you are paying for supplies and services, but the money is going to an employee. Once again, separation of duties is the key to prevention. One employee should enter invoices into the data system, another should issue the check or make the electronic transfer, and a third should match invoices to goods and services received.

• Verify expense reports. False expense reports are another common form of fraud. When an employee asks for reimbursement of expenses, make sure they are real.

• Safeguard your computers. A major downside of computerization is the facilitation of embezzlement. Data are usually concentrated in one place, accounts can be accessed from remote workstations or off-premises servers, and a paper trail is often eliminated. Your computer vendor should be aware of this, and should have safeguards built into your system. Ask about them. If they aren’t there, ask why.

• Look for “red flags.” Do you have an employee who refuses to take vacations, because someone else will have to look at the books? Does someone insist on approving or entering expenses that are another employee’s responsibility, “just to be nice”? Is an employee suddenly living beyond his or her means?

• Consider bonding your employees. Dishonesty bonds are relatively inexpensive, and you will be assured of some measure of recovery should your safeguards fail. In addition, the mere knowledge that your staff is bonded will frighten off many dishonest applicants.

• Keep in mind that office personnel are not the only ones susceptible to temptation. A colleague recently told me about a per diem physician in his employ who conspired with a receptionist to keep fees collected for cosmetic neurotoxin and filler procedures “off the books,” then split the proceeds among themselves.
 

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected]

 

I can almost hear you saying it now: “Here’s a column I can skip! Embezzlement has never been a problem in this office.” Unfortunately, theft from within is way more common in medical offices than most of us suppose – and it often occurs in full view of physicians who are convinced that it cannot happen to them. Most embezzlers are not particularly skillful, nor very good at covering their tracks. But their transgressions can go undetected for years, simply because no one is watching.

A friend’s experience was all too typical: His bookkeeper wrote sizable checks to herself, disguising them in the ledger as payments to vendors commonly used by his practice. Since she also balanced the checkbook, she got away with it for a long time. “It wasn’t at all clever,” he told me, “and I’m embarrassed to admit that it happened to me.” Is it happening to you, too? You won’t know unless you look.

Detecting fraud is an inexact science; there is no textbook approach that one can follow, but a few simple measures will uncover or prevent a large percentage of dishonest behavior:

• Hire honest employees. Check applicants’ references; find out if they are really as good as they look on paper. And for a few dollars, you can screen prospective employees on one of several public information websites to see if they have a criminal record, or have been sued (or are suing others). My columns on hiring and background checks can be found at http://www.mdedge.com/edermatologynews/managing-your-practice.

• Minimize opportunities for dishonesty. Theft and embezzlement are usually products of opportunity; there are many ways to minimize those opportunities. No one person should be in charge of the entire bookkeeping process. The person who enters charges should be different from the one who enters payments. The employee who writes the checks should not balance the checkbook, and so on. Internal audits should be done on a regular basis, and all employees should know that. Your accountant can help with this.

• Reconcile receipts and cash daily. The most common form of embezzlement is simply taking cash out of the till. In a typical scenario, a patient pays a $15 copay in cash; the receptionist records the payment as $5 and pockets the rest. Make sure a receipt is generated for every cash transaction, and that someone other than the person accepting cash reconciles the receipts and the cash daily.

• Insist on separate accounting duties. Another common scam – the one to which my friend fell victim – is false invoices: You think you are paying for supplies and services, but the money is going to an employee. Once again, separation of duties is the key to prevention. One employee should enter invoices into the data system, another should issue the check or make the electronic transfer, and a third should match invoices to goods and services received.

• Verify expense reports. False expense reports are another common form of fraud. When an employee asks for reimbursement of expenses, make sure they are real.

• Safeguard your computers. A major downside of computerization is the facilitation of embezzlement. Data are usually concentrated in one place, accounts can be accessed from remote workstations or off-premises servers, and a paper trail is often eliminated. Your computer vendor should be aware of this, and should have safeguards built into your system. Ask about them. If they aren’t there, ask why.

• Look for “red flags.” Do you have an employee who refuses to take vacations, because someone else will have to look at the books? Does someone insist on approving or entering expenses that are another employee’s responsibility, “just to be nice”? Is an employee suddenly living beyond his or her means?

• Consider bonding your employees. Dishonesty bonds are relatively inexpensive, and you will be assured of some measure of recovery should your safeguards fail. In addition, the mere knowledge that your staff is bonded will frighten off many dishonest applicants.

• Keep in mind that office personnel are not the only ones susceptible to temptation. A colleague recently told me about a per diem physician in his employ who conspired with a receptionist to keep fees collected for cosmetic neurotoxin and filler procedures “off the books,” then split the proceeds among themselves.
 

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected]