Management Essentials

Do the Right Thing

By Farrell “Toby” Tyson, MD, FACS

I was fumbling through the myriad late-night television channels when I stumbled across an old cult classic movie: Spike Lee's controversial Do the Right Thing. Its message was that one needs to avoid our in grain ed cultural responses, rise above the fray and do what was “right.”

This reminded me of one of my great ophthalmology mentors, Dr. Jim Rowsey, who constantly lectured on medical ethics and morals. As a resident, I always felt that his teachings reflected common sense and all medical professionals were endowed with them. After exiting residency and entering the real world of medicine, my illusions would be shattered.

■ A long habit of not thinking a thing wrong gives it the superficial appearance of being right. –Thomas Paine

It is sad to say but Medicare fraud does exist, and not as infrequently as one would hope. Given the steady decline in Medicare reimbursements, physicians have been pressured to find ways to make up for revenue shortcomings. This has manifested in a few instances as gross fraudulent billing, though the majority of fraud is what some doctors see as a “slight bending” of the rules. Examples can be seen in practices where all new patients are worked up as a glaucoma suspect until proven otherwise, or billing complex cataract codes for regular cataract cases that unexpectedly resulted in surgical misadventures.

■ Who lies for you will lie against you. –Bosnian Proverb

As the physician and the leader of our practices, we cannot tolerate “interpretation” or “creativity” in our billing or treatment. We may want endothelial cell counts on all cataract surgery patients preoperatively but we cannot ethically or legally bill Medicare for every surgery candidate. Our staff looks to the administration and physicians for leadership. They know that all patients should be treated as they would want one of their family members treated. They notice everything.

If you condone questionable personal or practice behaviors, you will reap what you sow. A culture of deceit will slowly flourish if staff sees you “cutting corners” or providing unethical care. These practices may benefit you in the short term, but in the end you will have taught your staff that it is acceptable to do the same to you.

■ It takes less time to do a thing right than it does to explain why you did it wrong. –Henry Wadsworth Longfellow

Another mentor of mine, Dr. Dimitri Azar, instilled in me that the right way to do research was without compromise. This might lead to results that you weren't expecting and delays in the progress of trials. One has to stay true to himself and to the science, and not be swayed by outside pressures. The rewards will be an intact reputation and respect for your research, though the monetary gain might be less.

This mindset leads to building an ophthalmology practice of excellence. It always starts with you setting the tone, and then by the people you hire. Your managers are extensions of you. They cannot be allowed to play outside the rules. Once you have instilled in everyone the ethical mindset, your practice will run much smoother.

A staff member who wants to do the right thing works to fix the problem while less scrupulous staff will spend more time trying to hide the problem. Over time, an ethically-run practice will attract the best and the brightest, and the chaff will move to more questionably run practices where they will feel more comfortable.

■ Character is much easier kept than recovered. –Thomas Paine

A quality reputation will precede you, but it has to be cultivated. All your dealings with staff, patients and industry need to be done in an honest and ethical manner. Even in negotiations with vendors, one needs to be scrupulous. Positions in industry change often; you never know who may be working with whom down the road. Once two parties have establish ed trust, they can achieve consensus more rapidly and the result will be greater savings and productivity — but if distrust is fostered, it can be an anchor to progress in all your dealings.

■ The time is always right to do what is right. –Martin Luther King Jr.

Even though taxes are going up and reimbursements are going down, we have to remember that we are medical professionals. As professionals, we are held to a higher standard. Even though the government and industry wants to paint us as medical providers to devalue us, it is incumbent on us to uphold the higher standards that medicine has always stood for.

We still control our own image. It is ours to protect. When temptations arise, back away from the slippery slope. Do the right thing. OM

Farrell C. Tyson, MD, FACS, is a refractive cataract/glaucoma eye surgeon at the Cape Coral Eye Center in Florida. He may be reached at tysonfc@hotmail.com.