Practical Pearls

A Handy Guide to the Best Take-Home Tips in the January 2011 Issue of Ophthalmology management

You must bill $6.57 to generate one dollar of take-home profit, so any cost savings achieved in a contract negotiation will have a sixfold impacton your bottom line … Find it!

Failure to follow specifications for “single-use” equipment, supplies, devices, injectables and medications can trigger a Conditions for Coverage citation of your ASC … Find it!

The problem with trying to hire an IT director is that medical offices don't know what questions to ask, what skills are important, and probably can't easily identify someone posing as an expert when he or she is not. So have your candidates vetted by someone in the IT field … Find it!

Unlike most cataract patients, uveitics are at risk for profound postop inflammation that might require additional surgery or lead to profound visual loss and blindness … Find it!

While easily-removed cohesive viscoelastics are good for maintaining space within the eye, dispersive OVDs are better for protecting the endothelium … Find it!

The timing of cataract surgery in the uveitic is probably the single most important factor. It is crucial that the patient achieve at least three months of quiescence prior to surgery—steroid-free if at all possible … Find it!

ASCs without “deemed” status certification are more often targeted for CfC inspections, but certification itself offers no security … Find it!

Uveitis patients frequently have compromised zonules due to chronic inflammation or trauma. Prior intraocular surgery (AC taps, iridectomy, trabeculectomy, vitrectomy) may cause weakened zonules. Consider using the capsular tension ring in such cases … Find it!

In negotiations, your first concession should be your largest; subsequent ones should decrease in size and importance. Concessions should never be equally sized, as the other party will figure that every time they ask for a concession they will continue to get the same result … Find it!

It is critical for your IT Director to act as a liaison between the technical world and the real world. You'll want someone with good people skills as well as a lot of patience in dealing with less tech nically gifted employees … Find it!

The use and placement of intraocular lenses in uveitis has been controversial in the past. Nevertheless, hydrophobic acrylic lenses are generally well tolerated … Find it!

If an inspection of your ASC finds deficiencies, keep in mind that there are two levels: a “condition level” deficiency is a basis for decertification, while a “standard level” deficiency is less severe. Know the appeals process and your rights. Check your deficiency citations at www.gpoaccess.gov/cfr/retrieve.html … Find it!

Practices that delay adopting EHR until 2012 will forfeit the chance to implement it gradually to simplify the transition. You'll have to demonstrate meaningful use immediately, on an unfamiliar system put into service all at once … Find it!

An ingenious way to decline an offer is to accept it, but add terms unacceptable to the other party. This keeps you in control … Find it!

Viewing subjective and objective patient data, such as visual fields and OCT, through an image management system may make for a more thorough, accurate glaucoma exam without adding to time expended on the case … Find it!

Because many uveitic cataracts are limited to posterior subcapsular and may be very soft, the surgeon must be comfortable with phacoaspiration. For the rock-hard nuclei, consider using chop techniques and liberal use of viscoelastic such as the soft shell technique … Find it!

A well-written personnel manual that spells out expectations, and consequences for not following policies, will help maintain power balances in your office … Find it!

Femtosecond laser surgery won't affect the type of viscoelastic needed for cataract surgery, but it will drastically reduce the amount of OVD needed during the procedure … Find it!

For small pupils, shallow chambers or IFIS eyes, a supercohesive viscoelastic is best for compartmentalizing the anterior segment, controlling the iris and stabilizing the pupil … Find it!

EHR certification is product- and version-specific. So while the vendor from whom you bought your EHR may have a certified system, it doesn't mean that your particular version is certified … Find it!

By the end of 2013, all ASCs must have a surveillance system for procedure-related adverse events, including surveillance for all patients for at least 30 days after discharge … Find it!

To support two claims for a patient with multiple conditions seen by two doctors in the same practice, each physician should have a progress note, usually documented on separate pages. A single chart entry signed by both providers does not adequately support separate charges … Find it!

A mock inspection of your ASC teams gives you the opportunity to find deficiencies prior to your actual inspection … Find it!

Steroid-induced hyperglycemia due to systemic prednisone use in uveitic cataract is easier to manage in insulin-dependent diabetics—patients can increase their insulin to compensate. Non-insulin diabetics are paradoxically harder to manage; seek guidance from the PCP. … Find it!

If you're uncertain of how to write a job description for an IT director, ask either the director of IT for a practice in your area or the local hospital to help you come up with specifics, including the certifications required for the job and the expected hours as well as duties … Find it!

Preoperative immunosuppression in uveitic cataract is key in achieving a good outcome. The type of uveitis determines the type of immunosuppression to use. … Find it!

CCHIT certification looks at many technical and functional aspects of an EHR, while ONC certification is solely oriented toward support of Meaningful Use criteria. ONC's focus is not on what the EHR can do, but on providing practices with an incentive to use it in meaningful ways … Find it!

When offering concessions, always require one in return—don't give anything away for free. What is of no consequence to you may be of great value to the other party … Find it!

By the end of 2015, all ASCs must have a certified infection preventionist on staff or contract with one for service … Find it!

Choosing an EHR is not the time to become unduly tight-fisted. All the good systems cost about the same. If your EHR costs you time in the exam room, it will cost you much more than what you ‘saved’ when you bought it … Find it!