Quick Hits

Proposed cataract database would confuse more than help

AAO calls plan “not feasible”due to differences in data collection.

By Robert Stoneback, Associate Editor

The AAO expressed doubt that a proposed international database would help establish global uniformity for cataract surgery, according to a Medscape report.

Set forth by the International Consortium for Health Outcomes Measurement (ICHOM), the proposed registry for cataract surgery data would allow physicians and researchers from around the world to share medical results.

“The idea was to establish an international consensus,” says Suzann Pershing, MD, an ICHOM cataracts committee member, according to Medscape Medical News. “This is something that is clinically meaningful,” and at least takes the basics into account.

An overview of the standards can be viewed at http://tinyurl.com/pzvh6hn. They would record data, such as ocular history and complications related to surgery, regarding four surgical approaches, including phacoemulsification and intracapsular cataract extraction.

In an interview, William L. Rich III, MD, the Academy’s medical director for health policy, says the AAO is “very supportive” of the general idea of countries adopting common measures for cataract surgery. “We have been working to harmonize cataract registry elements among the differing international registries for over three years, and our IRIS Registry can shadow pre-existing measures.”

IRIS, the AAO’s national database of patient data, went live March 2014.

“Based on this experience, however, the Academy knows all too well the extreme difficulties of adopting common data points,” Dr. Rich continues. “Different countries have different regulatory laws and privacy rules as well as long-adopted, divergent ways of collecting data.” Due to this, “it is not feasible or practical for ICHOM to expect all registries to start from scratch.”

In addition, every time a new medical device is introduced it will create additional data points to track. This makes it “unlikely [that] all data points can be defined up front to form the basis of international device surveillance as proposed by ICHOM,” Dr. Rich says.

REFERENCES

Avoid employment contract landmines

Book guides you in sidestepping costly mistakes.

By René Luthe, Senior Editor

New physicians often do not realize their own power when approaching their first employment contract, according to health-care attorney Dennis Hursh, of Hursh & Hursh, P.C. What typically happens is that the prospective employer offers the doctor a contract, informing him it’s the organization’s “standard contract.” “The physician thinks, ‘Well, if this is their standard contract, I won’t bother negotiating it,’” Mr. Hursh explains. But once on the job, the physician finds some very unsatisfactory situations.

It is not until the physician complains to his new colleagues that he learns it didn’t have to be that way. “They reply that they don’t do X anymore, because they negotiated X out of their contract. And this light bulb comes on over the new doctor’s head,” Mr. Hursh says. He addresses this and other costly errors in his book The Final Hurdle: A Physician’s Guide to Negotiating a Fair Employment Agreement (Advantage Media Group, Charleston, SC.).

A veteran health-care attorney warns against the common mistakes physicians make when negotiating employment contracts.

Beware the “integration clause”

Another common error physicians make in employment agreements is believing that a term stipulated in a letter of intent or offer letter is binding, even though it is absent from the employment contract. “The doctor will think, ‘I’m protected because I have this piece of paper from them that says they are going to do this.’” Again, the doctor learns he is wrong too late. “In almost every contract, there is what lawyers call an integration clause. It says that this contract contains the entire agreement between the parties, and anything that isn’t in this contract is not part of the agreement.”

It pays to get help

When the contract is up for renewal, physicians now know what they don’t want and begin negotiating. It is at this point that they often begin consulting with someone like Mr. Hursh.

After focusing on taxation while in law school, he began representing physician organizations as well as doing insurance work. “I was seeing a lot of managed-care contracts and drafting them for my other clients,” he says. When physicians began asking him to review their employment contracts, he saw a niche he could fill.

Other common land mines he addresses in his book:

• Call coverage. “In an employment contract, call coverage is huge,” Mr. Hursh explains. In one contract he negotiated, the first draft stated the employer would assign call; Mr. Hursh countered that call should be “equitable.” In the next round, however, the terms for call remained unchanged. When Mr. Hursh asked why, the lawyer representing the practice said the new physician should take call “24/7 for the next couple of years” — because the solo practitioner had been on call for the previous eight years. Most physicians won’t want to find themselves in that position.

• Restrictive covenants. While it is understandable that your new employer doesn’t want to risk introducing you to patients and referral sources, only to have you quit and open up shop down the street, physicians must look ahead as to what the employer’s terms would mean should they decide to move on. “Right now, if everything you have can fit into the back of your Ford Fiesta, a move is no big deal,” Mr. Hursh explains. “But if you marry and have children and they’re in school, a move of 30 miles is a huge deal.” Generally, a stipulation that you not open a new office location less than five miles from your previous employer for a year is fair, he says. Additionally, make sure it’s your new office location that’s specified in the restrictive covenant, not practicing medicine altogether.

• Tail insurance. Once a given, tail insurance — covering claims made by former patients after you’ve left the practice — has become more contentious as it has become more expensive. Many first-draft contracts Mr. Hursh sees make the physician responsible for paying it. “But it’s a lot of money, so often that’s something I’ll fight over,” he says.

The bottom line is that legal counsel will pay for itself. “Obviously I may be a bit biased, but I really think that with any major contract, it pays for you to have an attorney with experience in the area review it. You may be comfortable with everything that’s addressed in the contract, but it takes another set of eyes to see that something else isn’t addressed at all.”

Lost in a sea of software choices? Let Software Advice be your guide

Site offers physicians curated reviews

By Robert Stoneback, Associate Editor

In our increasingly digital world, finding the right software for a practice can be daunting. That’s why Software Advice is helping businesses of all kinds pinpoint the exact program they need to help their organization grow. Through its website, www.SoftwareAdvice.com, the company caters to professionals in hundreds of fields, including ophthalmology.

“Instead of wasting dozens of hours researching the right software for their practice, ophthalmologists can connect with our team of medical software advisers for a free 15-minute telephone consultation to short-list the best solutions for their practice size, needs and budget,” says Robert Bellovin, media relations manager for Software Advice.

“Our ophthalmology software listing page offers visitors a free buyer’s guide, detailed product information for 85 systems, and crowd-sourced reviews from real users all aimed at helping ophthalmologists make quick and educated IT purchase decisions.”

Most of the ophthalmology software programs are electronic medical records. Software Advice speaks to dozens of ophthalmologists on a monthly basis, each representing a practice employing up to 10 doctors.

The company, originally known as River Guide, was founded in 2005 in San Francisco by CEO Don Fornes. In 2009, the company moved its headquarters to Austin. In March 2014, Software Advice was acquired by Gartner, a global information technology research and advisory company.

While software vendors are free to submit information to the company for display, Software Advice relies on an internal team of market researchers to independently verify all the material sent in by manufacturers. This team also works with vendors to ensure all product information is up to date.

Reviews for each piece of software are given by professionals who use the programs in their practices. “Our team manually checks and authenticates every review before it is published on our site, with the goal of maximizing the usefulness of the crowd-sourced feedback,” Mr. Bellovin says. “Our team will verify …. to ensure that each review was submitted by a real user. If we [can’t] we will not publish the review.”

Recently, Software Advice’s staff has been helping ophthalmologists determine the best ICD-10-ready systems in order to “make their transition as easy as possible.”

More than 300,000 business software buyers have used Software Advice since 2005, according to Mr. Bellovin. OM