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PERIODIC SURVEY OF FELLOWS
American Academy of Pediatrics
Division of Health Policy Research
EXECUTIVE SUMMARY
Periodic Survey #48
Office Management Practices and Medical Fraud &
Abuse Programs
This report presents findings from Periodic Survey of
Fellows #48 on selected office management practices, and medical fraud
and abuse programs in pediatric practices. The survey was initiated
by the Committee on Medical Liability (COML) to explore pediatricians'
practices regarding telephone management resources, the documentation
of telephone contacts, patients' drug allergies, review of medical reports,
and negative findings from preventive care examinations, as well as
the presence of medical fraud and abuse programs in pediatric practices.
This report compares 2001 findings on office management practices with
data collected in 1996 (PS#34) and 1992 (PS#17). The medical fraud and
abuse questions were asked for the first time in 2001.
PS#48 was an eight-page self-administered questionnaire
sent to a random sample of 1,622 active U.S. members of the AAP. The
original mailing and four follow-up mailings to recontact nonrespondents
were conducted from February through May 2001. After five mailings we
received a total of 1,039 completed questionnaires for a response rate
of 64.1%. The findings on office management practices are based on the
790 pediatricians in 2001, 781 in 1996 and 1021 in 1992 who provide
direct patient care in an office-based setting. The medical fraud and
abuse findings are based on the 949 pediatricians who provide direct
patient care in any setting.
Office Management Practices:
-
In 2001, the proportion of pediatricians whose practice
provides written telephone protocols and/or informal training in telephone
management remains about the same as in 1996; both years show an increase
from 1992 (74.9%, 78.4%, 69.3%, p<.001). A majority of pediatricians
in 2001 and 1996 (51.8%, 53.0%) say their practice has a written triage
system for incoming telephone calls; in 1992, 40.0% reported having
such a system (p<.001). In 2001, the proportion of pediatricians reporting
computerized telephone management protocols increased slightly from
1996 (14.0% v 10.4%, p<.05).
- In 2001, about two-thirds of pediatricians say their practice keeps
records of all telephone contacts during office hours; this represents
a significant increase over the proportion so reporting in 1996 (68.9%
v 62.0%, p<.05) and in 1992 (62.4% v 44.1%, p<.001). In 2001, 53.2%
of pediatricians say their practice keeps records of all after hours
telephone contacts (this question was not asked in 1996 or 1992).
-
In 2001, a majority of pediatricians (56.4%) say
they routinely document patients' drug allergies both on the cover
of the patient's chart and in a specific place within the patient's
chart; in 1996, only 30.4% reported this practice (p<.001) and 22.7%
so reported in 1992. § In 2001, 89.4% and in 1996, 88.4% of pediatricians
say they routinely document their review of medical reports from other
sources; in 1992, significantly fewer pediatricians reported such
documentation (70.9%, p<.001).
-
About the same proportion of pediatricians in 2001
as in 1996 (65.3%, 61.5%) document negative findings from routine
preventive care examinations in the patient's medical record. Slightly
fewer pediatricians (58.5%) reported doing so in 1992.
Medical Fraud and Abuse
About 4 out of 10 pediatricians (37.8%) say their main
practice has a program in place to prevent or detect medical fraud or
abuse, 39.6% are not sure whether or not their practice has such a program,
and 22.7% say their office does not have a medical fraud and abuse program.
-
Among pediatricians who do not have such a program
in place, 51.7% say it is because their practice feels certain they
already comply with necessary federal/state/payor requirements, and
29.9% say it is because on one in their practice knows how to set
up a compliance program. Nineteen percent prefer to wait until compliance
programs are mandatory, 17.4% say it is too burdensome or costly to
maintain such a program and 16.4% say it is too costly to pay an outside
source to design such a program for their practice.
-
More than three fourths of pediatricians with compliance
programs in place report their practice has written policies and procedures
on compliance regarding coding, billing and documentation (85.67%),
mandates record documentation procedures (79.5%), and monitors coding
and billing for publicly-funded health services (78.0%). Seven out
of ten report their practice monitors coding and billing for privately-funded
health services (74.1%), conveys to employees the serious of compliance
and its violations (73.5%), discusses compliance issues at staff meetings
(72.3%), and has a policy on record retention (70.8%). About two-thirds
report their practice trains employees regarding the practice's policies
and procedures (65.5%), conducts audits on billing and coding (65.5%),
conveys its' commitment to prevent/disclose fraud and abuse (64.9%),
and has a staff person responsible for compliance programs (62.8%).
About half (52.1%) say their practice has a policy to ensure compliance
with regulations on the ethics of referrals. Only 19% report their
practice screens employees via the Office of Inspector General's (OIG)
List of Excluded Individual/Entities or other databases.
Pediatricians in hospital or clinic practice are more
likely to report having a medical fraud and abuse program in place than
pediatricians in group or solo/2-physician practices (46.7% v 37.1%
v 27.1%, p<.001).
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