scholarly journals Wading through Molasses: A qualitative examination of the experiences, perceptions, attitudes, and knowledge of Australian medical practitioners regarding medical billing

2020 ◽  
Author(s):  
Margaret Faux ◽  
Jon Adams ◽  
Simran Dahiya ◽  
Jon Wardle
Keyword(s):  
Qualitative Data ◽  
Current System ◽  
Health Financing ◽  
Daily Practice ◽  
Medical Practitioners ◽  
Grass Roots ◽  
Legal Literacy ◽  
Fit For Purpose ◽  
General Medical Practitioners ◽  
Medical Billing

AbstractBackgroundThe WHO has stated that all health systems haemorrhage money, citing one of the causes of financial leakage as non-compliant billing and fraud. In Australia, it has been estimated that leakage from Medicare caused by non-compliant medical billing may be 10-15% of the scheme’s total cost. Despite a growing body of international research suggesting that rather than deliberately abusing the health financing systems they operate within, medical practitioners may be struggling to understand complex and highly interpretive medical billing rules, there is a lack of research in this area in Australia. The aim of this study was to address this research gap by examining the experiences of Australian medical practitioners as they interact with Australia’s Medicare by engaging in conversations with them about their lived experiences conducting medical billing in grass roots practice.MethodThis study interviewed 27 specialist and general medical practitioners who claim Medicare reimbursements in their daily practice. Interviews were recorded, transcribed, and analysed using thematic analysis.ResultsThe qualitative data revealed five themes including inadequate induction, poor legal literacy, absence of reliable advice and support, fear and deference, and unmet opportunities for improvement.ConclusionThe qualitative data presented in this study suggest Australian medical practitioners are ill-equipped to manage their Medicare compliance obligations, have low levels of legal literacy and desire education, clarity and certainty around complex billing standards and rules. Non-compliant medical billing under Australia’s Medicare scheme is a nuanced phenomenon that may be far more complex than previously thought. Strategies to address the barriers and deficiencies identified by participants in this study will require a multi-pronged approach. The data suggest that the current system of ensuring compliance by Australian medical practitioners is not fit for purpose.

scholarly journals A Focus Group on Dental Pain Complaints with General Medical Practitioners: Developing a Treatment Algorithm

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Ava Elizabeth Carter ◽  
Geoff Carter ◽  
Robyn Abbey
Keyword(s):  
Focus Group ◽  
Treatment Algorithm ◽  
Signs And Symptoms ◽  
Daily Practice ◽  
Dental Pain ◽  
Group Discussions ◽  
Medical Practitioners ◽  
Surgical Emergencies ◽  
City Regions ◽  
General Medical Practitioners

Objective. The differential diagnosis of pain in the mouth can be challenging for general medical practitioners (GMPs) as many different dental problems can present with similar signs and symptoms. This study aimed to create a treatment algorithm for GMPs to effectively and appropriately refer the patients and prescribe antibiotics. Design. The study design is comprised of qualitative focus group discussions. Setting and Subjects. Groups of GMPs within the Gold Coast and Brisbane urban and city regions. Outcome Measures. Content thematically analysed and treatment algorithm developed. Results. There were 5 focus groups with 8-9 participants per group. Addressing whether antibiotics should be given to patients with dental pain was considered very important to GMPs to prevent overtreatment and creating antibiotic resistance. Many practitioners were unsure of what the different forms of dental pains represent. 90% of the practitioners involved agreed that the treatment algorithm was useful to daily practice. Conclusion. Common dental complaints and infections are seldom surgical emergencies but can result in prolonged appointments for those GMPs who do not regularly deal with these issues. The treatment algorithm for referral processes and prescriptions was deemed easily downloadable and simple to interpret and detailed but succinct enough for clinical use by GMPs.

scholarly journals EDUCATING MEDICAL PRACTITIONERS ABOUT MEDICAL BILLING: A SYSTEMATIC REVIEW OF THE LITERATURE

2021 ◽  
Author(s):  
Margaret Faux ◽  
Jon Adams ◽  
Jon Wardle
Keyword(s):  
Systematic Review ◽  
Medical Education ◽  
Health Systems ◽  
English Language ◽  
Grey Literature ◽  
Health Financing ◽  
Review Of The Literature ◽  
Medical Practitioners ◽  
Education Needs ◽  
Medical Billing

ABSTRACTIntroductionThe WHO has suggested the solution to leakage in health systems caused by waste, corruption and fraud is policing and prosecution. However, a growing body of evidence suggests leakage may not always be fraudulent or corrupt, with researchers suggesting medical practitioners may sometimes struggle to understand increasingly complex legal requirements around health financing and billing transactions, which may be improved through education. To explore this phenomenon further, we undertook a systematic review of the literature to identify the medical billing education needs of medical practitioners and whether those needs are being met.MethodsEligible records included English language materials published between 1 January 2000 and 4 May 2020, including empirical research, commentary, opinions and grey literature.ResultsWe identified 74 records as directly relevant to the search criteria. Despite a comprehensive international search, studies were limited to three countries (Australia, Canada, U.S), indicating a need for further work internationally. The literature suggests the education needs of medical practitioners in relation to medical billing compliance are not being met and medical practitioners desire more education on this topic. Evidence suggests education may be effective in improving medical billing compliance and reducing waste in health systems and there is broad agreement amongst medical education stakeholders in multiple jurisdictions that medical billing should be viewed as a core competency of medical education, though there is an apparent inertia to act. Penalties for non-compliant medical billing are serious and medical practitioners are at risk of random audits and investigations for breaches of sometimes incomprehensible, and highly interpretive regulations they may never have been taught.ConclusionDespite acknowledged significance of leakage in health systems due to poor practitioner knowledge of billing practices, there has been very little research to date on education interventions to improve health system efficiency at a practitioner level.

An Update on Airway Management

2020 ◽  
Keyword(s):  
Airway Management ◽  
Surgical Techniques ◽  
Daily Practice ◽  
Postoperative Management ◽  
Diagnostic Methods ◽  
Emergency Rooms ◽  
Specific Patient ◽  
Medical Practitioners ◽  
Preoperative Diagnostic ◽  
Airway Devices

In recent years, there have been many advances in the safe management of the patient's airway, a cornerstone of anesthetic practice. An Update on Airway Management brings forth information about new approaches in airway management in many clinical settings. This volume analyzes and explains new preoperative diagnostic methods, algorithms, intubation devices, extubation procedures, novelties in postoperative management in resuscitation and intensive care units, while providing a simple, accessible and applicable reading experience that helps medical practitioners in daily practice. The comprehensive updates presented in this volume make this a useful reference for anesthesiologists, surgeons and EMTs at all levels. Key topics reviewed in this reference include: New airway devices, clinical management techniques, pharmacology updates (ASA guidelines, DAS algorithms, Vortex approach, etc.), Induced and awake approaches in different settings Updates on diagnostic accuracy of perioperative radiology and ultrasonography Airway management in different settings (nonoperating room locations and emergency rooms) Airway management in specific patient groups (for example, patients suffering from morbid obesity, obstetric patients and critical patients) Algorithms and traditional surgical techniques that include emergency cricothyrotomy and tracheostomy in ‘Cannot Intubate, Cannot Ventilate’ scenarios. Learning techniques to manage airways correctly, focusing on the combination of knowledge, technical abilities, decision making, communication skills and leadership Special topics such as difficult airway management registry, organization, documentation, dissemination of critical information, big data and databases

scholarly journals ‘Say Ahhh’: What do dentists, general medical practitioners and community pharmacists do about halitosis?

2018 ◽  
Vol 69 (4) ◽  
pp. 311-320 ◽  
Author(s):  
Phyllis Lau ◽  
Chythra Meethal ◽  
Michelle Middleton ◽  
Malcolm Clark ◽  
Ivan Darby
Keyword(s):  
Community Pharmacists ◽  
Medical Practitioners ◽  
General Medical Practitioners

scholarly journals Problems experienced by role players within the managed healthcare context in Gauteng

Curationis ◽  
2000 ◽  
Vol 23 (2) ◽  
Author(s):  
S Mahlo ◽  
M Muller
Keyword(s):  
Quality Care ◽  
Working Relationships ◽  
Delivery Of Healthcare ◽  
Medical Practitioners ◽  
Replication Studies ◽  
Role Players ◽  
Group Interviews ◽  
Contextual Study ◽  
General Medical Practitioners

Role players within the context of managed healthcare in Gauteng experience problems in the delivery of healthcare, which negatively affect their working relationships. This in turn, affects the quality of care provided to patients. The purpose of this study is to explore and describe the problem experienced by different role players within the context of managed healthcare in Gauteng, as well as the suggested solutions to counteract these problems. These results will be utilised as the basis of a conceptual framework to formulate a strategy to enhance the working relationships amongst these role players. The strategy will not be discussed in this article as the focus is on the problems experienced by the role players in the delivery of healthcare, as well as suggested solutions in the counteraction thereof. A qualitative, exploratory, descriptive and contextual study was followed to explore and describe the problems, as well as the suggested solutions to counteract these problems. Focus group interviews were conducted to collect data from three private hospitals, three managed care organisations and four general medical practitioners in Gauteng. The participants were purposively and conveniently selected. Content analysis as described by Tesch (1990) was followed to analyse the data. The main problems experienced were related to inadequate communication, inadequate staff competence, cost saving versus quality care, procedural complexity, perceived loss of power by doctors and patients and the system of accounts payment. The suggested solutions focused mainly on empowerment and standardisation of procedures. It is recommended that replication studies of this nature be conducted in other provinces and that ethical standards are formulated within the managed healthcare context.

Progressing Towards a Freer Market in Australian Residential Aged Care

2021 ◽  
pp. 1-25
Author(s):  
Susan F Cochrane ◽  
Alice L Holmes ◽  
Joseph E Ibrahim
Keyword(s):  
Current System ◽  
Aged Care ◽  
Care Quality ◽  
Cultural Safety ◽  
Residential Aged Care ◽  
Royal Commission ◽  
Care Providers ◽  
Fit For Purpose ◽  
Market Driven ◽  
Care System

The Royal Commission into Aged Care Quality and Safety has again focussed attention on the failings of the Australian aged care system. Residential aged care in Australia has become increasingly market-driven since the major reforms of 1997. The aims of increased marketisation include providing residents with greater choice, higher quality services, and increasing providers’ efficiency and innovation. However, marketisation is not meeting these aims, predominantly due to asymmetries of knowledge and power between residents and aged care providers. These asymmetries arise from inadequate provision of information, geographic disparities, urgency for care as needs arise acutely, and issues surrounding safety, including cultural safety. We propose a human rights framework, supported by responsive regulation, to overcome the failings of the current system and deliver an improved aged care system which is fit for purpose.

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