IC41-R: Transitions: Is the Grass Always Greener?
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All property rights in the material presented, including common-law copyright, are expressly reserved to the speaker or the ASSH. No statement or presentation made is to be regarded as dedicated to the public domain. IC41-R: Transitions: Is the Grass Always Greener? Moderator: John J. Faillace, MD Faculty: R. David Graham, MD, Jeffrey M. Jacobson, MD, James M. Saucedo, MD, MBA and Jeffrey C. Wint, MD Session Handouts OnDemand 76TH ANNUAL MEETING OF THE ASSH SEPTEMBER 30 – OCTOBER 2, 2021 SAN FRANCISCO, CA 822 West Washington Blvd Chicago, IL 60607 Phone: (312) 880-1900 Web: www.assh.org Email: [email protected]
Transcript of IC41-R: Transitions: Is the Grass Always Greener?
All property rights in the material presented, including common-law
copyright, are expressly reserved to the speaker or the ASSH. No
statement or presentation made is to be regarded as dedicated to
the public domain.
IC41-R: Transitions: Is the Grass Always Greener?
Moderator: John J. Faillace, MD
Faculty: R. David Graham, MD, Jeffrey M. Jacobson, MD, James M. Saucedo, MD, MBA and
Jeffrey C. Wint, MD
SEPTEMBER 30 – OCTOBER 2, 2021
SAN FRANCISCO, CA
• No disclosures
• My story
Pittsburgh PA
• The grass truly is greener…
Transitions: Is the Grass Always Greener?
• The grass truly is greener…
Transitions: Is the Grass Always Greener?
• Why is the grass greener?
• Autonomy
• Why is the grass greener?
• Autonomy
• Why is the grass greener?
• Autonomy
• But with that said…
their first job
Transitions: Is the Grass Always Greener?
• Practice models
• Clinical gap – looking for expertise
• Looking to fill a strategic need
• Volume overflow capture
• Other: Shift call?/work?
• Contracts
• Always take your contract to a healthcare contract attorney in your state
• Always negotiate
• Negotiating can be scary – be prepared
• Select 2-3 things that are your highest priority and focus on these
• Understand the payment models
• Loan forgiveness?
• Malpractice insurance (tail insurance)
7/31/2021
3
Transitions: Is the Grass Always Greener? Transitions: Is the Grass Always Greener?
• Credentialing
• Need to begin AT LEAST 6 months prior to start date if possible
• Licensing
• Need to begin AT LEAST 6 months prior to start date if possible
• Can be difficult if do not live in state
• My experience
• Took almost 8 months to get verified/approved by various insurances
• Hospital privileges took months
13 14
All property rights in the material presented, including common-law copyright, are expressly reserved to the speaker or the ASSH. No statement or presentation made is to be regarded as dedicated to the public domain.
Speaker has not
SEPTEMBER 30 – OCTOBER 2, 2021
SAN FRANCISCO, CA
From Private Practice to Employed
James M. Saucedo, MD, MBA Associate Professor of Clinical Orthopedic Surgery
Houston Methodist Institute for Academic Medicine
ASSH Annual Meeting 2021
• Where did I look & how did I decide?
• What did I learn?
• Is the grass greener?
• Working harder & harder for less & less
• Hard to agree on vision & strategy as a group
• Personal happiness & satisfaction declining
• “Balance”
• “Opportunities”
• “Stability”
• More time… for my family, to write, to teach, to
volunteer, etc.
• Predictability (and stability)
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3 4
5 6
• Family considerations
– Certain models with certain players in certain settings
behave differently
• Not every private practice is perfect just as not every employed
model is evil
– You get the behavior that you reward
• Production-based compensation encourages “productivity”
What did I learn?
• A lot of logistical considerations
– Knowing your contractual obligations (how much notice?)
– Informing stakeholders (state medical board, patients, etc)
– Malpractice insurance, accounts receivable
• How much $ per unit of work?
• Convert productivity into
What did I learn?
• A lot of logistical considerations
• Important to be honest with yourself (& others)
– As you’re looking for your first (or next) job
– If you’re not happy
7 8
9 10
11 12
• Must / should include your family in decision
– Their happiness
– Their perspective
• You can’t find (shouldn’t look for) happiness in a job
– No job is perfect!
Is the grass greener?
– Net positive
– More flexible (believe it or not)
– Very supportive
• New practice doesn’t have everything
– Academic opportunities harder to pursue
– Well-run large institution = lots of rules & regulations = can
be slow to get certain things done (but better than average)
– Have not negotiated the next contract yet…
Thank you!
13 14
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Greener?
John J Faillace, MD, FAAOS
Associate Professor, Department of Orthopedic Surgery and Rehabilitation
University of Texas Medical Branch, Galveston, Texas
Disclosures:
• No relevant disclosures
Uniqueness of Solo Practice
• Space / Equipment / Personnel Sharing Agreements Possible
• X-ray, Therapy, Billing
• Maintained Insurance Contracts
• Delayed Revenue Stream
• Additional Concerns: Setting up the physical office, X-ray, Hard goods, personnel, etc
Plan
Ahead
• Transition Team: Lawyer, Credentialling, Real Estate Agent
• Savings / Resources (Loans)
• Others Follow Medicare
• Online Resources www.~
• Medicare / Medicaid
• Other Hand Surgeons, Ortho / Plastics Docs, ER Docs
• Plan visits, engage hospital administration for introductions
• Fliers / Post Card Announcing Yourself
• Office “Open House”
Obtaining Hospital Privileges
Don’ts
Choosing Malpractice Insurance
•Coverage • Claims-Made (need Tail) vs Occurrence ($$)
Malpractice Insurance Coverage
• Lawyer to Assist in Separation from Group
• $ well spent
13 14
JEFFREY C. WINT, MD ASSH annual meeting 2021 SF CA
RETIREMENT Common reasons AGE Financial security “burnout” Dissatisfaction Other interests
AGE Number and Percentage of Active Physicians ORTHOPEDIC SURGERY 2019
, Total active 19058 Under age 55 8168 Over age 55 10.890 Source https://www.aamc.org/data- reports/workforce/interactive-data/active-physicians-age-and- specialty-2019
RETIREMENT STATISTICS Nearly 30 percent of physicians retire between the ages of 60 and 65
12 percent retire before the age of 60 Source: https://www.ama-assn.org/practice- management/career-development/early-retirement-5-factors- physicians-should-evaluate
CONSIDERATIONS MEDICAL RECORDS CURRENT CARE FOR PATIENTS MALPRACTICE AND OFFICE INSURANCE LICENSURE CERTIFICATION CONTRACTS LEAVING THE DOOR OPEN
RETIREMENT Speaker Disclaimer: I am not retiring, I am not retired The more I learn the more questions I have Nothing else to disclose
RETIREMENT Your answers, your experience, your wisdom may vary Speak to retired colleagues Stories and experiences, and scenarios : good bad and banal… abound
MEDICAL RECORDS Retention - STATE LAWS- Range for adults Minors Hospitals and Practices differ
RECORDS retention rules vary EX: MASS -2008 Adult patients: 7 years from the date of the last patient encounter.
Minor patients: 7 years from date of last patient encounter or until the patient reaches the age of 9, whichever is longer .
Hospital 30 years after the discharge or the final treatment of the patient.
https://www.healthit.gov/sites/default/files/appa7-1.pdf
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MEDICAL RECORDS MEDICAL RECORDS GENERAL IF NOT STATE STATUTE OR UNSURE Adult patients, 10 years from the date the patient was last seen. Minor patients, 28 years from the date of birth. Deceased patients, five years from the date of death. SOURCE https://www.thedoctors.com/articles/medical-record- retention/
COMMON THEME 10 YEARS-- EACH STATE IS DIFFERENT Full records: 10 years after the last discharge of the patient. Full records: 10 years or 1 year beyond the date that
the patient reaches the age of majority (i.e., until patient turns 19) whichever is longer.
Summary of destroyed records for both adults and minors— 25 years.
RECORDS Records may be requested by the patient A provider cannot deny you a copy of your records because you have not paid for the services you have received.
However, a provider may charge for the reasonable costs for copying and mailing the records. The provider cannot charge you a fee for searching for or retrieving your records.
Source https://www.hhs.gov/hipaa/for-individuals/medical- records/index.html
Retainer of the records has the right to charge for copies? Access to records is a “big” issue
https://www.healthit.gov/sites/default/files/YourHealthInformationYo urRights_Infographic-Web.pdf
RECORDS CURRENT CARE WHO takes over ongoing care ACUTE vs CHRONIC CARE Post-surgical, when to stop surgery When to stop accepting new patients Practice Setting 90 days? Same as the customary time period for discharging a patient from your practice
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90 days? Same as the customary time period for discharging a patient from your practice
INSURANCE: MALPRACTICE OCCURANCE CLAIMS MADE TAIL who pays? TAIL does it require agreement not to practice? Other TAIL requirements can be age, time insured with that carrier
TAIL cost ? 2X last premium
INSURANCE: MALPRACTICE STOPPING SURGERY STOPPING “ALL” CLINCAL STILL SEEING IMEs , LEGAL work STILL RETAINING MEDICAL LICENSE INSURANCE office practice REQUIREMENTS for ancillary staff RECORD issues MEDICAL LICENSURE CHECK STATE REGULATIONS DO you “give up or not renew”? More difficult to get back once gone license expires; can take up to six months or more in many states.
Is retired status required CHANGE address Other states vacation home or if you retire “elsewhere:” SOME states require malpractice just to have a medical license
MEDICAL LICENSURE DEA, Controlled substance Need a practice address in that state
MEDICAL LICENSURE STATUS
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MEDICAL LICENSURE STATUS Retired status - relinquish Renew and be inactive – no CME needed Renew ( even if not clinical)
CERTIFICATION ABOS ABOS ABOS Diplomates are able to maintain their Board
Certification even if their practice situation changes and they pursue non-operative or non-practicing career paths
ABOS Diplomates maintain their Board Certification through the non-operative and non-practicing ABOS Maintenance of Certification (MOC) pathways.
Diplomates must still complete all ABOS MOC requirements, including submitting an Application, meeting continuing medical education and professionalism requirements, and successfully completing an ABOS MOC Knowledge Assessment.
Diplomates should call the ABOS office and speak with their Certification Specialist to find out further details/next steps
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COLLECTIONS ACCOUNTS Receivable Time frame Old debt Refunds Reviews for coding
HOSPITAL PRIVILEGES Levels of practice Reappointment
TIMEFRAME for notification IF your hospital records persist do you need to keep your office
records WHO notifies patients. LETTERS, NEWSPAPER ADS, or both
LEAVING THE DOOR OPEN MAINTAIN MEDICAL LICENSURE KEEP CERTIFICATION NOT SIGNING A TAIL AGREEMENT which limits you FORGE TIES NOW FOR FUTURE ACTIVITY Medical OTHER pursuits
ASSH As an ASSH Active Member ( 2096), you may be eligible to
change your status to one of the following: RETIRED MEMBER – DUES PAYING: 42 Available for those who have fully retired from the practice of medicine, regardless of age.
You will keep your full Active Membership benefits. Dues: $420
RETIRED MEMBER – NON-DUES PAYING: 99 Available for those who have fully retired from the practice of medicine, regardless of age.
This category has limited benefits. You will no longer receive the Journal of Hand Surgery, and you will no longer be listed in Find a Hand Surgeon.
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the Journal of Hand Surgery, and you will no longer be listed in Find a Hand Surgeon.
Dues: $0 LIFETIME MEMBER – DUES PAYING: 278 Automatic for Active Members for 30 or more years. You will keep your full Active Membership Benefits. Dues: $420
LIFETIME MEMBER – NON-DUES PAYING: 381 Available to Active Members for 30 or more years. This category has limited benefits. You will no longer receive the Journal of Hand Surgery, and you will no longer be listed in Find a Hand Surgeon.
Dues: $0
RETIREMENT: WE NEED MORE INFORMATION We all do this We need to learn more from our retired colleagues WE need a database, a collection of experiences, of regulations,
policy , law most of all an explicit schema --- guidance RETIREMENT takes planning
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2021 ASSH
JEFFREY C. WINT, MD ASSH annual meeting 2021 SF CA
1
RETIREMENT
ORTHOPEDIC SURGERY 2019
2021 ASSH
2
RETIREMENT
STATISTICS
Nearly 30 percent of physicians retire between the ages of 60 and 65
12 percent retire before the age of 60
Source: https://www.am a-assn.org/practice-m anagem ent/career-developm ent/early-retirem ent-5- factors-physicians-should-evaluate
4
RETIREMENT
CONSIDERATIONS
MALPRACTICE AND OFFICE INSURANCE
Speaker Disclaimer: I am not retiring, I am not retired
The more I learn the more questions I have
Nothing else to disclose
2021 ASSH
Speak to retired colleagues
Stories and experiences, and scenarios : good bad and banal… abound
7
EX: MASS -2008
Adult patients: 7 years from the date of the last patient encounter.
Minor patients: 7 years from date of last patient encounter or until the patient reaches the age of 9, whichever is longer .
Hospital 30 years after the discharge or the final treatment of the patient.
https://www.healthit.gov/sites/default/files/appa7-1.pdf
9
2021 ASSH
GENERAL IF NOT STATE STATUTE OR UNSURE
Adult patients, 10 years from the date the patient was last seen. Minor patients, 28 years from the date of birth.
Deceased patients, five years from the date of death. SOURCE https://www.thedoctors.com/articles/medical-record-retention/
COMMON THEME 10 YEARS-- EACH STATE IS DIFFERENT
Full records: 10 years after the last discharge of the patient. Full records: 10 years or 1 year beyond the date that the patient reaches the age of majority
(i.e., until patient turns 19) whichever is longer.
Summary of destroyed records for both adults and minors—25 years.
11
RECORDS
Records may be requested by the patient
A provider cannot deny you a copy of your records because you have not paid for the services you have received.
However, a provider may charge for the reasonable costs for copying and mailing the records. The provider cannot charge you a fee for searching for or retrieving your records.
Source https://www.hhs.gov/hipaa/for-individuals/medical-records/index.html
Retainer of the records has the right to charge for copies?
Access to records is a “big” issue https://www.healthit.gov/sites/default/files/YourHealthInformationYourRights_Infographic- Web.pdf
2021 ASSH
you can and should place a medical records request immediately.
Source: https://www.myretireddoctor.com
13
ACUTE vs CHRONIC CARE
When to stop accepting new patients
Practice Setting
90 days? Same as the customary time period for discharging a patient from your practice
ACTIVE PATIENT to notify traditionally “within 2 years” but …? Notify, letters, newspapers ads
14
TAIL does it require agreement not to practice?
Other TAIL requirements can be age, time insured with that carrier
TAIL cost ? 2X last premium
15
2021 ASSH
STILL RETAINING MEDICAL LICENSE
DO you “give up or not renew”?
More difficult to get back once gone license expires; can take up to six months or more in many states.
Is retired status required
SOME states require malpractice just to have a medical license
18
2021 ASSH
19
Renew ( even if not clinical)
20
CERTIFICATION ABOS
ABOS ABOS Diplomates are able to maintain their Board Certification even if their practice situation changes and they pursue non-operative or non-practicing career paths
ABOS Diplomates maintain their Board Certification through the non-operative and non- practicing ABOS Maintenance of Certification (MOC) pathways.
Diplomates must still complete all ABOS MOC requirements, including submitting an Application, meeting continuing medical education and professionalism requirements, and successfully completing an ABOS MOC Knowledge Assessment.
Diplomates should call the ABOS office and speak with their Certification Specialist to find out further details/next steps
21
2021 ASSH
Has a “retired” designation
They wish to know if you are not in clinical practice
Recertification pathways for non-clinical possible- individual consideration
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Each specialty society is different.
“Speak to yours”
2021 ASSH
TIMEFRAME for notification
IF your hospital records persist do you need to keep your office records
WHO notifies patients. LETTERS, NEWSPAPER ADS, or both
26
FORGE TIES NOW FOR FUTURE ACTIVITY
Medical
2021 ASSH
10
ASSH As an ASSH Active Member ( 2096), you may be eligible to change your status to one of the following: RETIRED MEMBER – DUES PAYING: 42
A va ila b le fo r th o se w h o h a ve fu lly re tire d fro m th e p ra c tic e o f m e d ic in e , re g a rd le ss o f a g e .
Yo u w ill ke e p yo u r fu ll A c tive M e m b e rsh ip b e n e fits.
D u e s: $420
RETIRED MEMBER – NON-DUES PAYING: 99 A va ila b le fo r th o se w h o h a ve fu lly re tire d fro m th e p ra c tic e o f m e d ic in e , re g a rd le ss o f a g e .
Th is c a te g o ry h a s lim ite d b e n e fits. Yo u w ill n o lo n g e r re c e ive th e Jo u rn a l o f H a n d Su rg e ry , a n d yo u w ill n o lo n g e r b e liste d in F in d a H a n d Su rg e o n .
D u e s: $0
LIFETIME MEMBER – DUES PAYING: 278 A u to m a tic fo r A c tive M e m b e rs fo r 30 o r m o re ye a rs.
Yo u w ill ke e p yo u r fu ll A c tive M e m b e rsh ip Be n e fits.
D u e s: $420
LIFETIME MEMBER – NON-DUES PAYING: 381 A va ila b le to A c tive M e m b e rs fo r 30 o r m o re ye a rs.
Th is c a te g o ry h a s lim ite d b e n e fits. Yo u w ill n o lo n g e r re c e ive th e Jo u rn a l o f H a n d Su rg e ry , a n d yo u w ill n o lo n g e r b e liste d in F in d a H a n d Su rg e o n .
D u e s: $0
28
We all do this
We need to learn more from our retired colleagues
WE need a database, a collection of experiences, of regulations, policy , law
most of all an explicit schema --- guidance
RETIREMENT takes planning
IC41-R: Transitions: Is the Grass Always Greener?
Moderator: John J. Faillace, MD
Faculty: R. David Graham, MD, Jeffrey M. Jacobson, MD, James M. Saucedo, MD, MBA and
Jeffrey C. Wint, MD
SEPTEMBER 30 – OCTOBER 2, 2021
SAN FRANCISCO, CA
• No disclosures
• My story
Pittsburgh PA
• The grass truly is greener…
Transitions: Is the Grass Always Greener?
• The grass truly is greener…
Transitions: Is the Grass Always Greener?
• Why is the grass greener?
• Autonomy
• Why is the grass greener?
• Autonomy
• Why is the grass greener?
• Autonomy
• But with that said…
their first job
Transitions: Is the Grass Always Greener?
• Practice models
• Clinical gap – looking for expertise
• Looking to fill a strategic need
• Volume overflow capture
• Other: Shift call?/work?
• Contracts
• Always take your contract to a healthcare contract attorney in your state
• Always negotiate
• Negotiating can be scary – be prepared
• Select 2-3 things that are your highest priority and focus on these
• Understand the payment models
• Loan forgiveness?
• Malpractice insurance (tail insurance)
7/31/2021
3
Transitions: Is the Grass Always Greener? Transitions: Is the Grass Always Greener?
• Credentialing
• Need to begin AT LEAST 6 months prior to start date if possible
• Licensing
• Need to begin AT LEAST 6 months prior to start date if possible
• Can be difficult if do not live in state
• My experience
• Took almost 8 months to get verified/approved by various insurances
• Hospital privileges took months
13 14
All property rights in the material presented, including common-law copyright, are expressly reserved to the speaker or the ASSH. No statement or presentation made is to be regarded as dedicated to the public domain.
Speaker has not
SEPTEMBER 30 – OCTOBER 2, 2021
SAN FRANCISCO, CA
From Private Practice to Employed
James M. Saucedo, MD, MBA Associate Professor of Clinical Orthopedic Surgery
Houston Methodist Institute for Academic Medicine
ASSH Annual Meeting 2021
• Where did I look & how did I decide?
• What did I learn?
• Is the grass greener?
• Working harder & harder for less & less
• Hard to agree on vision & strategy as a group
• Personal happiness & satisfaction declining
• “Balance”
• “Opportunities”
• “Stability”
• More time… for my family, to write, to teach, to
volunteer, etc.
• Predictability (and stability)
1 2
3 4
5 6
• Family considerations
– Certain models with certain players in certain settings
behave differently
• Not every private practice is perfect just as not every employed
model is evil
– You get the behavior that you reward
• Production-based compensation encourages “productivity”
What did I learn?
• A lot of logistical considerations
– Knowing your contractual obligations (how much notice?)
– Informing stakeholders (state medical board, patients, etc)
– Malpractice insurance, accounts receivable
• How much $ per unit of work?
• Convert productivity into
What did I learn?
• A lot of logistical considerations
• Important to be honest with yourself (& others)
– As you’re looking for your first (or next) job
– If you’re not happy
7 8
9 10
11 12
• Must / should include your family in decision
– Their happiness
– Their perspective
• You can’t find (shouldn’t look for) happiness in a job
– No job is perfect!
Is the grass greener?
– Net positive
– More flexible (believe it or not)
– Very supportive
• New practice doesn’t have everything
– Academic opportunities harder to pursue
– Well-run large institution = lots of rules & regulations = can
be slow to get certain things done (but better than average)
– Have not negotiated the next contract yet…
Thank you!
13 14
15 16
Greener?
John J Faillace, MD, FAAOS
Associate Professor, Department of Orthopedic Surgery and Rehabilitation
University of Texas Medical Branch, Galveston, Texas
Disclosures:
• No relevant disclosures
Uniqueness of Solo Practice
• Space / Equipment / Personnel Sharing Agreements Possible
• X-ray, Therapy, Billing
• Maintained Insurance Contracts
• Delayed Revenue Stream
• Additional Concerns: Setting up the physical office, X-ray, Hard goods, personnel, etc
Plan
Ahead
• Transition Team: Lawyer, Credentialling, Real Estate Agent
• Savings / Resources (Loans)
• Others Follow Medicare
• Online Resources www.~
• Medicare / Medicaid
• Other Hand Surgeons, Ortho / Plastics Docs, ER Docs
• Plan visits, engage hospital administration for introductions
• Fliers / Post Card Announcing Yourself
• Office “Open House”
Obtaining Hospital Privileges
Don’ts
Choosing Malpractice Insurance
•Coverage • Claims-Made (need Tail) vs Occurrence ($$)
Malpractice Insurance Coverage
• Lawyer to Assist in Separation from Group
• $ well spent
13 14
JEFFREY C. WINT, MD ASSH annual meeting 2021 SF CA
RETIREMENT Common reasons AGE Financial security “burnout” Dissatisfaction Other interests
AGE Number and Percentage of Active Physicians ORTHOPEDIC SURGERY 2019
, Total active 19058 Under age 55 8168 Over age 55 10.890 Source https://www.aamc.org/data- reports/workforce/interactive-data/active-physicians-age-and- specialty-2019
RETIREMENT STATISTICS Nearly 30 percent of physicians retire between the ages of 60 and 65
12 percent retire before the age of 60 Source: https://www.ama-assn.org/practice- management/career-development/early-retirement-5-factors- physicians-should-evaluate
CONSIDERATIONS MEDICAL RECORDS CURRENT CARE FOR PATIENTS MALPRACTICE AND OFFICE INSURANCE LICENSURE CERTIFICATION CONTRACTS LEAVING THE DOOR OPEN
RETIREMENT Speaker Disclaimer: I am not retiring, I am not retired The more I learn the more questions I have Nothing else to disclose
RETIREMENT Your answers, your experience, your wisdom may vary Speak to retired colleagues Stories and experiences, and scenarios : good bad and banal… abound
MEDICAL RECORDS Retention - STATE LAWS- Range for adults Minors Hospitals and Practices differ
RECORDS retention rules vary EX: MASS -2008 Adult patients: 7 years from the date of the last patient encounter.
Minor patients: 7 years from date of last patient encounter or until the patient reaches the age of 9, whichever is longer .
Hospital 30 years after the discharge or the final treatment of the patient.
https://www.healthit.gov/sites/default/files/appa7-1.pdf
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MEDICAL RECORDS MEDICAL RECORDS GENERAL IF NOT STATE STATUTE OR UNSURE Adult patients, 10 years from the date the patient was last seen. Minor patients, 28 years from the date of birth. Deceased patients, five years from the date of death. SOURCE https://www.thedoctors.com/articles/medical-record- retention/
COMMON THEME 10 YEARS-- EACH STATE IS DIFFERENT Full records: 10 years after the last discharge of the patient. Full records: 10 years or 1 year beyond the date that
the patient reaches the age of majority (i.e., until patient turns 19) whichever is longer.
Summary of destroyed records for both adults and minors— 25 years.
RECORDS Records may be requested by the patient A provider cannot deny you a copy of your records because you have not paid for the services you have received.
However, a provider may charge for the reasonable costs for copying and mailing the records. The provider cannot charge you a fee for searching for or retrieving your records.
Source https://www.hhs.gov/hipaa/for-individuals/medical- records/index.html
Retainer of the records has the right to charge for copies? Access to records is a “big” issue
https://www.healthit.gov/sites/default/files/YourHealthInformationYo urRights_Infographic-Web.pdf
RECORDS CURRENT CARE WHO takes over ongoing care ACUTE vs CHRONIC CARE Post-surgical, when to stop surgery When to stop accepting new patients Practice Setting 90 days? Same as the customary time period for discharging a patient from your practice
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90 days? Same as the customary time period for discharging a patient from your practice
INSURANCE: MALPRACTICE OCCURANCE CLAIMS MADE TAIL who pays? TAIL does it require agreement not to practice? Other TAIL requirements can be age, time insured with that carrier
TAIL cost ? 2X last premium
INSURANCE: MALPRACTICE STOPPING SURGERY STOPPING “ALL” CLINCAL STILL SEEING IMEs , LEGAL work STILL RETAINING MEDICAL LICENSE INSURANCE office practice REQUIREMENTS for ancillary staff RECORD issues MEDICAL LICENSURE CHECK STATE REGULATIONS DO you “give up or not renew”? More difficult to get back once gone license expires; can take up to six months or more in many states.
Is retired status required CHANGE address Other states vacation home or if you retire “elsewhere:” SOME states require malpractice just to have a medical license
MEDICAL LICENSURE DEA, Controlled substance Need a practice address in that state
MEDICAL LICENSURE STATUS
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MEDICAL LICENSURE STATUS Retired status - relinquish Renew and be inactive – no CME needed Renew ( even if not clinical)
CERTIFICATION ABOS ABOS ABOS Diplomates are able to maintain their Board
Certification even if their practice situation changes and they pursue non-operative or non-practicing career paths
ABOS Diplomates maintain their Board Certification through the non-operative and non-practicing ABOS Maintenance of Certification (MOC) pathways.
Diplomates must still complete all ABOS MOC requirements, including submitting an Application, meeting continuing medical education and professionalism requirements, and successfully completing an ABOS MOC Knowledge Assessment.
Diplomates should call the ABOS office and speak with their Certification Specialist to find out further details/next steps
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COLLECTIONS ACCOUNTS Receivable Time frame Old debt Refunds Reviews for coding
HOSPITAL PRIVILEGES Levels of practice Reappointment
TIMEFRAME for notification IF your hospital records persist do you need to keep your office
records WHO notifies patients. LETTERS, NEWSPAPER ADS, or both
LEAVING THE DOOR OPEN MAINTAIN MEDICAL LICENSURE KEEP CERTIFICATION NOT SIGNING A TAIL AGREEMENT which limits you FORGE TIES NOW FOR FUTURE ACTIVITY Medical OTHER pursuits
ASSH As an ASSH Active Member ( 2096), you may be eligible to
change your status to one of the following: RETIRED MEMBER – DUES PAYING: 42 Available for those who have fully retired from the practice of medicine, regardless of age.
You will keep your full Active Membership benefits. Dues: $420
RETIRED MEMBER – NON-DUES PAYING: 99 Available for those who have fully retired from the practice of medicine, regardless of age.
This category has limited benefits. You will no longer receive the Journal of Hand Surgery, and you will no longer be listed in Find a Hand Surgeon.
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the Journal of Hand Surgery, and you will no longer be listed in Find a Hand Surgeon.
Dues: $0 LIFETIME MEMBER – DUES PAYING: 278 Automatic for Active Members for 30 or more years. You will keep your full Active Membership Benefits. Dues: $420
LIFETIME MEMBER – NON-DUES PAYING: 381 Available to Active Members for 30 or more years. This category has limited benefits. You will no longer receive the Journal of Hand Surgery, and you will no longer be listed in Find a Hand Surgeon.
Dues: $0
RETIREMENT: WE NEED MORE INFORMATION We all do this We need to learn more from our retired colleagues WE need a database, a collection of experiences, of regulations,
policy , law most of all an explicit schema --- guidance RETIREMENT takes planning
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2021 ASSH
JEFFREY C. WINT, MD ASSH annual meeting 2021 SF CA
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RETIREMENT
ORTHOPEDIC SURGERY 2019
2021 ASSH
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RETIREMENT
STATISTICS
Nearly 30 percent of physicians retire between the ages of 60 and 65
12 percent retire before the age of 60
Source: https://www.am a-assn.org/practice-m anagem ent/career-developm ent/early-retirem ent-5- factors-physicians-should-evaluate
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RETIREMENT
CONSIDERATIONS
MALPRACTICE AND OFFICE INSURANCE
Speaker Disclaimer: I am not retiring, I am not retired
The more I learn the more questions I have
Nothing else to disclose
2021 ASSH
Speak to retired colleagues
Stories and experiences, and scenarios : good bad and banal… abound
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EX: MASS -2008
Adult patients: 7 years from the date of the last patient encounter.
Minor patients: 7 years from date of last patient encounter or until the patient reaches the age of 9, whichever is longer .
Hospital 30 years after the discharge or the final treatment of the patient.
https://www.healthit.gov/sites/default/files/appa7-1.pdf
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2021 ASSH
GENERAL IF NOT STATE STATUTE OR UNSURE
Adult patients, 10 years from the date the patient was last seen. Minor patients, 28 years from the date of birth.
Deceased patients, five years from the date of death. SOURCE https://www.thedoctors.com/articles/medical-record-retention/
COMMON THEME 10 YEARS-- EACH STATE IS DIFFERENT
Full records: 10 years after the last discharge of the patient. Full records: 10 years or 1 year beyond the date that the patient reaches the age of majority
(i.e., until patient turns 19) whichever is longer.
Summary of destroyed records for both adults and minors—25 years.
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RECORDS
Records may be requested by the patient
A provider cannot deny you a copy of your records because you have not paid for the services you have received.
However, a provider may charge for the reasonable costs for copying and mailing the records. The provider cannot charge you a fee for searching for or retrieving your records.
Source https://www.hhs.gov/hipaa/for-individuals/medical-records/index.html
Retainer of the records has the right to charge for copies?
Access to records is a “big” issue https://www.healthit.gov/sites/default/files/YourHealthInformationYourRights_Infographic- Web.pdf
2021 ASSH
you can and should place a medical records request immediately.
Source: https://www.myretireddoctor.com
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ACUTE vs CHRONIC CARE
When to stop accepting new patients
Practice Setting
90 days? Same as the customary time period for discharging a patient from your practice
ACTIVE PATIENT to notify traditionally “within 2 years” but …? Notify, letters, newspapers ads
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TAIL does it require agreement not to practice?
Other TAIL requirements can be age, time insured with that carrier
TAIL cost ? 2X last premium
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2021 ASSH
STILL RETAINING MEDICAL LICENSE
DO you “give up or not renew”?
More difficult to get back once gone license expires; can take up to six months or more in many states.
Is retired status required
SOME states require malpractice just to have a medical license
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2021 ASSH
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Renew ( even if not clinical)
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CERTIFICATION ABOS
ABOS ABOS Diplomates are able to maintain their Board Certification even if their practice situation changes and they pursue non-operative or non-practicing career paths
ABOS Diplomates maintain their Board Certification through the non-operative and non- practicing ABOS Maintenance of Certification (MOC) pathways.
Diplomates must still complete all ABOS MOC requirements, including submitting an Application, meeting continuing medical education and professionalism requirements, and successfully completing an ABOS MOC Knowledge Assessment.
Diplomates should call the ABOS office and speak with their Certification Specialist to find out further details/next steps
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2021 ASSH
Has a “retired” designation
They wish to know if you are not in clinical practice
Recertification pathways for non-clinical possible- individual consideration
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Each specialty society is different.
“Speak to yours”
2021 ASSH
TIMEFRAME for notification
IF your hospital records persist do you need to keep your office records
WHO notifies patients. LETTERS, NEWSPAPER ADS, or both
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FORGE TIES NOW FOR FUTURE ACTIVITY
Medical
2021 ASSH
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ASSH As an ASSH Active Member ( 2096), you may be eligible to change your status to one of the following: RETIRED MEMBER – DUES PAYING: 42
A va ila b le fo r th o se w h o h a ve fu lly re tire d fro m th e p ra c tic e o f m e d ic in e , re g a rd le ss o f a g e .
Yo u w ill ke e p yo u r fu ll A c tive M e m b e rsh ip b e n e fits.
D u e s: $420
RETIRED MEMBER – NON-DUES PAYING: 99 A va ila b le fo r th o se w h o h a ve fu lly re tire d fro m th e p ra c tic e o f m e d ic in e , re g a rd le ss o f a g e .
Th is c a te g o ry h a s lim ite d b e n e fits. Yo u w ill n o lo n g e r re c e ive th e Jo u rn a l o f H a n d Su rg e ry , a n d yo u w ill n o lo n g e r b e liste d in F in d a H a n d Su rg e o n .
D u e s: $0
LIFETIME MEMBER – DUES PAYING: 278 A u to m a tic fo r A c tive M e m b e rs fo r 30 o r m o re ye a rs.
Yo u w ill ke e p yo u r fu ll A c tive M e m b e rsh ip Be n e fits.
D u e s: $420
LIFETIME MEMBER – NON-DUES PAYING: 381 A va ila b le to A c tive M e m b e rs fo r 30 o r m o re ye a rs.
Th is c a te g o ry h a s lim ite d b e n e fits. Yo u w ill n o lo n g e r re c e ive th e Jo u rn a l o f H a n d Su rg e ry , a n d yo u w ill n o lo n g e r b e liste d in F in d a H a n d Su rg e o n .
D u e s: $0
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We all do this
We need to learn more from our retired colleagues
WE need a database, a collection of experiences, of regulations, policy , law
most of all an explicit schema --- guidance
RETIREMENT takes planning
