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6 ABOUT THE AUTHOR eggy J. Noonan is a Colorado-based health writer. She writes about Pbiotechnology, computers, jobs, and work life, but her primary interest is medicine and healthcare issues for consumers and practitioners. Her work has appeared in popular magazines, hospital publications, newspapers, monographs, books, and Websites. Previously, she was medical news columnist and contributing editor for Denver Medical Journal. ADVISORY BOARD Mary Jo Gorman, M.D., M.B.A., Chief Executive Officer, Advanced ICU Care, St. Louis, Mo. Scott Luria, M.D., Associate Professor, University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, Vt. Bernadette Melnyk, Ph.D., R.N., C.P.N.P., Dean and Distinguished Foundation Professor in Nursing, Center for the Advancement of Evidence-Based Practice, Arizona State University, Phoenix, Ariz. Patricia E. Powers M.P.P.A., President and CEO, Center for Health Improvement, Sacramento, Cal. Charles Young, M.R.C.P., Editor, BMJ Clinical Evidence BMJ Publishing Group, London, United Kingdom EDITOR Emily Paulsen SENIOR EDITOR Frank Murphy CREATIVE DIRECTOR Gary DeFazio ART/PRODUCTION DIRECTOR Dushan G. Lukic PUBLISHER Jeannette Brandofino MARKETING DIRECTOR Linda Zani Thomas MARKETING ASSOCIATE Kathleen Grey The content of Doctor s Digest: Evidence-based Medicine, including such material as text, graphics, images, and other material contained in the digest, is for informational purposes only. The content is not intended to be a substitute for professional advice. Always seek the advice of professionals with any question you may have. Reliance is at your own risk. The content of Doctor s Digest: Evidence-based Medicine is protected by copyright under both United States and foreign laws and under United States trademark laws. Title to the content remains with Brandofino Communications Inc. Any use of the content not expressly authorized by Brandofino Communications Inc. is a breach of copyright and trademark law. All rights not expressly granted are reserved to Brandofino Communications Inc. Doctor s Digest (ISSN ), January/February 2007, Volume 3, Number 1. Published bimonthly by Brandofino Communications, Inc., 12 Spruce Park, Syosset, NY For general subscription information & paid subscriptions circulation@doctorsdigest.net. Doctor s Digest is available on a paid subscription basis at the following annual rate: $54 (Foreign $108). Single copy price: $12. To order send check or money order payment to: Doctor's Digest, 12 Spruce Park, Syosset, NY 11791, Attn: Circulation Department (be sure to indicate title of issue, shipping address and phone number). Visit our Website at For Advertising Sales & Editorial call or write sales@doctorsdigest.net or editorial@doctorsdigest.net. Postage paid at Mechanicsburg, PA Copyright 2006 and published by Brandofino Communications, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means electronic or mechanical, including photocopy, recording or any information-retrieval system, without the permission in writing from the publisher. DOCTOR S DIGEST and the split diagonal, two toned publication cover are trademarks of Brandofino Communications, Inc. B R A N D O F I N O C O M M U N I C A T I O N S I N C.

7 Dear Medical coding and billing rules are extensive and complicated. Not only do Doctor: they vary from payer to payer, but they are constantly changing. In today s climate of managed care and declining reimbursement, it is crucial for physicians to have a thorough understanding of the fundamental concepts involved in CPT and ICD9-CM coding. With patient chart and superbill in hand, you re the ones who select the codes that are reported to the payers. By understanding coding concepts, you can help your practice get reimbursed appropriately and boost your bottom line. That s why Doctor s Digest launches a new regular feature with this issue. Next to the detachable bookmark insert we will run the Pocket Coding Advisor, written by Patricia Hubbard, C.P.C. The topics we select for PCA will be aimed at your needs as physicians. The purpose is to offer important tips on coding issues that may result in lost revenue or put the medical practice at risk for audit and payer profiling. For more tips as well as in-depth information on each topic, go to the Doctor s Digest Website ( Access to information is such a crucial part of practicing medicine. Not only has the body of clinical literature grown in size in recent years, its importance has spread beyond the science of medicine to the business of medicine. This issue of Doctor s Digest takes a hard look at the practice management implications of Evidence-based Medicine and gives physicians some powerful resources and tools for finding and weighing medical evidence. For a comprehensive list of EBM tools and reading material, please go to our Website at and download an expanded Resource Directory. How is Evidence-based Medicine affecting your medical practice? Is this a promising way to increase quality of care and manage healthcare costs? Or is it just another excuse for denying coverage and taking control away from physicians? As always, we want to know what you think. Please contact me by at publisher@doctorsdigest.net, or by fax at Jeannette Brandofino Publisher publisher@doctorsdigest.net

8 Evidence-based Guide to Well-Being Medicine Although at first glance Evidence-based Medicine (EBM) may look like a clinical topic, it is closely tied to the business of medicine. In fact, EBM is inextricably linked to the practice management from its very origins: the body of medical knowledge (the evidence) has benefited and grown as a result of electronic health records and health claims data. While the concept was developed as a clinical approach, payers are now taking the lead in using data to re-structure reimbursement and develop guidelines and best practices. No matter what they think of EBM, physicians must educate themselves on the topic and understand how it may directly affect them and their practice. In this issue, Doctor s Digest explores the practical aspects of EBM as it affects the business of medicine. From the computerization of medical records to reimbursement, liability and other financial issues, and even how physicians communicate with their patients, EBM is poised to make an impact on the day-to-day practice of medicine. Understanding Evidence-based Medicine 8 Although the core concept of EBM is not new, it is gaining prominence with the push to develop standard protocols and clinical guidelines for medical care. Some physicians believe that EBM will speed the time it takes for new treatments to move from bench to bedside. Others feel that it encourages cookie-cutter medicine that minimizes the unique relationship between physician and patient. It s possible to debate the merits of EBM, but it seems clear that it will influence the practice and the business of medicine in the coming years. Implementation: Advantages and Challenges 24 The way EBM gets implemented depends a great deal on the nature and size of the practice or healthcare organization. Physicians may incorporate Evidence-based Medicine into the business of practicing medicine on many levels using a variety of tools and techniques that serve the diverse needs of physician practices. Managed-care groups, hospitals, and health systems have the ability to track large amounts of data and can contribute to the pool of evidence as well as assessing evidence from other sources. However, most physicians practice by themselves or in groups of fewer than six doctors. These physicians can face special challenges in implementing and supporting EBM.

9 Effects on the Cost of Practicing Medicine 40 EBM has the potential to streamline aspects of patient care, which can save physicians and their staff time. EBM is also part and parcel of the pay-for-performance trend and other reimbursement changes. Physicians face a time management conundrum trying to keep up with preventive care recommendations while also addressing acute complaints. EBM may lead to the development of tools that help physicians prioritize recommendations and raise the quality of care without spending more time. New evidence may lead to payments for services previously not reimbursed. It is also leading to the development of best practices that may reduce the risk of malpractice claims Weighing Medical Evidence 60 Physicians practicing Evidence-based Medicine must evaluate medical literature and decide if the information applies to the patient. Doing this may require new skills and resources. To put the latest evidence into practice to benefit their patients, physicians must learn how to formulate the question, find the evidence in the appropriate resource, and figure out if it is applicable to their patient s situation. Bias is a fact of human nature. The key is to be able to detect the different types of bias in the medical literature and figure out how that bias affects the validity of the data in the case at hand. EBM and the Physician-Patient Relationship 86 By helping patients look carefully at the evidence, physicians can help them make important treatment decisions and help them stick with a treatment plan. EBM gives physicians a framework for explaining medical information to patients. It also helps physicians respond to questions that patients may have. While some physicians may resist the move toward EBM and dismiss it as cookbook medicine, proponents point out that creativity, individuality, and innovation are not stifled by the foundation truths on which recipes are based; rather, they grow from that foundation. Similarly, the practice of medicine will continue to thrive. Resources: For More Information 107 If you d like to learn more about Evidence-based Medicine, consult the list of online journals, training opportunities, and web-based resources.