Big changes are underway in the realm of medical coding, as the upcoming industry shift to a new set of codes promises more demand for medical coders than ever before.

On October 1, 2014 the United States is unilaterally switching from the old ICD-9 system of coding to the newer and more advanced ICD-10 system. ICD stands for International Classification of Disease, and volumes of ICD codes are developed and published by the United Nations-sponsored World Health Organization.   ICD-10 is the tenth edition of classification codes released by the WHO, replacing ICD-9 which has been used in the United States since the 70’s.

ICD-10, which was endorsed by the WHO in 1990 and adopted by most countries following its update in 1994, offers many advantages over ICD-9. ICD-9 codes are strictly numeric, consisting of 3-5 digits and allowing for a maximum of 17,000 codes. Not only have many coding chapters reached their limit of possible codes, but many of the codes themselves have become obsolete as diagnostic and procedural practices have developed over the years. In contrast, ICD-10 codes are in line with current medical standards and consist of 3-7 alphanumeric characters, allowing for 155,000 different codes.

So what does this mean for medical coders? For one, the nationwide change to ICD-10 requires a workforce that is familiar with the new codes. As ICD-9 codes will remain the standard until the October 1 deadline, many currently-employed coders may find themselves at a disadvantage if they haven’t yet familiarized themselves with the new codes. Experts anticipate that many companies will need to hire additional coders when the change comes in order to test internal systems and keep things running with minor slowdown¹.

Many organizations, such as the American Healthcare Documentation Professionals Group, offer training programs for ICD-10. In order to work coders must pass a Certified Coding Associate exam, which is administered by the American Health Info Management Association². The U.S. Department of Labor estimates the job growth rate for medical coders at 22%, making it one of today’s fastest growing fields, and expects over 41,100 new positions by 2022³.

While the switch from ICD-9 to ICD-10 will require a lot of work on behalf of hospitals, clinics, insurance companies, billing companies and more, it also promises a larger workforce more prepared for the future of medicine.

SOURCES:

1. http://www.govhealthit.com/news/during-icd-10-transition-dual-coding-will-take-toll
2. http://www.prweb.com/releases/2014/01/prweb11460420.htm
3. http://www.bls.gov/ooh/healthcare/medical-records-and-health-information-technicians.htm

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As the Affordable Health Care Act kicks into gear, millions more Americans find themselves with health insurance, and health care providers are faced with the difficult task of accommodating an unprecedented influx of new patients. In the midst of this struggle to meet the needs of our nation’s ill and infirm, Nurse Practitioners may prove to be the single greatest asset in managing this monumental change.

Although Nurse Practitioners have operated in the United States for over 40 years, many people don’t know about them or what kind of services they offer. For this reason, Tay Kopanos, vice president of state government affairs for the American Association of Nurse Practitioners calls them “the best-kept secret in health care.”

Nurse Practitioners hold master’s degrees and perform many of the duties commonly associated with primary care or family practice physicians. The road to becoming a nurse practitioner begins in the field of nursing, where most candidates first obtain a bachelor of science in nursing. Experienced nurses who wish to move to the next step must then achieve a master’s of science in nursing, and finally pass a board certification test before officially becoming a nurse practitioner.

Though nurse practitioners are not a complete substitute for physicians—and laws in nearly every state require they practice under the supervision of an MD—there are areas in which a nurse practitioner may be better suited for care. Studies have shown high satisfaction rates among patients treated by nurse practitioners, perhaps in part because of the bedside manner they develop during their time as nurses. “Local nurse practitioner said their training as nurses follows a different philosophy from a doctor’s medical training, focusing more on the total patient than just the disease,” says Diane D’Amico, a staff writer for The Press of Atlantic City. Similarly Jettie Deden-Castillo, an obstetrics/gynecology nurse practitioner and contributor to the San Diego Union-Tribune, relates: “An NP can function much like a primary-care physician, but with the heart of a nurse.”

The need for highly trained physicians will not diminish with further implementation of nurse practitioners.  If anything, their workloads should be lightened by the additional coverage provided by nurse practitioners, as many serious health concerns can be avoided if patients receive necessary preventive care and education. “In 1979, the vision was for nurse practitioners to manage the care of routine, healthy patients and free up physicians to take more complicated cases,” Deden-Castillo remarks. This teamed approach may be the best method we have for facing the country’s growing healthcare needs.

SOURCES:

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A social worker has developed a non-traditional method of treating service members suffering from post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) who have not responded to traditional treatment methods.  What is unique about the Warrior Canine Connection (WCC), developed by Rick Yount, MS, LSW?  As the name implies, the program treats military members by pairing them with canine companions, which they train to eventually become service dogs for mobility-impaired veterans.

Rick Yount created the first soldier-dog training program in 2008 after working in the child welfare system where he noticed the therapeutic value of involving his golden retriever, Gabe with the children. The program was so effective that the military invited Yount to design a service dog training program for its National Intrepid Center of Excellence (NICoE). The NICoE aims to treat service members with psychological health conditions who have not responded to traditional therapies.

The patients of the WCC are given the mission of training a 12-week old future service dog, and in doing so are forced to confront many of the issues experienced by those suffering from PTSD and TBI. Introducing the puppy to new environments, keeping it calm in arousing situations, and developing a close bond requires one to confront issues of self-isolation, anxiety, and emotional numbness.

Rather than honing in on clinical symptoms and treating patient deficiencies, the WCC approach instead seeks to empower soldiers by giving them a task that utilizes their strengths and serves a greater purpose. In this way, the WCC’s approach is in line with the warrior ethos of the army: “I will always place the mission first. I will never accept defeat. I will never quit. I will never leave a fallen comrade.”

Driven by the mission to aide their wounded comrades and holding to ethos of never accepting defeat, many soldiers have already benefited from this unique new treatment and so far the WCC has been a rousing success.

RESOURCES:

1. “Warrior Canine Connection — Puppy Training Program Tackles PTSD and TBI” by Lynne Soine, DSW, MSW, LMSW in Social Work Today, Vol. 13 No. 4 P. 16
   Accessed: http://www.socialworktoday.com/archive/070813p16.shtml

The post Social Worker Develops Strength-Based Canine Treatment first appeared on Sterling Medical.

As the demand for healthcare grows quicker than the supply, one of the most daunting setbacks lies in the lack of qualified anesthesiologists.  A study conducted by the American Society of Anesthesiologists (ASA) found that “a nationwide shortage of anesthesiologists is beginning to have a profound effect in larger hospitals, delaying elective procedures, and in extreme cases, closing down surgical suites.”¹ However, findings of a recent study suggest CRNAs may provide the greatest hope in meeting anesthesia needs in the future.

CRNA is the acronym for Certified Registered Nurse Anesthetist, also known as a Nurse Anesthetist. CRNAs are highly specialized nurses who hold graduated degrees, and are trained to administer anesthesia under the supervision of an anesthesiologist. In most states CRNAs are required to work under the gaze of a supervising physician. But due to demand, 15 states have waived this requirement, allowing CRNAs to practice independently of a licensed physician.

Some studies suggest that independently practicing CRNAs may provide a remedy to the dearth of anesthesiologists.  A retrospective review conducted by Dr. Murtaza Parekh, MD of Raleigh Endoscopy Center in North Carolina suggests that the risk is minimal.  Data from over 106,000 ambulatory endoscopy procedures, spread across 5 years, indicate that CRNAs may conduct anesthesia in certain types of procedures with little or no ill-effect. “The data showed no significant difference between CRNA with anesthesiologist supervision and CRNA alone in the frequency of aspiration…desaturation…laryngospasm…cardiac adverse events…perforation…and splenic injury.”²

Practitioners agree that highly complex and risky procedures require the supervision of an anesthesiologist to account for the extensive physiological variables. However, less risky procedures can likely be handled by CRNAs, whose numbers outstrip those of anesthesiologists due to less stringent education and licensing requirements. “In the end, MD supervision did not significantly impact safety outcomes with propofol in our ambulatory endoscopy center,” remarked Dr. Parekh.²

Still, some physicians aren’t sure that granting CRNAs more autonomy is the solution. Drs. Evan Pivalizza, MBChB and George W. Williams II, MD from the University of Texas’ Health Science Center both disagree with Dr. Parekh’s conclusion. “In terms of strength of evidence, which should be driving practice standards, this study is weak,” stated Dr. Pivalizza.²  The two doctors emphasized the need for anesthesiologist presence during procedures, stating “when physician anesthesiologists direct care, mortality is lower, especially in rescue situations, which by definition are unpredictable.”¹

While Drs. Pivalizza and Williams present legitimate concerns about breadth of CRNAs treatment scope, the question of what will assuage the need for anesthesia services remains. Whether their role remains strictly supportive or grows to be more independent, CRNAs are sure to be an integral part of healthcare in this country for years to come.

SOURCES:

1. http://www.prnewswire.com/news-releases/nationwide-anesthesiologist-shortage-delays-patients-surgery-76448857.html
2. http://www.medpagetoday.com/MeetingCoverage/ACG/42402

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The recent wars in Iraq and Afghanistan have produced a large increase in shrapnel injuries among our soldiers overseas.  However, the military is working to combat this trend by training its physicians in a breakthrough surgical technique created by an Ohio radiologist.

Dr. William E. Shiels II of Nationwide Children’s Hospital in Columbus, OH is the creator of a surgical technique known as ultrasound guided foreign body removal, or USFBR. While traditional methods of x-ray imaging are effective in locating metallic shrapnel, it is less adept at identifying wood, plastic, gravel, and other nontraditional materials commonly found in Improvised Explosive Devices (I.E.D.s). USFBR has thus far proven extremely effective in locating both metallic and non-metallic embedded objects. More accurate screening procedures ultimately lead to safer and more effective surgery.

So far, military doctors have relied exclusively on traditional x-ray techniques to identify embedded objects. Because these techniques are less accurate and often do not pick up non-metallic objects, more invasive, open surgery is often required for their removal. Using USFBR, surgeons can easily and accurately locate fragments, leading to less invasive surgery. According to its creators, USFBR “guides minimally invasive removal, often only requiring a .25 inch incision with little or no scarring or cosmetic deformity.”¹

William Shiels, DO is the chief of Nationwide Children’s Department of Radiology, as well as president of Children’s Radiological Institute, Inc. Dr. Shiels initially developed the technique at Nationwide Children’s Hospital, where he and his team of interventional radiologists continued to make improvements. To date, Dr. Shiels and his team have successfully utilized USFBR to remove foreign objects from over 800 patients.

Dr. Shiels and his team are now in the midst of adapting the procedure for use by the military. Along with his team of civilian and military radiologists, Dr. Shiels is currently engaged in training 48 military physicians at four military treatment facilities across the United States. This training initiative is funded in part by a $1 million research grant awarded through the U.S. Army Medical Research and Material Command.

Both the military and Dr. Shiels are optimistic about the potential for USFBR in treating wounded soldiers. Dr. Shiels espoused gratification at the opportunity to provide care for wounded service members, stating: “our hope is that USFBR will become part of the standard of care for war-related foreign body removal.”¹

SOURCES:

1. http://www.newswise.com/articles/nationwide-children-s-hospital-radiologists-train-military-physicians-in-foreign-body-removal-techniques

The post Radiology Technique Developed by Ohio Physician Used to Treat Soldiers first appeared on Sterling Medical.

When people think of speech language pathology, they typically envision a sterile office environment where patients recite drill-like speech patterns. However, the increasing prevalence of a technique known as hippotherapy ought to change some conceptions of what speech language pathology entails.

Hippotherapy, or equine-assisted therapy, is a physical, occupational, and speech-language therapy treatment strategy that utilizes the movement of a horse.  While riding on a horse may not appear to have anything to do with speech therapy, the spectrum of benefits provided by hippotherapy is wide-ranging.

According to the American Hippotherapy Association, the multidimensional movement provided by a horse is variable, rhythmic, and repetitive, which produces a calming effect on riders.  This in turn facilitates neurophysiologic systems that support all of our functional daily living skills.¹  A trained therapist or handler can adjust the horse’s gait, enabling them to control the degree of sensory input to the patient.

There is a growing trend in speech and language intervention toward developing naturalistic approaches to add to or replace the traditional, more drill-like methods traditionally utilized in speech-language therapy. Hippotherapy may be a viable option, as it offers a unique alternative for clients who languish in more conventional settings.²

Rachel Gerhart is one such proponent of hippotherapy for speech-language treatment. Her company, Pony Talk Speech Therapy, has operated in Reading, PA since 2010. Gerhart specializes in working with children age 10 and under, and uses horseback games to draw out their communication skills. Gerhart affirms that “being on the horse is a distraction, but a good one….A lot of them really don’t think they’re doing therapy.”³

Her clients notice the difference in their children’s progress as well. Joseph Geloso was four years old when he began hippotherapy with Gerhart, and since then his mother has noted significant improvement. “He was a little hesitant,” Nicole Geloso recalls, “but once he got on [the horse’s] back, he was a different kid.” During his 30 minute sessions Joseph, who is diagnosed with Down syndrome, moves from near-gibberish to intelligible speech to complete the games Gerhart creates.

Speech-language pathology is a diverse and expansive field of treatment, with much to offer those suffering from vocal impediments. The successful implementation of hippotherapy is just another sign of the field’s innovative expansion.

SOURCES:

1. http://www.americanhippotherapyassociation.org/hippotherapy/hippotherapy-as-a-treatment-strategy/
2. http://www.speechpathology.com/articles/therapeutic-riding-and-hippotherapy-what-1177
3. http://readingeagle.com/article.aspx?id=516374

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Despite the less-than-certain job prospects facing today’s college graduates, the new Dean of University of Cincinnati’s College of Pharmacy is confident his students will find jobs almost immediately out the door.  When asked in a recent interview how many upcoming College of Pharmacy graduates can expect to land jobs, Neil MacKinnon quickly responded: “Easy question, 100 percent.”*

MacKinnon’s response might sound overly optimistic, but there are several reasons that back up what he says.

Most notably, the implementation of the Affordable Care Act in January will extend healthcare coverage to millions of Americans, including roughly 164,000 uninsured residents in Southwest Ohio alone. “That’s a lot of new prescriptions,” quipped MacKinnon. “January is going to be crunch time. We’re going to be desperate in this country for family physicians, physician assistants, nurse practitioners and pharmacists.”

The employment of pharmacists is expected to increase by 25% between now and 2020, according to studies performed by the Bureau of Labor Statistics.  This is considerably faster than the average projected growth for all occupations, which is estimated at 14%. Contributing to this growth is not only an increase in healthcare coverage, but also the continuing growth of the pharmaceutical industry and the various personnel needed to prescribe and counsel patients on new drugs.

Prospective pharmacists should be enticed by high wages and a good work-life balance. The median annual salary for a pharmacist in Cincinnati is $116,000, and some entry-level pharmacists make just as much.  According to the Bureau, most pharmacists work a standard 40 hour workweek, with the occasional night and weekend shift.  Approximately 21% work part-time.  Perhaps this is because, according to MacKinnon, “pharmacy is the kind of field where somebody could take career breaks or work part-time to raise children and later return to a full-time job.”

SOURCES:

1. http://www.bizjournals.com/cincinnati/blog/2013/10/obamacare-to-create-pharmacy-jobs-new.html?page=all
2. http://www.bls.gov/ooh/Healthcare/Pharmacists.htm#tab-3

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As comic books and graphic novels become increasingly popular source material for major motion pictures, they are also providing inspiration in a more unlikely realm: psychology.  Chicago Psychologist Dr. Patrick O’Connor, PsyD, who specializes in treating teens and young adults, has pioneered an effort to use comic books for therapy.

Dr. O’Connor first got the idea to use comic books as therapeutic tools when working in foster care. Dr. O’Connor recalls, “one day I had a question about whether there were any Batman and Robin comics that dealt with similar father/son issues as my clients, given that Dick Grayson [Robin, Batman’s sidekick] is a ward of Bruce Wayne.”¹ His subsequent investigation into the question led Dr. O’Connor to the conclusion that comic books have the potential to be a great tool for connecting with patients.

Counselors and therapists have utilized the arts to connect with and help patients for years, and there are several qualities that make comic books an ideal vehicle for reaching teens and adolescents. Unlike books comprised solely of text, comic books have the added dimension of visual expression, making them more accessible to younger readers. And while a novel may appear daunting to those to aren’t avid readers, most single issue comic books take only 15 minutes to read.  “In the end, reading is reading, and if you have a child who hates to read, what better person than Batman or Spider-Man to get them interested?” Dr. O’Connor reflects.¹

Another reason comic books work so well with troubled adolescents is that many characters in the stories deal with similar issues. Classic superheroes such as Batman and Spider-Man were inspired to fight crime after experiencing its traumatic effects firsthand. Many comics today deal with serious themes, such as gang violence and substance abuse. During an Ask Me Anything thread on the popular website Reddit, Dr. O’Connor related one such instance in which the content of a comic book got through to a reader: “I had a 17 year old gang member with a history of violence and substance abuse pause while reading an issue of Irredeemable, point to this panel, and say, ‘This is how I feel about the world. This describes it perfectly.’ That opened up a huge door for us.”²

His success with patients led Dr. O’Connor to found Comicspedia, an online database containing hundreds of individual comic book summaries. What’s more, the entries on Comicspedia are categorized by the theme, allowing visitors to search for stories that address their topic of interest.

While Dr. O’Connor imagines he isn’t the first to utilize comic books for therapy, he hopes that by doing so he can open up doors for others to do the same. With Comicspedia as a freely available resource, “folks can cut down the number of steps between wondering how they can use comics to help others and actually doing it in practice.”¹

Sources:

1. http://www.comicbooked.com/patrick-oconnor-gets-comic-booked/
2.  http://comicsalliance.com/psychologist-superhero-comics-psychology/

The post Psychologist Uses Comics to Treat Patients first appeared on Sterling Medical.

The future looks bright for those in the practice of optometry, and perhaps even more so for those studying to become optometrists.  According to top sources, optometry as a profession is growing much faster than most fields on the job market, even amongst the other steadily growing groups in the medical field.

The Bureau of Labor Statistics estimates that the need for optometrists is currently growing at a rate of 33%, a rate considerably faster than most occupational fields in this country.  While the economic recession has slowed the growth of many major industries, the healthcare community stands out as one field that is growing at a steady rate, and with no signs of backing down.  Even compared to other professions in the medical field, the growth of optometrists exceeds its peers by a solid 7%¹.

The need for optometrists is growing for several reasons.  The healthcare industry at large is growing at a faster rate than most, due in large part to the nationwide insurance coverage mandated by the Affordable Care Act.  With the number of insured American reaching unprecedented levels and more insurance companies offering vision care benefits, the need for optometrists to meet demand is at an all-time high.  Medical care in general is also on the rise, as one of the nation’s largest demographics, the baby boomers, begin to retire and enter old age.  Not only does the aging boomer population come with an increased need for medical care, it also leaves a vacuum of optometrists and other healthcare providers as members of the generation begin to retire.

Optometrists provide the vast majority of ocular related care in this country.  Though not as educationally learned as ophthalmologists, who are physicians and surgeons specializing in eye care, optometrists are what most people think of when they picture an eye doctor.  Optometrists are responsible for conducting standard vision tests, prescribing and fitting corrective lenses, and even diagnosing and treating many standard eye-related diseases.

Optometrists enjoy many of the perks commonly associated with doctoral medical practitioners, yet few of the drawbacks.  Optometrists, like most upper level medical professionals, require a four year post-graduate degree.  However, whereas physicians, surgeons, and even dentists require additional post-doctoral training in the form of internships or residencies, optometrists are able to begin practicing soon after graduation.  In order to become a licensed optometrist, candidates must first obtain a Doctor of Optometry degree (OD) from an accredited optometry program.  The Accreditation Council on Optometric Education is the only accrediting body for OD programs, and currently accredits over 20 programs throughout the United States and Canada².

Most optometrists enjoy regular hours and steady work.  Roughly half of the optometrists practicing in this county do so in stand-alone clinics, and in 2010 approximately 22% were self-employed in private practices³.  Other work settings for optometrists include physicians’ offices, health and personal care stores, and outpatient care centers. And because the scope of care provided by optometrists doesn’t involve life-threatening or urgent care treatment, optometrists are typically not required to work many hours past that of a normal work week.

The average pay for optometrists, while slightly lower than that of practicing physicians or dentists, is still very high.  The median, or middle, annual wage for optometrists in 2010 was $94,990, although members of the highest 10% earned $166,400 or more⁴.  Taking into consideration the time and monetary investment required in order to obtain an OD, optometrists wind up coming out on top.

With more Americans enjoying vision coverage than ever before, the need for optometrists will only continue to grow.  Coupled with the increasing health needs of the boomer generation, and the vacancy left as they continue to exit the workforce, those interested in pursuing optometry as a profession are looking at a bright future indeed.

Sources:

1. http://www.bls.gov/ooh/healthcare/optometrists.htm#tab-6
2. http://www.aoa.org/optometrists/for-educators/accreditation-council-on-optometric-education/accredited-programs
3. http://www.bls.gov/ooh/healthcare/optometrists.htm#tab-3
4. http://www.bls.gov/ooh/healthcare/optometrists.htm#tab-5

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Demand for Physical Therapists remains high across the US, despite calls in Congress for drastic cuts to Medicare.  Graduates from accredited Physical Therapy degree programs have their pick of locations whether applying for their first job, or changing positions.

Physical therapy employment opportunities are remarkably secure and abundant in the United States due to a variety of factors, including a shortage of physical therapists, an aging pool of professionals, and healthcare reform. This trend in job security for physical therapists has been on the rise since at least the early 2000s, but has dramatically increased in the past two years. According to Forbes, “In 2010, only 0.4 percent — one in 250 — of PTs seeking work were jobless,” (“Demand for Therapy Jobs Critically High in 2012,” Forbes).

Factors bolstering demand include funding from the Individuals with Disabilities Education Act of 2004, providing free access to children in need of physical therapy, and the aging of baby boomers.

Healthcare reform, pressures to update record keeping methods, a shortage in Physical Therapists, and cuts in government funding are playing significant roles in the influence of market trends in the Physical Therapy profession as a whole and will continue to do so throughout 2012, according to the American Physical Therapy Association. Automatic cuts in Medicare payments to physicians and physical therapists have been delayed until after November, due to the hot button nature of issues surrounding Medicare in this significant election year.

While the APTA is attempting to work against certain government influences, it is rushing to adapt to others, specifically healthcare reform. On Tuesday, February 7, the APTA announced it will be holding an audio conference in late March to discuss and evaluate the significant changes implicit with the reform.

The conference will allow clinicians, managers, owners, and patients to gain a unique perspective and deeper understanding of new policies, such as, “reforming payments, healthcare delivery, and the workforce” (“Registration Open for Health Care Reform Audio Conference,” Physical Therapy in Motion). APTA vice president Justin Moore will conduct the conference and address additional, “contemporary issues surrounding the upcoming Supreme Court decision on the constitutionality of the law, the pressures on states to implement key provisions, and efforts in Congress to repeal, revise, and redirect funding related to the Affordable Care Act.”

Another trend the Physical Therapy profession is hurrying to adapt to is the need for digitalized information, particularly with regards to health records. Concerning Electronic Health Records (EHRs), the APTA has released a Guide to Understanding and Adopting Electronic Health Records, which “aims to help physical therapists (PTs) and physical therapist assistants (PTAs) assess and implement EHRs,” (“APTA Launches Guide to Electronic Health Records,” Physical Therapy in Motion).

The guide not only helps users to successfully adopt the new system, it allows them to understand the importance of the transition and how it will ultimately affect the Physical Therapy profession as a whole.

Sources

1. “Call to Action: Congressional Action Needed on Caps and Cuts” http://www.apta.org/PTinMotion/NewsNow/2012/2/6/CapSGR/?blogid=10737418615&category=APTA%20Working%20For%20You
2. Registration Open for Health Care Reform Audio Conference”http://www.apta.org/PTinMotion/NewsNow/2012/2/7/HCRAudioConference/
3. “APTA Launches Guide to Electronic Health Records”http://www.apta.org/PTinMotion/NewsNow/2012/2/7/EHRGuide/
4. “Demand for Therapy Jobs Critically High in 2012” http://www.forbes.com/sites/moneywisewomen/2012/01/27/demand-for-therapy-jobs-critically-high-in-2012/

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