Jones Kory, Lebron Ricardo A, Mangram Alicia, Dunn Ernest
Department of Surgery, Methodist Health System, 221 W. Colorado, Pavilion 1, Suite 100, Dallas, TX 75208, USA.
Am J Surg. 2008 Dec;196(6):878-81; discussion 881-2. doi: 10.1016/j.amjsurg.2008.08.008.
Surgical education has undergone radical changes in the past decade. The introductions of laparoscopic surgery and endovascular techniques have required program directors to alter surgical training. The 6 competencies are now in place. One issue that still needs to be addressed is the business aspect of surgical practice. Often residents complete their training with minimal or no knowledge on coding of charges or basic aspects on how to set up a practice. We present our program, which has been in place over the past 2 years and is designed to teach the residents practice management.
The program begins with a series of 10 lectures given monthly beginning in August. Topics include an introduction to types of practices available, negotiating a contract, managed care, and marketing the practice. Both medical and surgical residents attend these conferences. In addition, the surgical residents meet monthly with the business office to discuss billing and coding issues. These are didactic sessions combined with in-house chart reviews of surgical coding. The third phase of the practice management plan has the coding team along with the program director attend the outpatient clinic to review in real time the evaluation and management coding of clinic visits.
Resident evaluations were completed for each of the practice management lectures. The responses were recorded on a Likert scale. The scores ranged from 4.1 to 4.8 (average, 4.3). Highest scores were given to lectures concerning negotiating employee agreements, recruiting contracts, malpractice insurance, and risk management. The medical education department has tracked resident coding compliance over the past 2 years. Surgical coding compliance increased from 36% to 88% over a 12-month period. The program director who participated in the educational process increased his accuracy from 50% to 90% over the same time period.
When residents finish their surgical training they need to be ready to enter the world of business. These needs will be present whether pursuing a career in academic medicine or the private sector. A program that focuses on the business aspect of surgery enables the residents to better navigate the future while helping to fulfill the systems-based practice competency.
在过去十年中，外科教育经历了根本性的变革。腹腔镜手术和血管内技术的引入要求项目主任改变外科培训方式。目前已有六项核心能力。一个仍需解决的问题是外科实践的商业方面。通常，住院医师完成培训时，对收费编码或如何建立诊所的基本方面知之甚少或一无所知。我们介绍我们在过去两年实施的项目，该项目旨在教授住院医师实践管理。
该项目从8月开始每月进行一系列10次讲座。主题包括介绍可用的诊所类型、谈判合同、管理式医疗以及诊所营销。医学和外科住院医师都参加这些会议。此外，外科住院医师每月与业务办公室会面，讨论计费和编码问题。这些是结合外科编码内部病历审查的教学课程。实践管理计划的第三阶段是编码团队与项目主任一起参加门诊，实时审查门诊就诊的评估和管理编码。
对每次实践管理讲座都进行了住院医师评估。回答记录在李克特量表上。分数范围为4.1至4.8（平均4.3）。关于谈判员工协议、招聘合同、医疗事故保险和风险管理的讲座得分最高。医学教育部门在过去两年中跟踪了住院医师的编码合规情况。在12个月的时间里，外科编码合规率从36%提高到了88%。参与教育过程的项目主任在同一时期将其准确率从50%提高到了90%。
当住院医师完成外科培训时，他们需要准备好进入商业领域。无论从事学术医学还是私营部门的职业，这些需求都将存在。一个专注于外科商业方面的项目能使住院医师更好地应对未来，同时有助于实现基于系统的实践能力。
