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Biomedical subjects

W L Larimore

Publications and source records attributed to W L Larimore.

At least 19 recordsLinked to original sources
PubMed1995

SOAP to SNOCAMP: improving the medical record format.

Not since the development of the SOAP note in the problem-oriented medical record has there been a significant need to alter the format of medical record documentation. With the intrusion of third-party audits, malpractice attorney subpoenas, medical guidelines, and reimbursement code criteria into the practice of medicine, there is a need to expand the traditional SOAP note. This article proposes a new acronym, "SNOCAMP," for medical record documentation. SNOCAMP retains the SOAP format, which includes subjective, objective, assessment, and plan of treatment, with the addition of nature of the presenting complaint, counseling, and medical decision-making. It is hoped that this new, more explicit format will prove successful in meeting the divergent needs of practicing physicians, the patients they serve, and the inquiring minds that look over their shoulders.

Diagnosis↗
PubMed1995

Maternity care in family medicine: economics and malpractice.

BACKGROUND: The number of family physicians delivering babies in Florida in 1991 was at an all-time low. Concerns about malpractice risk and insurance costs have resulted in only 2% of Florida's family practice residency graduates choosing to deliver babies. The purpose of this study was to compare the practices of family physicians in Florida who delivered babies in private practice (termed the "OB group") with those who did not (the "non-OB group"). METHODS: A potential study group of 293 family physicians was mailed an extensive survey that explored 132 variables related to medical practice economics and demographics, lifestyle and satisfactions, and malpractice costs and risks. RESULTS: The obstetrical (OB) group was significantly more likely than the non-OB group to perform a variety of procedures and report more patients under age 6 years (15% vs 5%; P = .003) and fewer patients 65 years or older (19% vs 33%; P < .001). Even though the number of patients seen and the number of hours worked were similar, the 1991 incomes were much higher for those practicing maternity care (mean = $164,000 vs $104,000; P = .04). Compared with the non-OB group, the OB group was more likely to report that their financial and psychological compensation was adequate (P < .001), would be more likely to choose medicine as a profession again (94% vs 60%, P < .05), paid more for malpractice insurance (mean = $22,000 vs $11,000; P = .01), and reported 30% fewer nonobstetrical malpractice claims. CONCLUSIONS: Family physicians in Florida who deliver babies, as compared with those who do not, are more likely to report (1) increased financial and psychological satisfaction for the same hours worked; (2) increased satisfaction with medicine and family practice; (3) more frequent performance of a wider range of procedures; (4) younger practices serving a greater number of complete families and fewer Medicare patients; (5) a more diverse and comprehensive hospital and office practice; and, despite paying significantly higher malpractice insurance premiums, (6) few obstetrical malpractice claims and lawsuits, and (7) fewer nonobstetrical malpractice claims and lawsuits.

Chi-Square Distribution↗
PubMed1994

Pregnancy care liability misperceptions among medical students in Florida.

BACKGROUND: Previous studies have demonstrated a professional liability insurance (PLI) fee misperception among medical students that had a direct influence on their subsequent decision making concerning the provision of pregnancy care (PC) in family practice (FP). In Florida, the paucity of family physicians providing PC and prenatal services led to the present study, which was designed to survey those senior medical students in Florida who were interested in FP to determine their opinions regarding pregnancy care-related liability issues. METHODS: All fourth-year medical students in the three allopathic medical schools in Florida who were members of a family practice interest group (FPIG) were mailed a short questionnaire by an independent researcher. The questionnaire asked students about a) whether they planned to deliver babies in practice, b) the cost of first-year liability insurance, and c) the risk of being sued if they provided PC in family practice. RESULTS: Fifty-one medical students (64% of the FPIG members in Florida) provided responses to the mail survey. Of the 51 respondents, 57% plan to enter FP residencies, and 31% were either somewhat likely or very likely to provide PC in FP. Those unlikely to do PC listed PLI cost and risk as their primary concerns. A comparison of medical students planning to provide PC with those not planning to provide PC services revealed average estimates of PLI premiums that were discordant by $5,000 per year. Furthermore, estimates in both groups exceeded the actual first-year rates of PLI insurance by more than $20,000 per year. Ninety percent of the students estimated that the actual risk of being sued for malpractice while providing PC was "high." Students' perceptions of PC PLI cost, and risk of being sued, were learned primarily from sources outside of the medical school. CONCLUSIONS: This study suggests a problem in the medical education of FP-bound students that allows students to develop misperceptions about the liability cost and risk of providing PC in FP.

Adult↗
PubMed1994

Coding and reimbursement for gastrointestinal endoscopic procedures in primary care.

Endoscopic diagnostic procedures have become part of the comprehensive care provided by many primary care physicians, and when these physicians interact with third-party payers, they must correctly report the endoscopic services they have provided. Included in this review are commonly used upper and lower gastrointestinal endoscopic procedure codes; corresponding reimbursement values from one state's Medicare and Medicaid program; lists of diagnosis codes used in reporting upper and lower endoscopy services; and instructions for reporting visits and intravenous anesthesia associated with endoscopy procedures.

Anesthesia, Intravenous↗