Yearly Archives: 2013

A friend of mine recently shared a pretty disappointing experience she recently had with her primary care practice when she sought treatment for a painful, infected spider bite.  Or, perhaps I should say, an experience she had with her former primary care practice, since the practice refused to see her -- stating that she was no longer a patient because she hadn't been in for a visit for three years, and therefore "couldn't be seen" until she scheduled a new patient wellness exam. My friend was told that this was the policy of the IPA that the practice was part of -- and that she had "no choice but to go to urgent care."  In this context, urgent care was presented to my friend almost as sort of a downgrade -- like, "go wait in line at urgent care." It felt to my friend -- who was already a bit nervous about her injury -- like the practice really didn't care about her at all. Luckily, the urgent care center they recommended was friendly and appealing, and a doctor saw her quickly and treated her infection (which turned out to be spreading alarmingly fast) carefully and attentively.  Not surprisingly, the doctor at the urgent care center was happy to let her know that he could also act as her PCP -- and, my friend is considering making the switch, even though she had been with her prior practice for nearly 20 years! Why did the PCP risk losing such a valuable patient?  (Besides being a long-term patient herself, my friend has two teenaged children who will soon need to graduate from their pediatricians.  So, that's three patients potentially sacrificed for lack of a recent wellness visit.  Moreover, my friend is the ideal patient for primary care: pays her bills at time-of-service and is always diligently compliant with advice.) One guess is that the IPA doesn't want to miss out on the chance to bill for a new patient wellness visit at a higher rate.  (The practice may not even realize this is an underlying motivation.)  But, is that $50 or

Since I started my career in the publishing world, Marketo's post today about their "Facebook Editorial Calendar" caught my eye.  While the idea of calling Facebook posts "editorial" is perhaps a tad grandiose, the concept they're describing is really helpful for the idea-challenged social media maven. Their basic idea is to assign a post type for each day of the week -- famous quotes on Monday, statistics/infographics on Tuesdays and Thursdays, etc.  A medical practice using Facebook could adapt this idea -- say, copy the motivational quote idea on Monday, have a nutrition tip on Tuesday, explore or debunk a news item on Wednesday, have a link to a helpful site on Thursday, etc. Have you experimented with the idea of organizing your posts into assigned daily categories like this?  We'd love to hear about it! Here's a link to Marketo's idea.

I used to do a lot of work on airplanes.  But, that was back in the olden days when I flew for work internationally -- I had elite status and so almost never flew coach.  It's a lot easier to get something done when you can actually fit your laptop on the tray-table in front of you (pretty difficult in coach these days -- especially if the person in front of you tilts back even a little). Besides the shrinking seat-space problem, Bloomberg Business Week adds a few medical reasons to skip cracking open the laptop: you're headache-y, you're forgetful, your heart's working harder, etc.  (I'm still confused about why they seem to assume most people have hangovers, however.) But, they left out one reason that I think might trump them all: no privacy.  Recently, I was on a flight and the person in the row in front/across from me opened up her laptop, clicked onto the plane's WI-FI, and began working in her practice's Practice Fusion EMR.  (Yes, I could clearly see it was Practice Fusion.)   Potential privacy violation?  I wondered how many records the people directly next to her could see -- and what a morally challenged individual might do if she left her computer open while in the bathroom line.  You really never know who you're sitting next to on a flying bus, after all.

Given the maze that is healthcare today, it makes sense that navigators to help patients understand the path to care would be a wonderful way to improve outcomes -- especially for the critically ill and under-insured.  Research from Accenture shows they also improve the bottom line. Read the post on the Harvard Business Review blog.

Regarding my post of a few days ago about the marketing webinar Judy and I did for Kareo -- apparently a technical glitch has prevented Kareo from posting it.  They're working on it and hope to have it up within a week.  If you want to access it via an alternative source (gotomeeting's archive -- requires registration), send a message to our "info" email and I'll send you the details.

Branded thumb drives: isn't it great when you get one at a conference?  They're so handy to have around!  But, that handiness also makes them a risk for your practice. Even having a policy against downloading patient records to an external drive may not be enough to make thumb drives worth the risk: as this story from the Salt Lake Tribune   illustrates, just having a policy isn't enough if people aren't aware of it (or choose to ignore it).  Although the employee in the story -- who downloaded 6,000 patient records to a thumb drive, and then lost it somewhere en route between UT, CO and DC -- was fired, the missing records could still be found by someone with less-than-honest intentions.  And, the woman's employer, a Medicaid claims processor,  did have a policy against downloading patient records -- the "star employee" just didn't know about it. Of course, while this fired downloader seems to have had purely innocent intentions, the story also illuminates how easy it would be to download thousands of records onto a drive and slip it into a pocket -- and later sell those records to criminals.  Some estimates put the value of patient medical identity data at $50/patient or more on the black market. That's why you probably won't see a Capko & Company branded thumb drive as a gift any time soon.  Even though they're irresistible!

Just published a new long-form piece in PracticeLink magazine -- it includes so many great ideas contributed physicians and marketers from a wide variety of specialties (e.g., OB/GYN, rheumatology, radiology, urology, and more).  Really creative ideas like forming your own networking group, using charitable work to expand your business, and bolstering your confidence about thinking outside the box.  Real solutions from the trenches! Check it out at magazine.practicelink.com.

Judy Capko and Laurie Morgan presented a webinar on "Marketing for Medical Practice Profitability" sponsored by Kareo last week.  If you missed out on the chance to join in, Kareo very kindly makes all their webinars available on their website at: http://www.kareo.com/resources/webinars -- this one should be available by the end of the day on Friday, March 29.  

For those of you following the Healthgrades situation we've been working on -- i.e., hospitals 'claiming' individual physicians' listings without the physicians' permission, rebranding the pages with hospital logos and information, and diverting calls to a call center for the benefit of the hospital -- here is an update. On the plus side, Healthgrades did respond to our request to remove the hospital branding from our doctors' listings -- they referred to this as removing the hospital 'module.'  The listings now show with the physicians' numbers only, and the hospital-branded wallpaper and other artifacts have been removed. Regarding our questions about why Healthgrades allowed this takeover of listings to happen in the first place, the response from them was less satisfactory. They asserted that "just like Facebook," they "own all the content" and "have a right to sell advertising against it."  I pointed out that Facebook -- despite all the privacy criticism it generates -- does not actually do anything approximating diverting people to a third party's phone center. (!)   Additionally, when I asked them why this was done without the physicians' permission, their answer was that "the hospitals all contacted the physicians" -- but, I know for a fact this is untrue.  And, if Healthgrades "owns all the content," then why would it be the responsibility of an advertiser to validate Healthgrades' content? As an aside, I do have some personal experience that is quite relevant to this situation.  I worked in media for more than 15 years, and even owned and published a yellow pages-style directory.  It's simply not the case that diverting a prospect who is looking for a particular person or business to a call center for the benefit of a third party (or the directory) is typical revenue-generating practice in media.  It is one thing to take public information to build directory listings -- that's acceptable and reasonable, and if the physician gets extra exposure and awareness from it, that's a good faith type of trade-off.  But, leveraging the physician's own awareness generating efforts and referral pipeline development to drive callers to a hospital's call

The Wall Street Journal had a thought-provoking opinion piece by Scott Gottlieb, MD, on Friday entitled "The Doctor Won't See You Now. He's Clocked Out."  Gottlieb asserts that the ACO model ObamaCare encourages is basically handing hospitals a monopoly in many markets, and encouraging them to buy up practices to take advantage of higher, 'facility' reimbursement rates from Medicare.  And he adds that, once employed, physicians are less motivated to take ownership of the full spectrum of patient care (e.g., because they hand their patients off to another hospital physician at the end of their shift).  The overall picture is higher costs and less productive physicians. As someone who's studied economics, I find it hard to argue with Gottlieb's analysis of the effect of market power: hospitals will inevitably use their monopoly (or quasi-monopolistic) positions in many markets to drive higher prices.  I wonder, though, if that won't -- at some point -- create opportunities for more entrepreneurial doctors.  To the extent that hospitals and other larger systems raise rates, that should make working with smaller, more nimble, and less expensive independent practices more attractive to payers.  And, that may ultimately enable more entrepreneurial physicians to find a path to keeping their practices open and profitable, and even developing new models (as occurred with, for example, ASCs in the past).

Today I stumbled upon an intriguing, although somewhat troubling, blog post from last fall entitled, "Disrespect ... is the Elephant in the Hospital."  The post referred to two academic papers by Lucian Leape of the Harvard School of Public Health that closely examine how a hospital environment that tolerates disrespect -- whether from doctors to nurses, staff to patients, administrators to clinicians or physicians to patients -- leads to all kinds of bad outcomes, including very demonstrably increasing medical errors. Tolerated disrespect isn't just a hospital problem -- it can happen in organizations of any sizes, including private practices.  And, the potential consequences aren't just clinical.  If a manager or physician creates the sense that staff aren't respected contributors to the team, it stifles staff contributions.  Team members who are in a position to observe operational problems will be discouraged from pointing them out -- and so the practice misses out on an opportunity to improve. And, of course, the daily grind of disrespect will eventually cause your practice to lose its best employees. Once a pattern of disrespect is well-established, it can be tough to break.  If a practice manager seems to treat staff dismissively or is demeaning to them, corrective action by the physician(s) he or she reports to is imperative.  If a physician seems unable to interact with staff without condescension or bullying, an intervention (perhaps with the help of an outside coach) is needed, and it may be necessary to carefully structure how he or she works with staff. Above all, the first step to repairing an office environment that has become hostile is to provide the means for staff to confidentially (anonymously) provide honest feedback, without fear of retaliation.  For a small practice, it may be helpful to work with a neutral outside party to gather employee opinions in a "safe" manner, and summarize them so that management can take corrective action.

My new column this month gave me a chance to share some anecdotes about really interesting, high-performing medical practices that have achieved their success by breaking a few rules!  One of my favorites, because it's so much fun to think about how these doctors and practice managers inspired us and taught us quite a few new tricks. Repertoire Magazine  

A few months back, we shared a link to HARO ("Help a Reporter Out"), a wonderful service that distributes daily inquiries from journalists from all sorts of publications -- we've seen everything from American Medical News, Medical Office Today, to national magazines like Parenting and Best Health, to national television outlets like CNN and Fox News.  The service also features queries from local news stations, websites and publications, too. Are you thinking, so what?  Well, the wonderful thing about HARO is that, unlike ordinary PR work -- i.e., the slog of pitching, pitching, pitching to reporters -- when you respond to a query on HARO, you are actually helping the reporter.  Meaning the reporter wants to hear from you and hear what you have to say. Getting your name and your practice's name and point-of-view out in the media has tremendous value.  The audience will perceive you as an expert selected by the journalist to comment on the subject.  This can elevate your image versus others medical practices in your specialty in your area. And don't let lack of time during the day hold you back from responding!  At least when the story is for print or web, the reporter will usually allow you to answer via email, instead of by phone or in person during business hours.  We do email 'interviews' all the time with reporters here at Capko & Company.  This also gives you more time to think about your answer -- if you're concerned about coming up with your best response on-the-spot. We often share items from HARO that we think will help our client practices and other friends -- if you don't want to receive the daily HARO emails (3x), join our email list (see sidebar) and you'll receive the tidbits we send out that are relevant to your practice.

If you haven't had a chance to read all of our 13 tips for 2013, here is the full list: Master the deductible re-set [commit to less bad debt in 2013!] Analyze your E/M code distribution [reduce audit risk, bill for what you've earned] Cash management quick tip [copays are not petty cash!] Patient service=patient care [the dreaded patient service conflation situation] Review maintenance contracts [don't let auto-pilot become auto-overpay] Get educated [lifelong learning: not just for clinicians] Reach out to local employers [you've got more than one customer] Manager's report card [everyone needs feedback, goals and recognition] Analyze payer performance [remember that you decide which payers you will accept] Engage staff with better meetings [such a simple idea, so much opportunity for upside!] Review payer contracts [it's okay to admit they've been stuffed in a drawer -- just pull them out and read them] Review your directory listings [don't miss out on free promotion -- or let errors online impact your revenue] Make haste slowly [take on important challenges with care -- and get help to jumpstart your planning!]

So, if we asked you where your payer contracts are, you could tell us, right?  And you'd know when you last reviewed them -- and when the next renewal period comes up? Or, are they ... at home, in a closet, where they've been (untouched) for several years?  Are they ... 'somewhere around here'? Well, we're not surprised.  Many of our clients have tucked their payer contracts in a drawer, only to forget about them.  So, don't feel TOO bad about this -- but, feel just bad ENOUGH to resolve to change your habits now! Reviewing your payer contracts annually -- before they end/automatically renew -- is more important than you think.  Many contracts have evergreen provisions that can make extension of your current rates mandatory -- even if you would have been eligible for an increase.  We've worked with practices that have foregone years of increases because they didn't realize their rates would remain unchanged if they failed to contact the payer at renewal time.  (Even when rate increases seem negligible, several years worth of them add up to significant foregone profit.) There also may be provisions in your contracts that you've forgotten about that can lead you to inadvertently fall out of compliance -- which can lead to unexpected reimbursement problems down the road. Bottom line: set a tickler to review each of your contracts a month or so before they renew.  (And, if you can, try to reset your contracts so that they all renew around the same time -- so that you can do your review in one fell swoop.)