Laurie Morgan

About Morgan

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The threads of payment reform and quality programs are coming together

It seems like forever now that practices have been dealing with multiple, complex, incentive and penalty initiatives from the federal government: Meaningful Use, PQRI/PQRS, eRx, PCMH and, more recently, "value-based" programs (value-based purchasing for hospitals, and the upcoming value-based purchasing modifier for physicians). If you're like us, the onslaught of these programs has seemed more like a series of separate carrots and sticks (amplified by private payer programs that have built on the government's pay-for-performance approach) than a coherent strategy for driving change.  Rarely do notices about these programs include helpful guidance as to how they're interrelated.  (Perhaps it would just be to hard to fit those details in amongst the deadlines, bureaucratic details and confusing specs!) That is why it is at least helpful to finally be seeing -- after years of programs popping up and interrupting practice operations, demanding attention without saying why (except when why was 'get a bonus' or 'avoid a penalty') -- the outlines of inter-connectedness among all of the government's many programs. For example, Medicare's Physician Compare website provides information about a physician's participation in various quality initiatives, like PQRS and ePrescribe.  (This is perhaps a good opportunity to remind you to check this -- and all -- the directories in which you or your providers are listed.  There are often errors -- if contact, specialty or location data is incorrect on a key directory, it can cost you patients.  And if the CMS has incorrect data about your participation in important incentive programs, you'll want to follow up on that immediately to remedy their data or your submissions.  As we say all the time, this need to check goes for payer directories (!) and public directories like Healthgrades and Vitals.) Anyway, a sample of quality participation data as it is displayed on the Medicare site appears below.  For some patients, knowing you're participating in these programs could make the difference in selecting your practice: Besides PQRS participation, the Physician Compare site shows participation in ePrescribe and Meaningful Use as well. Of course, the integration of this data into directories is just the beginning. 

By |2022-01-01T22:52:12-08:00November 26th, 2013|

Reduce medical ID theft risk: check patient IDs at your front desk

Are your front desk staff members verifying ID and insurance cards when checking patients in?  If not, they should be.  Here's why: Checking ID is your first line of defense against medical identity theft -- and your patients'.  By checking ID and comparing against the name in the record, you can confirm you are actually treating the patient (and not someone who stole or "borrowed" their insurance card).  By asking for ID, you protect your staff against accepting fraudulently presented insurance, and protect your patients from medical identity theft.  (Besides the hassle and financial consequences of medical ID theft for patients, there can be clinical consequences, too, because their records will be updated with the health information of the person using their insurance.  The consequences of this can potentially be deadly -- and very difficult to fix.) Checking ID provides a convenient way to verify address at the same time.  Patients may have moved and not realize how important it is to let your staff know.  Invalid address information can cause claims to be denied -- especially from the CMS.  This is an entirely avoidable hassle.  Checking ID gives your staff a chance to ask the patient, "is this your current address?" While your staff should always check ID, it's not necessary -- or desirable -- to scan or photocopy the ID; it is best not to store this personal information in your systems.  (Plus, if it is scanned one time, that might discourage your staff from checking the ID itself next time.)

By |2022-01-01T22:52:12-08:00November 26th, 2013|

Still time (but not much!) to avoid a PQRS penalty in 2015

There is still time for providers to avoid the PQRS penalty for 2013 reporting, which will mean a 1.5% deduction from Medicare reimbursements in 2015 (ouch!).  The following two methods still apply for individual providers: -Submit via a qualified EHR vendor -- if your EHR is provided by a vendor that has been permitted by the CMS to submit directly, submitting data could be much easier than you think.  Be sure to contact your vendor to find out what their capabilities are.  Even if not qualified to submit directly, your vendor may be able to help you submit via a registry -- the second method available to not just avoid the 1.5% penalty in 2015, but also earn a .5% incentive for 2013. -Submit a single, valid measure via a single claim.  You can do this!  This approach will not permit you to earn an incentive this year, but you will avoid the penalty in 2015 -- and you'll have gotten your feet wet for more comprehensive compliance in 2014.  (Do it now -- don't delay -- to be sure your claim is accepted and qualifies.)      

By |2013-11-24T17:46:46-08:00November 24th, 2013|

The faulty statin risk calculator: more on using your website and EMR to communicate

Well, the new, evolving, confusing statin news appears to be a gift that keeps on giving.  (Only practices that are fielding loads of calls from confused patients are probably considering it just the opposite.  An anti-gift that keeps on giving perhaps?) In case you haven't heard yet, the New York Times reports today that the risk calculator provided by the American Heart Association and the American College of Cardiology appears to be flawed.  The calculator may be significantly overstating patient risk and suggesting that millions of people who don't need statins should be considered candidates to take them.  (I won't get into the details here -- the Times article does a nice job of simplifying what might have caused the problems with the calculator.) But I will take the opportunity to point out, as I did last week, that confusing and unnerving media stories like this create an opportunity for your practice to use technology to help manage contacts from confused or nervous patients while also reinforcing your practice's bond with them.  Your website or social media presence can be a great way to remind people not to change their own treatment plans without advice from their physician (for example, if this is the message your physicians feel should be emphasized).  And your EMR can become a helpful tool to quickly identify your subset of patients who might be confused so that you can reach out to them proactively. Imagine how grateful an anxious cardiac patient might be to hear from your practice with clarification about this news, and whether he needs to worry about it.  Your EMR can make reaching out like this a lot easier (yes, an EMR can make something easier!) -- and you can possibly meet a needed Meaningful Use measure at the same time.

By |2016-08-19T17:37:29-08:00November 18th, 2013|

The surprise statin news is a perfect use for your website or social media space

The recent, confusing, conflicting news about new statin guidelines presents a perfect opportunity for your practice to use technology to solve a pressing problem -- and engage with patients. To recap briefly,  new statin guidelines were released on Tuesday by the American Heart Association and the American College of Cardiology. The new guidelines include changes to both the recommended LDL targets for patients currently on statins (potentially reducing frequent blood testing for many patients) and the types of patients who should be on statins (potentially increasing substantially the numbers of patients who could be prescribed the drugs).  Additionally, the guidelines could affect the frequency of prescribing of drugs like Zetia that are intended to work alongside statins. But the new guidelines are controversial.  The New York Times attempted to illuminate the many angles to these new guidelines and also pointed out that the new recommendations are controversial within the medical community.  It quoted a cardiologist from the Cleveland Clinic noting that physicians may have different ideas on how to respond -- and that some may not change their recommendations to their patients.  The article has already attracted nearly 700 comments -- many very forceful and signed by physicians. Now, just two days later, the Times has published a strong opinion piece against the new statin guidelines. For cardiology, primary care, and other practices that prescribe statins and treat related issues like diabetes, these reports are likely starting to prompt calls from concerned patients.  Handling an unexpected flurry of these sorts of calls can be very disruptive -- and can lead to some unhappy, stressed-out patients if they're unable to get through to discuss their concerns. It's likely, though, that physicians in your practice have already begun crafting standard responses.  For example, perhaps your physicians have already told staff to tell patients that call in asking, "should I stop taking Zetia?" to continue their current treatment plan but make an appointment if they would like to discuss whether changing it makes sense in their case. Sharing links to articles that your physicians believe explain the new guidelines in an appropriate and

By |2022-01-01T22:52:12-08:00November 14th, 2013|

Remember, EFT is best

Mary Pat Whaley at Manage My Practice has posted great information about payers 'encouraging' practices to accept payment by virtual credit card, instead of by check or EFT. This method of payment is not a good deal for practices.  Merchant fees are deducted from credit card payments -- meaning a further reduction in the reimbursement received from health plans that use this credit card method.  Additionally, it adds costs because the virtual cards have to be manually keyed (increasing potential for errors and hassles -- and usually meaning a higher merchant fee than a swiped transaction as well).  If the credit cards are set aside to be keyed in batches (as it seems they would inevitably be in many busy practices), that introduces another delay in receiving payment that would already be in the bank if transmitted by EFT.  And, as the AMA pointed out in its letter to the CMS objecting to the use of virtual cards for VA reimbursement, credit card remittance advices are not standardized as payer EFT remittances are -- another source of inefficiency and cost. EFT is still the best way for practices to receive payments quickly, without any extra fee deductions, and without requiring additional, costly staff handling.  (Minimizing staff handling also reduces embezzlement risk.) All payers are required to meet federal standards for EFT in 2014 -- and that means that you can request EFT from any payer you work with.  As you know, we always recommend that practices use EFT with every payer: no checks in the office means less chance of one 'disappearing,' less aggravation taking them to the bank, etc.  Virtual credit card payments are just one more inferior alternative to EFT. As Mary Pat noted in her post, it's important to check any new contract you sign to be sure you're not inadvertently agreeing to credit card reimbursement.  (And, as we're always reminding you, this is another reason for a tickler to review your contracts annually, to be sure they don't already contain language that allows changing reimbursement mechanisms.  And watch those amendments and other mailings from plans, too!)

By |2022-01-01T22:52:12-08:00November 11th, 2013|

Could the ACA-mandated grace period be problematic for your practice?

Many practices already suffer losses from surprise payment retractions by health plans.  These can occur when patients attempt to exploit system update lags after leaving their employer (and therefore the employer's plan) or the grace period after failing to maintain payments on their own policy.  (So, the patient knows he's not paid his premium or that he's left the employer plan, but also knows he's still "covered" because of payment grace period or because of the 30-day window to elect COBRA coverage -- even though the coverage will eventually be retroactively cancelled to the last paid day.) Any retraction of payment for services already rendered is a blow for providers and their practices, but most state policies regarding timely payment of claims and premium grace periods help limit the exposure for retraction of reimbursement to 30-45 days. However, the Affordable Care Act (ACA) contains a provision that mandates a much longer grace period -- 90 days -- for subsidized plan participants.  The ACA authors intended that plan members who receive subsidies be allowed more leeway for missing payments because of lower incomes and possible hardship -- but, the longer grace period also creates opportunity for abuse and financial exposure for practices. Hospital and physician groups made note in the ACA comment period of the potential for the grace period to result in uncovered services being rendered.  Extending the grace period increases the likelihood that significant services can be provided before a plan can be cancelled for unpaid premiums.  Providers argued that plans should have to bear these costs -- especially in the case of subsidized membership, since plans would presumably be receiving at least part of the premium cost from the government.  However, in the final rule, the CMS allowed plans to deny claims in months two and three of the grace period.  This means that payments already issued to providers could be retracted -- leaving practices and hospitals on the hook for the cost of care already provided. How can practices prepare for and protect themselves from these unexpected costs?  A few things to evaluate: Has your state negotiated

By |2013-11-09T18:08:14-08:00November 11th, 2013|

Obamacare scam alerts: a great use for your site and social media

A few days ago, Megan McArdle of Bloomberg offered a helpful introduction to the emerging scams inspired by Obamacare.  Scary stuff. Spreading the word about these risks is a great way to connect with patients and reinforce that you're watching out for them.  And it's a great use of your practice's Facebook page or blog -- a quick post takes just seconds, but will immensely benefit patients who follow your feeds.  

By |2022-01-01T22:52:12-08:00November 9th, 2013|

Medicare Advantage plans dropping doctors: what does it mean?

News reports have been trickling in over the past couple of weeks -- growing in number -- about Medicare Advantage (MA) plans dropping doctors. First, we heard about UnitedHealthcare in CT dropping doctors -- then news came out about the same carrier dropping patients in NY, FL, RI, NJ, and, just yesterday, OH.  Sam Unterricht, MD, the head of the State Medical Society of New York, said in a Fox Business interview a few days ago that other plans like Empire Blue Cross and Emblem were following UHC's lead in his state -- and that he expects this MA plan activity to spread nationwide. What's driving this (by all accounts, extremely sudden) behavior on the part of MA plans?  The Tampa Bay Times reports that UHC attributes it to quality ratings ("[providers that] demonstrate the highest quality at the greatest value will be rewarded for their efforts.")   But, the effort to trim MA costs as part of the funding plan for the ACA probably plays a role. Unterricth said that one of the plan representatives he spoke with said that an anticipated 8% reduction in reimbursements to MA plans from Medicare as part of the ACA was at least partly behind all the physician cuts.  The timing -- coming on the heels of news of thousands of patients dropped from individual health plans -- does suggest a connection to ACA-mandated changes in 2014. Certainly, UHC's statement that quality ratings drove the decisions isn't incompatible with Unterricht's view that ACA cuts to MA reimbursement were behind them.  After all, if reimbursements to MA plans from the CMS are going to decline, then quality related bonuses are going to be that much more important to plans going forward.  It makes sense that they would try to goose their rankings to make up lost ground on reimbursements through bonuses. What does this mean for practices that serve MA patients?  Some practices in some markets might have argued that MA is a pain: it's like the restricted, non-negotiable reimbursement of Medicare combined with the hassles of dealing with a private payer.  But, we suspect

By |2022-01-01T22:52:13-08:00November 5th, 2013|

Time to update your practice’s cash fee schedule?

As independent professionals, the partners at Capko & Morgan have purchased insurance privately for many years.  I've been a member of my HMO for 20 years, and have been paying for it myself as a small businessperson/independent professional since 2001.  I had a good plan that seemed to generously exceed all of the ACA requirements, and then some -- I was very satisfied with it.  Unfortunately, that wasn't sufficient to protect me from cancellation.  I was notified about a month ago that I had been shifted into an exchange plan that is significantly more expensive, with huge increases in copays and deductibles, and numerous excisions of benefits I valued that I would now have to pay for 100% out of pocket. Now, lest you think this little anecdote has nothing to do with the headline for this post, let me get to the point.  Like so many others in my predicament, I'm pressed to look at options.  I have never in my adult life contemplated doing without a comprehensive health plan.  But, I have heard from others in my position that they're considering 'going naked.'  The logic?  Paying for coverage that doesn't really kick in until you've paid about $11K into the system might make less sense than paying cash, then signing up for coverage in the unfortunate event you'll actually need to use it.  For some people who lost much lower-priced, catastrophic-only coverage, the financial realities are even more stark -- they just may feel they cannot afford to pay thousands of dollars more each year for coverage, even though they may receive considerably greater benefits in return. If a significant proportion of the independently insured population opts to pay the ACA penalty instead of purchasing or continuing to purchase coverage, what might that mean for your medical practice?  One possibility is that more people will want -- or need -- to pay cash for services. For primary care and urgent care practices, this means it's more important than ever to set up your cash-only fee schedule -- and to let patients know that it's available.  Cash pay could be a real opportunity for primary care practices -- and you

By |2022-01-01T22:52:13-08:00November 2nd, 2013|

Amazon ebook promotion ends today

The four-day promotion on Amazon offering Laurie Morgan's just-published ebook -- Get the Best From Your Medical Billing Service (Management Rx) free ends today. If you're using a third party billing service or considering engaging one, don't miss the chance to get this comprehensive, 15-page guide at no charge. The book includes 30 screening questions for interviewing services, tips on how to manage the relationship, and a list of key reports and how to use them to evaluate billing service performance. The regular price is just $6.88 (already a bargain :)), but why not download it today for free?  (In exchange, it would be a nice gesture to share a rating/review of the book.) The book is published in Kindle format -- easy to read not just on Kindle devices, but on any smartphone, PC, iPad or other tablet using the free Kindle software. (If you are a Prime member of Amazon, you can borrow the book for free at any time -- not just during the promotion. If you're not a member, you can sign up for a free trial of Amazon Prime. If you miss your chance to download for free during the promotion, a free trial of Prime can allow you to borrow it.) We hope you appreciate this free promo from Amazon, and that you will check the book out and share your thoughts on it with a review!

By |2022-01-01T22:52:13-08:00October 29th, 2013|

Conference attendance is so important for practice managers

Just back from speaking at the wonderful Association of Otolaryngology Administrators (AOA) annual conference -- what a valuable event. It's such a great experience as a speaker to participate in such a well-attended, well-run event. In both of my sessions, attendees  were so attentive, taking notes, asking great questions, and making great comments and sharing anecdotes about their own practices.  The attendees were helping each other as well as benefiting from content from all of us speakers. I have no doubt all attendees will go home with dozens of ideas to improve their practices' profitability. I was just one of dozens of qualified presenters -- what a download of information for the attendees.  And they were clearly so motivated to soak up as much information as possible.  (For example, I tried to sneak into the talk before mine -- which started at 7:30 AM! -- on the Affordable Care Act.  Standing room only, despite the early hour.) Physicians may sometimes doubt the value of sending a manager off to a conference like this.  The cost may be in the neighborhood of $2,000 when travel and downtime are figured in, so it's not a trivial expense.  But just one coding tip that brings more revenue or marketing tip that brings more patients -- or compliance tip that avoids an audit -- would pay for that expense many times over.  And the network that attendees can form is absolutely priceless.  This is especially true when your specialty has a dedicated practice administrators association like the AOA -- but, even at the larger/general practice management events like MGMA, medical office managers will meet like-minded professionals they can bounce ideas off of and gain advice from in the future. In tight times, cutting out conference attendance may seem like an easy choice. However, you may be unknowingly hurting your practice's chances to grow new revenues, stay ahead of regulatory issues, or nip costly problems in the bud.  It's useful to be picky about attending events -- make sure they'll have a variety of relevant subject matter that is important to your practice.  But don't

By |2022-01-01T22:52:13-08:00October 26th, 2013|

Medical billing service ebook promotion starts today!

Laurie Morgan's just-published ebook -- Get the Best From Your Medical Billing Service (Management Rx) -- will be available free on Amazon.com starting today! This one-time promotion runs from October 25 - October 29. This detailed, 15-page guide is the easy way to get up to speed on selecting and managing a billing service. You'll learn tips for screening potential services (including 30 screening questions), managing the relationship, and using reports to evaluate billing service performance. The regular price is just $6.88 (already a bargain :)), but you can get it free over the next four days.  (In exchange, it would be a nice gesture to share a rating/review of the book.) The book is published in Kindle format -- easy to read not just on Kindle devices, but on any smartphone, PC, iPad or other tablet using the free Kindle software. (If you are a Prime member of Amazon, you can borrow the book for free at any time -- not just during the promotional period. Use this link if you'd like to sign up for a free trial of Amazon Prime. If you miss your chance to download for free during the promotion, a free trial of Prime can allow you to borrow it.) We hope you appreciate this free promo from Amazon, and that you will check the book out and share your thoughts on it with a review!

By |2022-01-01T22:52:13-08:00October 25th, 2013|

Monitor your physicians’ directory listings for accuracy

We often point out to our followers how important it is to monitor your payer directories and the online physician directories aimed at consumers for accuracy.  Now, from here in California, is more proof of how important it is to do so: Covered California, the state's health insurance exchange, has just disabled its provider directory because it contains too many errors.  (This story from the Los Angeles Times notes some -- like listing obstetricians as ophthalmologists and wrongly denoting whether physicians are speakers of languages like Russian and Farsi.) This post is not intended to pile on about exchange and ACA (Obamacare) glitches!  Rather, this move by Covered California offered an opportunity to reinforce how easy it is for incorrect information to enter a provider directory.  Once incorrect information is published, it can be replicated all over the internet -- as happens especially with the physician ratings directories.  (This is one more reason that Covered California did the right thing by disabling their directory until they had more confidence in its accuracy.) This problem was not caused by practice managers or physicians, but, unfortunately, it is one more thing that practices need to take some responsibility for -- lest their patients become misinformed (or unintentionally turned away, for example when a plan incorrectly lists a physician as not accepting new patients or fails to denote specialty/subspecialty properly). Practice managers: get in the habit of checking directories periodically, or assign this responsibility to a staff member.  Every practice should establish a tickler to check payer directories -- at least once a year.  You can tie it to contract renewal (another thing you need a tickler item for), or, better yet, find out if there is a schedule for new directories to be prepared from each of your health plans.  And check your listings on online consumer directories like Google+ Local, Healthgrades and Vitals at least annually; this is a great opportunity to both correct errors and add custom information (pictures, URL, custom text) as permitted (free marketing!).

By |2022-01-01T22:52:13-08:00October 21st, 2013|

Free promotion from Amazon: Laurie’s new medical billing service ebook

Laurie Morgan's just-published ebook -- Get the Best From Your Medical Billing Service (Management Rx) -- will be available *free* on Amazon.com from October 25 - October 29. If you're using or considering using a medical billing service, this detailed, 15-page guide is for you.  Learn tips for screening services, managing the relationship, and evaluating billing service performance. The regular price is just $6.88, but why not get it for free during the promotion?  (In exchange, it would be a nice gesture to share a rating/review of the book.)  Mark your calendar! The book is published in Kindle format -- easy to read not just on Kindle devices, but on any smartphone, PC, iPad or other tablet using the free Kindle software. (Incidentally, if you are a Prime member of Amazon, you can borrow the book for free at any time -- not just during the promotional period.  Use this link if you'd like to sign up for a free trial of  Amazon Prime.)

By |2022-01-01T22:52:13-08:00October 19th, 2013|

New study about workplace theft; are your internal controls in order?

A new study from the Rotman School of Management in Toronto about workplace theft and cheating may have important implications for medical practices. The study found that deprivation effects -- such as being harmed by the recent recession, or by new public policies -- reduce employees' commitment to ethical behavior.  Prior to feeling deprived, people tend to believe they'll maintain their moral standards regardless of circumstances; however, when put to the test of reduced financial well-being -- especially compared against peers -- the study found that people may relax their standards, especially when they believe their change in position is unfair. This is a helpful reminder to practices to make sure internal controls are in place, to reduce temptation.  The recession (ongoing in some markets), deep resentment of the ACA among some staff, and the added workload from new regulations all may contribute to employees feeling disadvantaged versus peers outside of medicine, or even versus patients.  (Some employees may also feel sympathy for patients whose health plans will carry more patient responsibility payments in the coming year, too -- perhaps resulting in losses from co-pay waiving and the like.) Internal controls are the kindest way to protect your practice against internal theft.  By setting up procedures and structures that reduce temptation and make theft more difficult, you reduce the need to be suspicious or personally monitor employees -- and allow your practice the freedom to cultivate the family-like atmosphere that so many of us want.  If your internal controls need a review, please don't hesitate to get in touch.

By |2022-01-01T22:52:14-08:00October 17th, 2013|

A taste of MBA training for doctors — without the hassle and cost

If you follow this space, you may already know that I'm dubious about the value to physicians of stopping out for an MBA.  As an MBA-holder myself, I think the coursework can be overkill for independent physicians who just want to run their practices better (this is less the case for those that intend on corporate careers, of course). So much of modern MBA training focuses on things that aren't generally relevant to the small/medium business owner (and, therefore, the typical private practice physician partner).  Even worse, some of the business basics that doctors need most usually aren't well covered by MBA programs -- managing people; the minutia of local, state and federal regulations; the marketing of a small, local business; real estate finance; negotiations, etc. The other issue facing physicians (and sometimes practice managers, too) is the opportunity cost -- and actual cost.  The opportunity cost is the income lost by taking time off from practicing/working to attend an MBA program, and the actual cost is the (often very high) tuition at business schools.  For many, perhaps most, private practice owners and managers, it just may not 'pencil out' to take the time and invest the money*. One solution that can work well as a substitute is taking local classes (e.g., nights and weekends) that focus just on what you really need and want to learn.  This can be a reasonable approach -- and even a trial to see if further investment in MBA education is of interest.  But, there is also the issue of having to attend class at set times -- not always convenient ones. Now, though, there is a better alternative: MOOCs, massively open online courses.  Incredibly, some of the most prestigious business programs in the country, including Stanford, Wharton and Columbia, are making some of their most valuable content available through the free platforms like Coursera and EdX.  And it's not only self-directed -- i.e., you take the classes at your convenience -- it's FREE!  (Yes, unbelievable.) Lest you think this is just throw-away content, Business Insider has kindly assembled a list of some of

By |2022-01-01T22:52:14-08:00October 16th, 2013|

Beneath recent KLAS small practice EHR rankings lies more than one story

Medscape's story last week about new KLAS research ranking EHRs for practices of 1-10 physicians had some helpful insights. The top system, Athenahealth, was praised for its high level of service and continuous improvement of the product -- despite getting dinged by some respondents for its "high cost."  (Specific product improvements or features that were most appreciated were not mentioned, but I have to wonder if Athena's tight integration of EHR and PMS was one reason its clients were happier.  As I've posted before, I think this integration is a huge factor in getting the most from billing technology -- and will only become more apparent with the ICD-10 conversion.)  Athena wins, even though it is the high cost provider -- does that mean low cost solutions can't satisfy? Not necessarily, according to the survey: PracticeFusion, the famously free EHR, came in third -- and its score of 86.3 was not far off from Athena's 86.9.  Like Athena, it got points for ongoing development, but did get a few criticisms, though, for missing features.  We have often suggested that practices check out PracticeFusion if cost is their primary concern, but to be prepared to evaluate if it fits their specialty; this data seems to bear out the idea that PracticeFusion can be a great solution for many practices, but there's no substitute for actually trying it out for your own to be sure it fits your specialty, meets your functionality expectations and can be efficiently integrated into your patient flow. Unfortunately, while I don't want to call out any particular offenders, suffice to say that many of the EHRs on the bottom of the pile have been troublesome for practices we've worked with.  In some -- but not all -- cases, this is at least partly because the vendors have historically been much more focused on (and effective with?) larger networks and hospitals. Perhaps the most interesting aspect of this story from our point-of-view is that churn in the EHR market continues -- and it's a good thing.  When more practices feel free to switch from an unsatisfactory EHR, we'll see more benefit from these (painful)

By |2022-01-01T22:52:15-08:00October 9th, 2013|

Teaching your medical practice employees vs. coaching them

Today's Harvard Business Review  features a wonderful tip for medical office managers: Know when to coach versus when to teach. Teaching -- i.e., demonstrating or instructing an employee on exactly what to do -- is key for bringing new employees up to speed (aka, training).  It can also be useful when corrective action is needed -- e.g., "Emily, please be mindful of HIPAA when speaking with patients about private information -- ask them to step out of the reception area, like so." Teaching can backfire, though, with competent and motivated employees who just need a little help with problem-solving. Coaching -- supporting and gently helping staff find the right solution -- is the right approach in that case. For example, let's say one of your receptionists is having trouble collecting co-pays -- but, she's a quick learner who's eager to try new things. Giving her ideas and asking questions about what she's already tried could help her develop an effective style she's comfortable with -- and that she'll be able to use routinely. By coaching employees with ideas and, most important, asking questions, you help your employees feel competent and trusted. What's more, even though it might take a little longer to solve today's problem, your coaching might lead to your employee finding a better solution that will pay off over the long run.  For example, if your instinct would have been to pick up the phone to get urgent payer feedback, but your encouragement leads a biller to find an important source of information via the payer's portal, that could save a lot of time for you and your biller down the road.

By |2022-01-01T22:52:15-08:00October 8th, 2013|

A Harvard Business Review Daily Idea that’s perfect for practices

Harvard Business Review recently published a "Daily Idea" about leadership that seems tailor-made for medical practice managers and doctors.  The idea: the best leaders are both tough and nice. Those of us who've worked primarily in business know that the question of whether toughness or niceness drives more productivity from employees is almost as old as business study itself.  Everyone has a theory.  But, HBR's analysis suggests that common sense wins out in the end: while a small percentage of employees with each polarized type of boss will ultimately be highly engaged, bosses that blend both styles get employees fully engaged a whopping 68% of the time. Beyond these results, though, the tough+nice approach seems ideal for medicine in particular because it so aptly matches what healthcare is really about.  It's a tough field in which errors are much more damaging and crucial to avoid than just about any other business, but it's also a field that people pursue primarily because they are personally drawn to helping and caring for others.  It only makes sense that the best physician leaders and practice managers would combine high standards and expectations with compassion and kindness.

By |2022-01-01T22:52:16-08:00September 26th, 2013|

Wharton School online MBA-level courses: free!

I've previously recommended Dr. Christian Terwiesch's introductory MBA-level operations management course on Coursera -- and, great news, it's being offered again this fall. UPenn/Wharton have expanded their selection on Coursera to include four "MBA foundation" courses in operations, marketing, finance and accounting -- an incredible opportunity for physicians and practice managers alike to explore these first-year courses (and maybe learn if further MBA training is right for them). I can vouch for Dr. Terwiesch's operations management course -- I took it to get a refresher on my own MBA training in operations, and was delighted to find that many of his excellent examples were actually drawn from healthcare. The course will provide you with some new insights for evaluating your own practice workflow.  Best of all, it's presented in digestible online sessions of 15-20 minutes -- perfect for busy professionals. To learn more about the ops course and the entire MBA Foundation Series, visit this link -- or to see more about Penn's other offerings on Coursera, or the program in general, visit coursera.org.

By |2013-09-25T11:48:31-08:00September 25th, 2013|

ICD-10: The only thing to fear is fear itself

Did any of you catch the ICD-10 TweetChat Kareo hosted on Tuesday?  I participated representing our team(@capkoandcompany); three other panelists from different segments of the medical management world joined in as well (@brad_justus, @modmed_EMA, @hitconsultant).  Kareo does a wonderful job reaching out to its clients and the entire practice management community with events like these -- and we were delighted to have the opportunity to participate!  (Kareo published a summary on its blog -- and you can also search all the tweets using #kareochat .) As expected, there were many smart, informed comments -- and some really good questions by the Kareo folks in particular.  But, I was struck by the relative silence from people who weren't from the billing/practice management/technology expert community (i.e., from actual billers, coders and practice managers) -- especially because one of the themes that emerged from our chat was the sense that small and medium private practices (in particular) have been holding off dealing with ICD-10.  Did the audience that could benefit the most shy away from the chat altogether? The drumbeat of journalists, bloggers and other experts about the need to deal with ICD-10 NOW (or face likely disaster!!) has gotten louder and louder in recent months, and I sometimes wonder if it sometimes has some negative unintended consequences. In our zest to create helpful urgency (and dispel the dream that ICD-10 will be delayed again), are we pushing people towards fear-induced denial and procrastination? Seemingly every week, we work with medical practices that have not begun to prepare for ICD-10 at all -- and they're scared.  But while their foot-dragging has not been ideal by any means, it's also not a guarantee of disaster.   Converting to ICD-10 is not going to be easy, but it's also not something that's beyond the reach of any practice to manage -- especially because so much help will be available from vendors and payers (provided you ask!). It seems from our vantage point that too many practice administrators, billers and coders have already decided -- without even really getting started -- that ICD-1o will be an unavoidable

By |2022-01-01T22:52:16-08:00September 13th, 2013|

Your partner’s spouse is not your advocate

It almost always starts out the same way. A practice (usually a small one) loses its manager, or has its first financial troubles and realizes it really needs a professional manager, and one partner says innocently enough, "What about my wife?  She's got an amazing corporate background, and is getting bored at home with the kids.  She could work for a few months part-time, get us turned around, and then we could hire someone permanently." It sounds like a perfect solution.  After all, aren't the partners' spouses goals the same as the partners?  Who can we trust more than one of our wives (or husbands)?  Besides, it's only temporary .... After those few months, the miracle replacement manager who could be as loyal/smart/affordable as the partner's wife has, predictably, failed to materialize. And everyone is so grateful for the "magic" the temporary manager has pulled off -- it seems like she has literally saved the practice from bankruptcy! -- why would we want to replace her? Years go by.  The manager amasses more and more control over the business side of the practice. Maybe she seems a little insulted when you ask about the status of a particular account, or why a particular vendor has been getting paid so much. Then, little by little, some of the partner discussions that used to guide financial decisions stop happening.  The manager, after all, is "almost like a partner" anyway.  No one feels comfortable confronting or curtailing the manager -- their dear partner's husband (or wife) -- so problems fester.  The manager wants more pay -- argues it's "market rate" -- who will be willing to contest this?  The festering worsens.  The manager's productivity analysis seems to always favor her husband at bonus time.  Resentment is growing, bottled up.  Is the practice earning all the revenue it should?  Are payer contracts negotiated to best advantage? Nobody knows, and nobody feels comfortable asking. And what if the practice has new financial problems a few years down the road?  Where is our heroine now?  She's doing her best to appear neutral and professional, while simultaneously

By |2022-01-01T22:52:16-08:00September 3rd, 2013|

Participate in our new survey: rep behavior

We're looking for feedback on drug/device/technology rep behavior -- specifically, what kinds of behaviors are likely to trigger the opposite of the reaction reps are hoping for, making you disinclined to want to spend time listening to a pitch?  What's really annoying -- even disruptive to your practice? And, on the flip side, if there are any things reps have done for your practice that have been surprisingly welcome, helpful, etc., we'd love to hear that, too! All responses to the survey will be strictly anonymous (you don't even have to identify yourself if you don't want to), and will help us with an article we're writing that will help reps who want to learn how to connect more effectively (and less annoyingly) with the practices they serve. To complete the survey, click on this link - and thank you!

By |2013-09-03T17:29:06-08:00September 3rd, 2013|

Reminder: Subscribe to our email list and receive our posts in your inbox

Did you know we offer email subscriptions to our blog? It's the easiest way to be sure you don't miss a post you might value or wish to comment on. Our subscriptions are managed by Google's trusted Feedburner service: it's free, you can opt in or out whenever you like, and we promise not to bother you more than a couple of times a week with postings.   Enter your email address: Delivered by FeedBurner

By |2022-01-01T22:52:16-08:00August 31st, 2013|

Judy Capko Q&A on PCMH

Judy's webinar and follow-up Q&A on patient-centered medical homes (PCMH) are now available on Kareo.com at the following links: Q&A Webinar    

By |2022-01-01T22:52:16-08:00August 28th, 2013|

UHC’s new payment portal could help patients … and practices?

Several media outlets have reported that UnitedHealthcare has just unveiled new capabilities on its MyUHC.com patient portal that allow patients to make credit card payments for their portion of their care (e.g., deductibles, co-insurance) and better understand how the sharing of financial responsibility works.  UHC promises that the site will help make members more educated consumers about their healthcare -- presumably encouraging them to be more judicious about spending by raising their awareness of the costs of care.  The on-site demo shows that the site will offer at-a-glance summaries of all their accounts -- out-of-pocket spending, progress against deductible, even utilization of FSA and HSA accounts. The information side of this -- implemented with help from InstaMed -- looks like a huge leap forward.  Will patients embrace the payment portion as well?  It will also be interesting to see how the patient payment portion plays out for practice collections.  For example, will practices be able to easily log in to confirm that a patient has made, say, a pre-payment needed before surgery?  What reconciliation tools will be available?  And will patients be more likely to request "bill me" because they'll say they plan to pay at the portal?  The portal also is expected to allow patients to "easily" dispute claims -- what does this feature mean for practices? Another open question: the demo states that the ability to make payments may not be available for all plans.  Will this lead to more collection confusion for practices with UHC patients?  On the plus side, anything that clarifies the portion of the bill that is owed by patients -- and places the responsibility for that breakdown on the health plan, not the practice -- is bound to ease the burden practices face to explain large amounts owed to bewildered (and sometimes unhappy) patients.  Practices might even encourage patients to look up and verify their amounts due while at their front desks. Have any readers received communication from United about the new portal at their practice? To read more or check out the demo: UHC Adds Provider Payment Service to Member Portal [Health

By |2022-01-01T22:52:17-08:00August 22nd, 2013|

Great, free webinar about payer contracts via Navicure

Penny Noyes's recent webinar for Navicure provided a boatload of helpful info about working with payer contracts -- for free and with CEU credit from AAPC to boot! Check it out here: Working With Payer Contracts - Increase Your Reimbursement

By |2013-08-21T17:03:27-08:00August 22nd, 2013|

Patients getting lost because of internet map errors?

Recently, we worked with a practice that was spending several minutes on the phone -- sometimes ten minutes or even more -- giving verbal driving directions to all of its new patients. Yikes! The practice did it for two reasons.  First, they believed that patients were frequently getting lost when relying on directions from the web -- and that this was causing patients to miss appointments or arrive very late; consequently, they thought the time investment was worthwhile to prevent these problems. Second, they believed that patients valued this "personal touch." Of course, there are numerous costs associated with spending so much time with each patient on a matter that really should be more automated.  Most immediately noticeable to us was the receptionists' reluctance to interrupt the lengthy process of giving directions to pick up other incoming calls, so other patients -- perhaps patients with urgent needs -- were frustrated in their attempts to reach the practice.  Voicemail piled up -- and, quite possibly, prospective patients may just have dialed the next practice on their list of referrals. The practice's assumption about the 'personal touch' was also problematic -- they genuinely believed people valued this extra time with a 'real human,' but, really, who wants to stay on the phone ten minutes or more, jotting directions that will have to be read while driving?  This is 'service' circa 1985 at best!  Worst of all, some of the patients who were familiar with the area might even have been a little insulted at the implication that they could not find the address without spoon-fed directions. Unfortunately, problems with mapping sites and GPS systems giving inaccurate directions to your practice are not terribly uncommon -- especially if you're located in a new office park or other location on new street.  Some street names are also prone to more user error -- for example, here in San Francisco, problems when people confuse "street" for "avenue" are legendary; a location on 4th Street could be a 30-minute drive from the same address on 4th Avenue at some times of the day.  But, even though your location might be more prone than others to these

By |2022-01-01T22:52:17-08:00August 21st, 2013|
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