medical practice business

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

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.  

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

We’ve changed our name to reflect the immeasurable value provided to our firm and our clients over the last five years by Laurie Morgan. If we’ve had the pleasure of working with you over this period, you’ve surely benefited from Laurie’s uncanny knack for uncovering problems and zeroing in on the most effective, elegant solutions.  For her friends and colleagues – some of whom share her stellar academic credentials and many years of experience – she has long been the go-to-source for solutions to seemingly intractable business problems. Few have Laurie’s combination of academic understanding, in-the-trenches management experience, ability to deeply observe, and her resolute determination to find solutions. We couldn’t be more pleased to recognize her contributions and to have her working beside us on your behalf at Capko & Morgan.

by Joe Capko Frequent readers of this blog will appreciate that we consistently recommend that management foster a culture of support and mutual respect toward all staff.  Consistently, the best-run practices  invest in their employees and, correspondingly, reap the benefit of a highly-motivated, creative and responsible staff.  While we still advocate such an approach, one recent study that looked into the effects of electronic monitoring on restaurant workers got us thinking that there may be relevance to the medical practice. As in medical offices, employee theft is a considerable problem in the restaurant industry. It is estimated that 1% of revenues are lost to theft – a huge problem when profits average, as in the casual dining segment studied, about 3.5% of revenue.  The study, Cleaning House: the Impact of Information Technology Monitoring on Employee Theft and Productivity (), found striking changes in staff behavior upon the start of employee monitoring. The employee monitoring was via the algorithm-based Restaurant Guard product sold by NCR and can be integrated with their POS systems.  This electronic system is designed to flag employees that have a relatively large number of suspicious activities within the IT system, e.g., transferring a food order from one table to another, voiding partial orders, etc. To cut to the chase, bottom line revenues increased dramatically – almost a three thousand dollar a week!  What is perhaps most surprising is that the vast majority of the increase to the bottom line was a result of improvements on the sales side – meaning that while employees stole less, they also actively sold more, especially more high-margin drinks. Restaurants are particularly vulnerable to this type of theft because they tend to be high-volume enterprises with a relatively large number of cash transactions.  Nonetheless, with patient financial responsibility being an ever increasing part of your practice, we have to accept that the consequences of theft can be direr than ever for medical practices, too. It’s our hope and expectation that EHRs and practice management systems will eventually offer tools to alert busy managers to irregular patterns in staff behavior that may indicate theft. 

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

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!

We're looking forward to participating -- it's open to all, so join in at 10am Pacific/1pm Eastern on Tuesday, 9/10. Follow us -- @CapkoandCompany Follow Kareo -- @GoKareo    

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Chances are good that your EHR includes some easy-to-implement patient portal features that can save your staff time and increase the profitability of your practice.  As an example, consider your current intake process for new patients. Most practices still use a paper form that is filled out by patient at the time of the first appointment and that is subsequently re-entered by staff into the EHR – a needlessly cumbersome and tedious process for the patient and staff.  Fortunately, almost all EHRs that include patient portals can help automate this process, sometimes completely. In the best implementations, patients can log-in to the portal and complete their forms whenever they prefer – and the data entry task for your staff essentially disappears, saving time and eliminating possible errors.  How might this feature alone affect your bottom line? Paul Louiselle reported in the Journal of Medical Practice Management (Nov/Dec 2012) that his pediatric surgery practice will save roughly $23,000 in staff time in the first year alone by automating new patient intake forms. Many duties of your front desk staff are highly repetitive and, as such, are potential opportunities for automation.  We take for granted phone trees that can help by providing directions or hours of operation in addition to simply routing calls, but it’s important to remember that at one point even these phone systems were cutting-edge technologies.  Patient portal functionality, will become ubiquitous in coming years - the sooner you implement, the more your practice can profit.  If you cannot take on another task, don't get discouraged. Many practices we help have existing staff that will embrace a new career challenge – understanding the potential for a patient portal to help your practice can be a wonderful opportunity for one of your staff to really shine. Among their many functions, patient portals often offer secure electronic communication between patients and physicians, lab results, prescription refills and other clinical features. The adoption of these and other clinical functions warrants caution.  Physicians are often and rightly concerned about how communicating with patients via the patient portal will affect reimbursement.  Physician owners or practice

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    

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

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

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

An article on Entrepreneur magazine's website spotlights four ways any small business -- including a medical practice -- can be the victim of crimes committed by employees.  Worth a quick read: http://www.entrepreneur.com/article/227689?goback=%2Egde_4802172_member_266727166#%21