Small Practice

Small Practice

How to Avoid Being a Dumb-Ass Doctor, Blog Edition

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Evil Dr Rob Part 2It’s been two years since I first started my new practice.  I have successfully avoided driving my business into the ground because I am a dumb-ass doctor.  Don’t get me wrong: I am not a dumb-ass when it comes to being a doctor. I am pretty comfortable on that, but the future will hold many opportunities to change that verdict.  No, I am talking about being a dumb-ass running the businessbecause I am a doctor.

We doctors are generally really bad at running businesses, and I am no exception.  In my previous practice, I successfully delegated any authority I had as the senior partner so that I didn’t know what was going on in most of the practice.

The culmination of this was when I was greeted by a “Dear Rob” letter from my partners who wanted a divorce from me.  It wasn’t a total shock that this happened, but it wasn’t fun.  My mistake in this was to back off and try to “just be a doctor while others ran the business.”  It’s my business, and I should have known what was happening.  I didn’t, and it is now no longer my business.

This new business was built on the premise that I am a dumb-ass doctor when it comes to business.  I consciously avoided making things too complicated.  I wanted no copays for visits (and hence no need to collect money each visit).  I wanted no long-term contracts (and hence no need to refund money if I or the patient was hit by a meteor or attacked by a yeti).   The goal was to keep things as easy as possible, and this is a very good business policy.

Go Beyond Using Your EHR; Practice Heads Up Medicine

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Tom GuillaniWhen providers and their staff don’t have the time or tools to effectively communicate with patients, a slew of issues can result: from physicians missing important cues and misdiagnosing patients to preventable hospital readmissions and poor outcomes because patients didn’t understand or follow care guidelines.

The problem has become endemic. According to one study, 80% of what doctors tell patients is forgotten as soon as they leave the office. Beyond that, 50% of what the patient did recall is incorrect. In addition to impact communication and follow up have on care and outcomes, patients are expecting a different experience than they once had. Nearly two thirds of patients now say they would consider switching to a physician who offers access to medical information through a secure Internet connection.

Google Algorithm to Favor Websites That Work on Mobile Devices

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In a major update, the search giant has announced that on April 21, the algorithm will be updated to favor websites that are designed to work on both mobile and desktop devices, now often referred to as Responsive Website Designs.

Does your practice have a responsive website?

Google has had multiple mobile initiatives, including the GoMo campaign where the company provided free tools to help small businesses build websites that worked on mobile devices without the dreaded pinching, resizing, and squinting. That campaign had limited success because the technology didn’t quite work as elegantly as possible, but just last week Google took its most aggressive approach yet by declaring that they were going to start penalizing websites that did not have mobile capabilities.

Once referred to as mobile-friendly website design, geeks refer to it simply as responsive website design now. So how does one get a mobile-friendly, er, responsive website?

The Doctor- Patient Relationship and the Outcomes Movement

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Screen Shot 2015-10-01 at 9.46.12 AMIn a recent Harvard Business Review article, authors Erin Sullivan and Andy Ellner take a stand against the “outcomes theory of value,” advanced by such economists as Michael Porter and Robert Kaplan who believe that in order to “properly manage value, both outcomes and cost must be measured at the patient level.”

In contrast, Sullivan and Ellner point out that medical care is first of all a matter of relationships:

With over 50% of primary care providers believing that efforts to measure quality-related outcomes actually make quality worse, it seems there may be something missing from the equation. Relationships may be the key…Kurt Stange, an expert in family medicine and health systems, calls relationships “the antidote to an increasingly fragmented and depersonalized health care system.”

In their article, Sullivan and Ellner describe three success stories of practice models where an emphasis on relationships led to better care.

But in describing these successes, do the authors undermine their own argument?  For in order to identify the quality of the care provided, they point to improvements in patient satisfaction surveys in one case, decreased rates of readmission in another, and fewer ER visits and hospitalizations in the third.  In other words…outcomes

Patients are NOT Customers

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Screen Shot 2015-03-21 at 4.26.26 PMRecently I wrote about the problems with Maintenance of Certification requirements.  One of the phrases I read repeatedly when I was researching the piece was “the patient as customer.”  Here’s a quote from the online journal produced by Accenture, the management consulting company:

Patients are less forgiving of poor service than they once were, and the bar keeps being raised higher because of the continually improving service quality offered by other kinds of companies with whom patients interact—overnight delivery services, online retailers, luxury auto dealerships and more. With these kinds of cross-sector comparisons now the norm, hospitals will have to venture beyond the traditional realm of merely providing world-class medical care. They must put in place the operations and processes to satisfy patients through differentiated experiences that engender greater loyalty. The key is to approach patients as customers, and to design the end-to-end patient experience accordingly.

Except for one thing.  Patients are NOT customers.

The definition of a “customer” is a person or entity that obtains a service or product from another person or entity in exchange for money.  Customers can buy either goods or services.  Health care is classified by the government as a service industry because it provides an intangible thing rather than an actual thing.  If you buy a good, like a car, you voluntarily decide to shop around and get the best car you can for the price.  Even a vacation, especially a vacation package or a cruise, is a good.  A nice dinner, while a good in the sense of the food, is also a service.  You buy the services of the cook and servers.

Here is why the patient shouldn’t be considered a customer, at least not in the business sense.

1. Patients are not on vacation.  They are not in the mindset that they are sitting in the doctors office or the hospital to have a good time.  They are not relaxed, they have not left their troubles temporarily behind them.  They have not bought room service and a massage. They are not in the mood to be happy.  They would rather not be requiring the service they are requesting.  Which leads to number 2:

2. Patients have not chosen to buy the service.  Patients have been forced to seek the service, in most cases.

3. Patients are not paying for the service.  At least not directly.  And they have no idea what the price is anyway.

4. Patients are not buying a product from which they can demand a positive outcome.  Sometimes the result of the service is still illness and/or death.  This does not mean the service provided was not a good one.

5. The patient is not always right.  A patient cannot, or should not, go to a doctor demanding certain things.  They should demand good care, but that care might mean denying the patient what the patient thinks he or she needs.  The doctor is not a servant; she does not have to do everything the patient wants.  She is obligated to do everything the patient needs.

6. Patient satisfaction does not always correlate with the quality of the product.A patient who is given antibiotics for a cold is very satisfied but has gotten poor quality care.  A patient who gets a knee scope for knee pain might also be very satisfied, despite the fact that such surgery has been shown to have little actual benefit in many types of knee pain.

Doctors Going the Distance (In Education)

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We need more doctors.

Between older care providers retiring, and the general population shift that is the aging of the Baby Boomers, we are running into a massive demographic of more, older patients, living longer and managing more chronic conditions. This puts incredible pressure not just on the remaining doctors and nurses to make up the gap, but strains the capacity of schools to recruit, train, and produce competent medical professionals.

So how can schools do more to reach students and empower them to enter the healthcare field?

The increasing popularity of online programs (particularly at the Masters level, among working professionals looking for a boost to their career advancement) has called forth a litany of studies and commentaries questioning everything from their technology to their academics,compared to traditional, on-campus programs. More productive would be questioning the structure and measuring the outcomes of degree programs in general, rather than judging the value of a new delivery mechanism against an alternative more rooted in tradition than science.

In terms of sheer practicality, though, a distance education—yes, even for doctors and surgeons—makes a certain amount of sense. One of the hottest topics in the medical community right now is Electronic Health Records (EHRs) and the ongoing struggle to fully implement and realize the utility of such technology.

Surviving the Affordable Care Act Grace Period

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Screen Shot 2015-04-16 at 10.39.10 AMSince the first open enrollment in 2014 more than 11 million people have gotten coverage through the insurance exchanges established through the Affordable Care Act (ACA). While the plans offered through the exchanges are provided by the same insurers you deal with every day, there are some differences.

The biggest one is the 90-day grace period. As we near the end of the grace period for 2015, many practices are still struggling to manage the ins and outs to ensure they get paid. Here’s why.

When a person goes into the exchange to select a policy, they get a 90-day grace period to pay premiums. This grace period is between the insurance company and the policy holder. As with other coverage, when the patient makes an appointment and/or goes to the doctor, he or she shows the insurance card. When the practice verifies eligibility, it shows that the patient is covered. If the patient comes into the office during the grace period, the claim will go out as usual and get paid. However, if the patient did not pay their premium during this grace period, the insurance company will come back to the practice and ask for the money back. Then, the practice has to bill the patient directly. This is difficult for providers for many reasons, not the least of which is that the longer it takes to bill a patient, the lower the chances of getting paid.

As a provider you may feel a strong reaction to this 90-day grace period and want to wait to see patients until the grace period is past. This is probably not realistic. Patients need care, and you need to have a positive relationship with your patients. So, here are a few steps to help manage the grace period and ensure you get paid:

  1. If the patient is in this grace period, ask them to bring proof of payment of their premium (cancelled check or receipt of some kind).

  2. If the patient cannot provide this, have them pay at least 50% of the billed charges at the time of service.

  3. Have patients sign a contract that states that they will pay the charges if the payer denies them or asks for the payment back after services are rendered.

  4. Implement a credit card on file option. Patients provide a credit or debit card and sign a contract that it can be charged up to a specified amount (i.e., $150). If the payer denies the claim or asks for the payment back, the practice can charge the card and send a receipt to the patient.

Over 30% of physicians believe that the largest barrier to good healthcare is inadequate insurance coverage. So it is no wonder that over 40% of physicians also believe that the Affordable Care Act is mostly good and a similar number are accepting exchange plans. However, this doesn’t change the fact that the new plans come with challenges.

As a small business you can’t really afford to wait too long to get paid, or worse, have to return payments and then wait again. By implementing some simple steps now you can help reduce the headaches of exchanges plans in the years to come.

Kathleen Young is the CEO and co-founder of Resolutions Billing & Consulting, Inc., which was founded in 2003. Kathleen is also the owner of Healthcare Chart Audits, which offers auditing to physicians and attorneys. Kathleen has been in healthcare since 1989 and has worked for physicians, large corporations and three billing companies. Kathleen is a CPC and a CPMA with the American Academy of Professional Coders and speaks to many groups on coding, billing, and auditing.

 

Why Doctors should Recommend Quantified Self Technologies for Their Patients

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The United States population suffers from staggering numbers of lifestyle related diseases. We know the situation is not improving. Recent research found that over half of the country has prediabetes or diabetes. The facts don’t lie—the vast majority of the US burden of disease are due to lifestyle.

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Photo Credit: Dr. DArriush Mozzafarian

People know they should eat less and exercise more, but they don’t. They don’t because without the right knowledge and direction, behavioral change is really hard. Doctors also know they should be advising their patients on lifestyle, but they don’t.

Being Graded

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Munia Mitra MD“Lawyers aren’t graded.”

“CEOs aren’t graded”

“How would you feel if I tracked every e-mail you sent and tracked how many people responded to them? You wouldn’t like that very much would you?”   

“The people who make EMRs. Why aren’t they graded?”

If there’s one negative I hear time and time again from doctors when the subject of quality measurement comes up, it’s this one near-universal complaint. The world is unfair, the cards are stacked against us.

As a specialist at a busy urban medical center I hear the complaints almost every day from colleagues and peers at other hospitals. We’re being singled out for unfair treatment:  They’re out to get us. It’s the world against the doctors.

Many of the so-called experts I’ve talked to at meetings around the country express disdain when the topic of physician resistance to quality improvement programs comes up.

But it shouldn’t be terribly surprising that the idea that one’s performance is being tracked can be seen as intrusive and threatening. The reaction is in many ways completely predictable.