Thursday, August 16, 2018

Small Practice

Small Practice

My Doctor Just Gave Me His Cell Phone Number …

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flying cadeuciiThat’s right…it really happened.

At the conclusion of a recent doctor visit, he gave me his cell phone number saying, “Call me anytime if you need anything or have questions.”

In disbelief, I wondered if this was a generational thing – and whether physicians in their late thirties had now ‘gone digital’.

My only other data point was our family pediatrician, who is also in her late thirties. Our experience with her dates back nearly seven years when my wife and I were expecting twins.  A few pediatricians we met with mentioned their willingness to correspond with patients’ families via email as a convenience to parents.  The pediatrician we ultimately selected wasn’t connected with patients outside of the office at that time, but now will exchange emails.

Will Independent Physicians Go Extinct?

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Richard Gunderman goodLife is tough for physicians in solo and small group practice.  The federally mandated introduction this fall of ICD-10 requires physicians and their staffs to learn a new system of coding diseases.  “Meaningful Use,” another federal program, requires physicians to install and use electronic health records systems, which are complex and expensive.  And PQRS, the Physician Quality Reporting System, is beginning to penalize physicians for failing to report individual data for up to 110 quality measures, such as patient immunizations, each of which takes time to collect and record.

Of course, such requirements are not being imposed solely on solo and small-group physicians.  In many ways, they affect all physicians alike.  Yet the burdens of complying are disproportionately high for small groups, which cannot spread out the costs of purchasing equipment, hiring employees and consultants, and training personnel over so large a number of colleagues.  Hospitals and large medical groups can afford to hire full-time specialists to meet these challenges, but such approaches are not economically feasible for a group that consists of only a few physicians.

Such challenges are not just raining down –  they are pouring down on the heads of physicians.  Some physicians fear they smell a conspiracy to drive solo and small-group practitioners out of business.  And the problem is not just the money.  It’s also the time.  Many physicians already work long hours and simply cannot afford to shop for such systems, negotiate contracts, and enter data.  We personally know physicians who report spending two hours each evening completing records that they did not have time to attend to while they were seeing patients.

A Radical Policy Proposal: Go Easy On Older Docs

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flying cadeuciiThrough Dec. 15, federal regulators will accept public comments on the next set of rules that will shape the future of medicine in the transition to a super information highway for
Electronic Health Records (EHRs).  For health providers, this is a time to speak out.

One idea:  Why not suggest options to give leniency to older doctors struggling with the shift to technology late in their careers?

By the government’s own estimate,in a report on A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure, a fully functioning EHR system, for the cross-sharing of health records among providers, will take until 2024 to materialize.The technology is simply a long way off.

Meanwhile, doctors are reporting data while the infrastructure for sharing it doesn’t exist.  Now, for the first time, physicians will be reporting to the federal government on progress toward uniform objectives for the meaningful use of electronic health records.  Those who meet requirements will be eligible for incentive payments from Medicare and Medicaid, while those who don’t may face penalties. In addition, audits are expected to begin in 2016.

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.

 

Patient-Centered Service

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flying cadeuciiAmerican healthcare has a customer service problem.  No, customer service in the US is terrible when it comes to healthcare.  No, the customer service in the US healthcare system is horrendous.  No, healthcare has the worst customer service of any industry in the US.

There.  That seems about right.

What makes me utter such a bold statement?  Experience.  I regularly hear the following from people when they come to my practice:

  • “You are the first doctor who has listened to me.”
  • “This office makes me feel comfortable.”
  • “I didn’t have to wait!”
  • “Where’s all the paperwork?”
  • “Your office staff is so helpful. They really care about my needs.”
  • “This is the first time I’ve been happy to come to the doctor.”
  • “It’s amazing to have a doctor who cares about how much things cost.”
  • “You explain things to me.”
  • “You actually return my calls.”

A Powerful Tool For ICD9-ICD10 Conversion

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Screen Shot 2015-06-19 at 6.19.20 PM

Prior to attending medical school, Parth Desai took a gap year to help his mom manage his dad’s small internal medicine practice.  She was worried about how she was going to handle the looming transition from ICD-9 to ICD-10.  Parth said he would help her out.

He looked at different consultants and programs, but they were all too complicated, too expensive, or both.  He also looked at a number of different ICD-10 training programs, but didn’t really find anything that he thought was that good.  He wanted help with code conversions, but everything he saw was slow, or required additional personnel, or was too costly.

So, he did what lots of entrepreneurs do, he decided to build what he needed himself.  He enlisted his former college roommate, Will Pattiz, a “tech whiz, outdoor enthusiast, and filmmaker” to help him and together they developed software that automates the conversion of ICD-9 to ICD-10 codes. 

Calcium Scan and Subtractive Medicine

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Being a radiologist, I rarely speak to patients, but I was asked to counsel Mrs. Patel (not her real name, so calm down HIPAA totalitarians), who was worried about the risks of radiation from cardiac calcium CT scan. Because of her risk factors for atherosclerosis, her cardiologist wanted her to take statins for primary prevention, but she was reluctant to start statins. They eventually reached a truce. If she had even a speck of calcium in her coronary arteries she would take statins. If her calcium score was zero she wouldn’t. This type of shared decision making is the most frequent reason why cardiologists order calcium scans at my institution.

My Triple Aim of Medication Assisted Treatment for Opioid Addicted Patients

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by HANS DUVEFELT, MD

My second foray into Suboxone treatment has evolved in a way I had not expected, but I think I have stumbled onto something profound:

Almost six months into our in-house clinic’s existence, I have found myself prescribing and adjusting treatment for about half of my MAT patients for co-occurring anxiety, depression, bipolar disease and ADHD as well as restless leg syndrome, asthma and various infectious diseases.

Years ago, working in a mental health clinic, we had strict rules to defer everything to each patient’s primary care provider that wasn’t strictly related to Suboxone treatment. One problem was that many of our patients there didn’t have a medical home or had difficulty accessing services. Another problem was that primary care providers unfamiliar with opioid addiction treatment were uncomfortable prescribing almost anything to patients on Suboxone.