Friday, October 30, 2015

The Legal Audit: A 10 Step Checklist for Your Healthcare Practice

10 Step Checklist for Your Healthcare Practice
Heathcare Practice
Legal Checklist

Medical practices are always preaching preventative medicine to their patients. They can be well-advised to practice their own legal preventative medicine through an internal audit of the legal issues involving the practice. Dealing with these issues now rather than when a problem arises will save time, money and stress. According to attorney Charles E. Rosolio, P.A., at, the following is a good checklist that all medical practices should follow when conducting an internal legal audit:
  1. Employment agreements. It is always good to examine all employment contracts to make sure that they are up to date, have not expired or are not outdated by actual practice and implementation. Confirm that there is consistency throughout the practice on all aspects of the terms and conditions of employment.
  2. Contracts with health care providers. Check to see that the practice is in compliance, that the other contracting party is in compliance and all terms and conditions are being met. Pay particular attention to the renewals and termination scenarios to avoid unintended results. 
  3. Compliance with healthcare regulations (HIPAA, Stark, Fraud and abuse). With the ever-changing landscape of health care regulations, examine all current arrangements to insure continued compliance. Examine written contracts and also review implementation to insure that the actual practice is consistent with current regulations.
  4. Policy manual and employment manuals. Insure that such manuals are up-to-date and compliant with actual practice as well as current law. This is an evolving process and an inconsistent or out-of-date manual can spell trouble later. This includes social media policies, a key element with any policy or employment manual.
  5. Reporting requirements for lenders and financial institutions. Examine the reporting requirements in any loan documents to lenders to make sure that the practice is in compliance and has provided all that is required under loan or line of credit agreements with such institutions. 
  6. Corporate documents up to date. Make sure that the governing documents of the practice are up to date. If the practice is a professional corporation or some other type of entity that requires the preparation of minutes on at least an annual basis, attend to these requirements. Work with the practice’s tax advisors to insure that whatever needs to be reflected for purpose of tax compliance has been addressed. 
  7. Contracts with service providers. Review these on a regular basis. Many times, they will have termination requirements and automatic renewals that should not be ignored. Better terms can sometimes be obtained with a long-standing vendor.
  8. Insurance issues, particularly with malpractice carriers. Coverage and compliance requirements should be examined on a regular basis to make sure that the practice is adequately covered.
  9. Review of significant contracts. If there are any other significant contracts not outlined above, they should be reviewed for the same issues as discussed.
  10. Polling for potential claims among group members. Check with the practice physicians to see if there are any potential claims that may be present or percolating so that they may be addressed early and properly. 
Do not hesitate to involve your legal professionals in an internal audit. They can identify issues that may not be identified by a non-lawyer and can offer advice before the issue becomes a real problem.

For more information or guidance, contact:
Charles E. Rosolio
1 Olympic Place, Suite 900 | Towson, MD 21204
Office: 410.576.8912 | Mobile: 410.949.6666
Fax: 410.576.8999

Wednesday, October 14, 2015

There’s Still Time to Succeed at PQRS - Here’s How

Joy Rios
According to Joy Rios, MBA, CHTS-PW, “The year is closing in on us and the countdown to MU and PQRS submission season has begun.”

You may think that the game is over, but there’s still time to make a big impact in your quality score even if you thought it was too late.

At this stage of the game, if you haven’t started PQRS, let’s talk about your best options.

Since the deadline to report as a group passed at the end of June, eligible providers - even if practicing as part of a group - will need to report as individuals.

The two options left to report as an individual are either through your EHR or through a Registry.

Option 1: EHR Reporting

It is important to understand the measures for which your EHR can capture data and whether or not the measures align with your specialty.

Question: In your EHR, when you run the PQRS report, how many measures have a denominator and of those measures, which ones have a numerator greater than zero?

Answer 1: If the answer is 9 or more and the measures align with your specialty, you will likely be able to use the EHR-Direct method to report.

To do so, confirm that your EHR vendor can generate a QRDA I or QRDA III file that passes the validation test to be submitted to QualityNet.

Then make sure you have the right user roles set up to be able to submit that QRDA file — they will most likely be the Security Official and the PQRS Submitter roles.

Answer 2: If you run the PQRS report and you show results for fewer than 9 measures AND/OR if your numerators are particularly low for the measures for which you are capturing data, you may want to consider reporting through a Registry.

Option 2: Registry Reporting

Although you can report 9 individual measures (covering at least 3 NQS domains) through a Registry, you would need to submit data for at least 50% of your Medicare patients from January 1 - December 31, 2015. If you have not been collecting data, this method is too difficult to chase.

However, there is a more attainable Registry-based reporting method — via a Measures Group.
The beauty of the Measures Group method is you only need to collect data on a minimum of 20 patients, 11 of whom must be on Medicare. This is a task that can be completed by the end of the year.

CMS has defined 22 groups of measures (aka a Measures Group) to choose from this year. Each group revolves around a particular topic (i.e. Oncology Care, Diabetes, IBD, etc.) However, if none of those match your patient population, I implore you to consider the Preventive Care group.

This group is designed to collect data on patients aged 50 years and older with a specific patient encounter code (i.e., 99201 - 99205, 99212 - 99215).

You’ll need to collect data on a total of 10 measures that are geared toward preventive care. For example, you’ll ask the patient if they’ve had a flu shot this year or whether they have had their Pneumonia vaccine - that’s two. You’ll ask it for eight more measures.

Then you’ll fill out a Data Collection Worksheet for each of the 20 patients. Don’t worry, this document is provided by the Registry. Once data has been collected on enough patients, you’ll transfer that information over to an Excel Document and upload that to the Registry.

The Registry will then submit the data on your behalf to CMS.

And that’s it - you’re done.

Where can you sign up with a Registry? Well, Joy’s personal favorite is - it will cost about $300 per provider and is worth every penny.

The clock is ticking and if you have done nothing for PQRS up until now, this would be your best option to avoid up to 6% in penalties.

For more information on how to successfully participate in PQRS this year, check out my book,  ABCs of PQRS: Your 2015 Guide to Successfully Participating in the Physician Quality Reporting System or order at (800) 933-3711. Also now available on Kindle.

Thursday, September 3, 2015

Don't Let Loan Debt Drag Down Your Practice

medical practice and debt
Avoid Debt!
Even after you allow for a banker’s vested interest in writing capital loans, many physician-owned practices—especially those with only one or two partners or shareholders—find themselves sliding down the slippery slope of debt financing. Most business owners, including doctors, would never advise friends or family members to live off their credit cards! But when debt threatens to overwhelm their practices, that’s essentially what they’ve done in their businesses.

Unless you can print your own money, a high-debt strategy is untenable for the long term. (That’s how the Fed manages to stay afloat in a sea of red ink.) If your practice has more than six or eight significant loan/lease arrangements, consider that a potential red flag and possibly a signal to talk to your banker about consolidation.

However, the big trouble with consolidation loans is this: Once a practice has lowered its monthly debt payments, it can become tempting to activate new lines of credit. In the end, it’s in worse shape than it was before signing the consolidation note. Since the “profit margin” in a private practice refers primarily to the owners’ compensation, a practice that uses credit lines to pay doctor salaries is following a no-win strategy: Questionable at best—downright foolish at worst.

Physicians often throw money away every month by not properly managing their loans and leases. They lose control incrementally—taking out a loan here, an equipment lease there, and a business line of credit—and eventually find themselves “treading water” financially. Equipment leases have become very common. They often have hefty prepayment penalties written in, so even physicians earning a good return on the equipment investment wind up paying every penny of interest demanded by the contract. A capitalization loan usually rewards the debtor for early pay-off.

Physicians might want to consider loan consolidation, capital financing instead of leases, and real estate investment rather than facility rental. That last bit of advice can serve as an integral part of a good exit strategy. Real property increases the practice’s overall value when it comes time to sell.

When looking for help with financing, medical practices should seek out banks with departments specializing in healthcare providers’ unique needs.

Thursday, August 13, 2015

Patient-Friendly Loans to Improve Collections

We’ve long advocated that medical practices abandon their traditional “Pay-me-or-else” approaches to debt collection and switch to a “How-can-I-help-you?” posture. Healthcare collections bring special challenges that are not quite like any other billing process. Consider these unique characteristics:
  • Unplanned debt. Even the most conscientious and frugal folks don’t really expect to incur medical debt. Patients feel unlucky and resentful from the outset.
  • Third-party payers. Patients don’t usually understand how insurance works—and new, higher copayment requirements mean uncharted territory for even the savviest patients.
  • Healthcare as a fundamental right. Popular opinion today views healthcare as a right to be provided regardless of ability to pay. Whether you agree or not, the question remains: Who pays for care to the entitled?
  • Physician image. The media have relentlessly recast physicians as a bunch of rich, greedy, heartless vultures preying on humanity’s misery. Even people who don’t buy that characterization can hardly help thinking, “I think they have enough without my money, too.
Factors like these make patient collections an uphill battle from the outset. And practices that have tried to become more “business-like” in their billing and collections have often seen their slightly improved collections come at the cost of their public professional image. At a time when the predominantly third-party-payer system necessitates increased patient volume—resulting in reduced time with each patient—a hard-nosed collection policy drives a wedge ever deeper between the doctor and his or her patients.

Hospitals have traditionally suffered worse collection ratios than physicians—for many reasons. An impersonal approach to billing and collecting (sometimes outsourced) has hurt more than it has helped. Those institutions exploring “interest-free” financing are starting to report some real successes.

In a sense, hospitals have found a way to do what many practices used to do before profit margin tolerances became critically thin. Most medical practices used to let patients pay whatever they could, without interest or penalty. Hospitals never could afford to do that because people on such an “honor system” have a hard time paying a faceless institution. Paying your doctor—especially one you continue to see on occasion—carries a different dynamic.

Larger practices may be able to arrange with a local bank for an interest-free loan program for their patients. (As a matter of fact, the first time we heard of this, we were working with a very creative administrator at a 35-doctor multi-specialty practice back in 1988! He made a deal with a local bank for affordable interest and limited recourse.)

Get your accountant to help you crunch the numbers and project costs and benefits for offering interest-free financing for patients with large balances. (Remember, though, it’s not interest free for you!)

If you enjoy reading the blog entries in "Solving Problems in the Medical Practice" you may want to check out all the great products at Greenbranch Publishing.

Friday, August 7, 2015

Smart Strategies in Dealing with Difficult Patients

Dealing with difficult patients
Dealing with difficult patients.
Prevention still trumps any remedy you can devise. If you want to minimize patient complaints, take the time (and we're talking about a lot of time!) to formulate, document, and implement thorough policies and procedures covering every aspect of your practice. Then communicate these policies thoroughly and effectively—it would be hard to “over-communicate.”

Billing issues and lengthy wait times top the list of complaint topics that ignite patient tempers at most medical offices. But other typical triggers include: Staff members giving hasty/incomplete/confusing answers to their billing questions, office personnel addressing patients too familiarly (first names, for example); and providers discounting/dismissing patients’ online research.Very often, these triggers mask underlying concerns or worries that cause the real anxiety. Handling unhappy patients requires the daunting task of uncovering the real issues.

You can avoid a certain amount of confrontation by making sure you have clearly communicated your office policies from the outset. Clear financial policies and patient-friendly rescheduling procedures go a long way in preventing those volatile moments.

Dealing with an angry patient absolutely requires unwavering professionalism on your part. Train staffers to maintain their best demeanor in the face of confrontation. Use scripting and role-playing to prepare employees for these tough moments of truth. Make confrontation-training an ongoing program—staff members need constant reminders.

Elevate empathy to become a core value for your office. Failing to empathize results in the patient feeling like his or her complaint has been brushed off—marginalized. Teach staffers to see things from patients’ points of view. Ask them, “How would you feel in this situation?” Show workers how to use tactics like “reframing,” wherein the employee helps the disgruntled patient see a situation from a very different angle, thus redefining it.

Teach communication strategies like asking the patient a couple of obvious questions that elicit a “yes” answer. That actually helps set a positive tone for the rest of the conversation. Insist that staffers follow up all the way to a successful conclusion if even remotely possible.

Create patient handbooks, brochures, Web pages, and posters that inform and remind everyone about how you intend to serve each person who comes to your practice. Monitor staff members closely to make sure everyone is following the rules.

Of course, even the best-constructed boat might bump an iceberg once in a while. That’s why you teach “emergency” procedures to the whole crew. Service disasters will happen—and your staff members must know how to execute “disaster-recovery” procedures as well.

Six tips are:
  1. Letting the angry patient know you understand 
  2. Soliciting what the angry patient wants from you 
  3. Offering the help you can provide (and clearly describing what you can’t do) 
  4. Setting limits on what patient behaviors you will tolerate 
  5. Assuming the patient is probably doing the best he or she can do 
  6. Believing in yourself—that you’re also doing the best you can do 
Believing in yourself (and the patient) can energize you and help you stay “above the fray.” It helps keep you from taking the patient’s anger personally and increases your personal patience. Finally, be circumspect about introducing humor into a heated situation. Avoid making light of the situation directly—you don’t want the patient to think you don’t take him or her seriously!

Finally, give your frontline staffers the authority (within reasonable limits) to resolve situations—and a direct path to your door if the solution requires even more authority. Maintain detailed patient-complaint logs. Use the logs as quality improvement tools.

If you enjoy reading the blog entries in "Solving Problems in the Medical Practice" you may want to check out all the great products at Greenbranch Publishing.

Wednesday, July 22, 2015

How Do You Choose the Physician Leader in Your Medical Practice?

Leader in Your Medical Practice
Leader in Your Medical Practice
We’ve served in practices where the partners or shareholders simply take turns at the helm. In these organizations, a title like “president” or “managing partner” really bears little weight beyond signing contracts and bank notes, and moderating governance meetings. Other groups we’ve worked for have tended to make “president” a life sentence—especially for a charismatic doctor whom the others trust.

The “good-ol’-boy” approach to leadership won’t carry your group very far down the road in the drastically changing environment in which a successful practice must operate in the next few years. Groups that want to remain firmly in control of their own destinies will have to get more serious and more businesslike in their governance. And that calls for exceptional, gifted leaders who exhibit at least these four kinds of characteristics.Instead of electing a “nice guy or nice gal” to be a figure-head, take a look at your partners and determine who among you already exhibits these characteristics:
  • A doctor who demonstrates self-discipline (think about medical records, patient scheduling, self-control in difficult moments) will more likely serve as an effective leader.
  • Doctors who already “set the pace” among their peers show that they can lead others.
  • Doctors who embrace change and show resilience in handling the bumps and curves have a better chance at inspiring their peers to “hang in there” through the challenging times.
  • Doctors who avoid “analysis paralysis” and show a determination to reach well-thought- out goals can help their colleagues continue to move forward.
Increasingly uncertain times lying ahead for physicians and group practices call for stronger physician leadership than ever. Seismic changes are on the horizon, and successful physician leaders will have to navigate territory heretofore uncharted. High-performing physician leaders exhibit four characteristics consistently:

Physician leaders increasingly must lead more than their partners in their groups. They are called to lead growing, complex health systems now. With the emphasis shifting to value over volume, healthcare delivery will continue to become more team-oriented. Physician leaders will have to organize and lead teams of providers.

The requirement for physicians to lead physicians hasn’t changed—and it’s as challenging a task as ever. The shifting environment makes it more complicated than ever, and the new healthcare paradigm demands strong physician leadership.

Monday, July 20, 2015

ZocDoc to Present Webinar on Strategies for Patient-Centered Healthcare with Industry-Leader Greenbranch Publishing -- (and complimentary book included)

Patient-Centered Practice
Patient-Centered Practice
Digital health platform ZocDoc will present a free webinar for healthcare providers on strategies to create a more patient-centered experience, as part of Greenbranch Publishing's regular webinar series.

The free online session – titled "The New Patient-Centered Practice: What You Must Know to Succeed" – will take place Wednesday, August 5, 2015 at 1 p.m. ET and will be led by ZocDoc Vice President of Marketing Richard Fine and The Journal of Medical Practice Management®, Publisher Nancy Collins.

Sign up at or call (800) 933-3711.

The webinar will offer key insights into patients' shifting expectations when it comes to transparency, convenience and instant gratification. Tools and strategies will be presented that healthcare providers can use to accommodate patients' new expectations and to modernize their practices.

The joint webinar on August 5 will address topics including:
  • How patients are "changing the rules" and the implications for your practice
  • Tools and strategies to accommodate patients' growing expectations
  • What you need to know about online reviews and why your online presence can't be ignored
  • How ZocDoc provides a solution and blueprint for success

"Running a profitable medical practice takes more than your staff's strong clinical skills," said Nancy Collins, CEO of Greenbranch Publishing. "Today's medical practice management is complex – including managing the patient process, technology needs, receivable management needs and personnel management. We are pleased to give Greenbranch audiences access to authoritative presentations to enhance their knowledge of medical practice management."

As a bonus, the first 200 registrants for the webinar will also receive a free copy of the best-selling book by Judy Capko and Cheryl Bisera, The Patient-Centered Payoff: Driving Practice Growth Through Image, Culture and Patient Experience, published by Greenbranch Publishing, (238 pages and a $51.00 Value).

About ZocDoc: Each month, millions of patients turn to ZocDoc to find in-network, neighborhood doctors, instantly book appointments online, see what other real patients have to say, get reminders for upcoming appointments and preventive check-ups, fill out paperwork online, and more. Patients can book more than 1,800 different types of procedures via ZocDoc, across more than 50 different medical specialties.

About Greenbranch Publishing:Greenbranch Publishing has earned a loyal following for its medical practice management educational materials, including the flagship publication, The Journal of Medical Practice Management and highly regarded books and seminars for physicians and practice managers covering reimbursement, practice development, compliance, patient safety, and financial and operational issues.

Sign up for the FREE webinar and receive the complimentary Patient-Centered Payoff book: or (800) 933-3711

Thursday, July 16, 2015

A Method to Prevent Physician Turnover ... Hire for Culture Fit

Physician Turnover
Reducing Physician
When you abandon a sinking ship, you don’t generally interview the other passengers in each lifeboat to see if you’ll be able to fit in with the group. And as long as physicians feel that there’s no hope in their current practice settings (solo or small group), they will be tempted to jump at any employment opportunity that seems to offer them some sense of security.

“Survival” decisions are very different from long-range commitments. Doctors focusing on escaping their current situations are likely going to discount “cultural fit” when evaluating employment offers from larger practices and health systems. That’s a huge mistake. We all know it’s important. A physician who operates under a very different value system than the organization that employs him or her will not stay long—and will spend a good amount of time looking elsewhere for employment.

Some pundits estimate that the next few years we will see the biggest exodus from private practice in history. That means a lot of doctors looking for, evaluating, and accepting employment offers. We expect things will move at a relatively rapid pace and that some markets will be seriously shaken up.

But regardless of how these dynamics unfold for you or your organization, don’t let desperation cloud your judgment. Recruiting organizations feel pressure to fill vacancies or to capture the best available doctors on the block. Candidates feel pressure to find a job. In the short run, you may keep the bills paid or cling tentatively to your market share; but in the long run, employers and employees will be on the hunt sooner rather than later.

The huge wave of practice mergers and acquisitions washing through the healthcare marketplace has many physicians looking for new jobs—some joining group practices for the first time in their careers. Diverse expectations about accountability, autonomy, and more put many newly employed physicians on a track for disappointment and threaten the group’s ability to retain doctors.

Reducing turnover requires hiring the right physicians in the first place. To accomplish that, there are three important steps that are critical for hiring the right ones:

Defining your unique organizational culture. Identify your core values, vision, and mission, and determine how they affect day-to-day life in the practice.

Screening candidates for cultural fit. Communicate these values clearly to recruits, and ask questions that elicit each candidate’s personal values for comparison.

An onboarding process for new recruits. Provide thorough orientation for new hires. Create a deliberate mentoring program that pairs new recruits with veteran group members.

Various studies estimate the costs associated with an established physician’s departure at nearly a million dollars for some specialties. A prolonged medical staff vacancy costs can approach $100,000 per month.

If you enjoy reading the blog entries in "Solving Problems in the Medical Practice" you may want to check out all the great products at Greenbranch Publishing.

Tuesday, July 7, 2015

Here's How to Confront a Medical Practice Employee with a Performance Problem

medical practice HR
Dealing with difficult
Few physicians or managers relish the idea of confronting an underperforming staff member. Those few who don’t seem to be bothered by it have either become callous over the years or have a bit of a sociopathic streak. But like some of the tougher jobs facing parents, you have to steel yourself and “just do it.”

Having an organized method for dealing with this issue is the best approach. It provides a roadmap to keep you on track when emotions run high and threaten to deter you from the hardest parts, and it helps you treat employees consistently. Whenever you appear to go soft on a worker after being tough with another, you open yourself up to accusations of discrimination.

Committing to consistent accountability in your organization can yield incredible improvement in its effectiveness—if you also cultivate a supportive environment that shows an equal commitment to each employee’s professional success. That’s a hard balance—and it’s impossible if you aren’t sincere in your support for individual workers.

If your practice has a history of tolerating poor performance, your attempts to move toward accountability and quality improvement will meet daunting resistance from almost everyone. So you will have to develop nerves of steel to make it through the transition. The results, however, will be worth the pain and hard work.

There is a consistent pattern among managers at all levels: a pronounced lack of skill or will to sit down with under performers and have those tough conversations about their failings. Most experienced managers consider this skill set as part of basic management; but for various reasons, they lack the will to confront.

Here's a six-point methodology for effectively confronting an employee who doesn’t measure up:
  • Prepare. Gather your evidence of underperformance and organize it to present to the problem employee. Prepare an outline of what you want to say and how you want to say it. Keep in mind that your objective is to improve and salvage the employee—not to punish him or her.
  • Explain the issues. Keep your cool, and explain where he or she is failing and the effect it’s having on the organization. Avoid being harsh—but don’t “sugarcoat” it.
  • Ask for reasons and listen. Give the staffer an opportunity to explain his or her side of the story. Replace the tendency to scream, “What the blank were you thinking?” with something less confrontational: “Help me understand how this could happen.”
  • Solve the problem. If you have listened carefully, you should be able to ascertain the underlying problem(s) contributing to the employee’s failure. But continue to encourage the employee’s participation. Have a collaborative discussion. The employee will be more committed to a solution he or she helped develop.
  • Ask for a commitment, and set a follow-up date. Summarize the action plan to make sure you both understand it, and set a reasonable date to meet again and check on progress.
  • Express confidence and consequences. Early conversations (or minor problems) don’t require an emphasis on consequences, but sometimes you have to “turn up the heat.” Try to end on a positive note: “I know you can do this.”
Always document such meetings, and follow up without fail. Missing a follow-up date will seriously erode your credibility.

If you enjoy reading the blog entries in "Solving Problems in the Medical Practice" you may want to check out all the great products at Greenbranch Publishing.

Monday, June 15, 2015

Malpractice Cases and the Impact on Doctors' Time

Malpractice Cases and Doctors' Time
Malpractice and Doctors' Time
Anyone who has worked with physicians—or any healthcare providers, for that matter—know that medical malpractice claims inflict tremendous burdens— financial, emotional, work, and time—on the entire healthcare system.

Can you say, “Duh!”? We’ve known that for a long time! These cases don't necessarily consume all his or her time, but it lurks about in the corners of the physician’s mind, both conscious and unconscious.

The financial costs aren’t even measurable. Consider the ways that today’s flood of litigation imposes costs on an already struggling system. To name just the big, obvious ones:
  • Legal costs, legal-system resources, and breathtaking jury awards; 
  • Six-digit annual malpractice premiums; 
  • Loss of physician (and support staff) productivity; and 
  • Defensive medicine’s redundant and unnecessary tests and procedures. 
The most common solution proposed by healthcare advocates—tort reform—seems to be working in some states. The thousands of lawyers we have elected to Congress and to state assemblies resist the idea, but not just to serve their own interests. Damage caps threaten the rights of plaintiffs. When a bad provider has indeed been negligent, the system needs to go further than a financial “slap on the wrist.” Punitive damages are needed to punish wrongdoers. Further, damage caps address only one small portion of the system costs. Productivity loss and defensive medicine costs will continue to burden the system.

We’ve become a real fan of properly executed “disclosure and apology” programs. Other scientific studies show tremendous positive impact on the medicolegal systems where such programs have been implemented. The beauty of disclosure and apology programs is that they bring providers and patients to the same side of the table. The tort system makes them enemies—a disclosure/ apology system can make them allies.

Resolved claims take less time—but still a long time. After a suit is filed, it takes from 16 to 21 months to come to a conclusion. The litigation process can actually be more distressing for the doctors than the potential financial damages. During adjudication, the stress can be nearly overwhelming, as physicians deal with a loss of reputation and the loss of time spent dealing with the claim instead of practicing medicine.

The suffering reaches beyond the physician to include his or her staff, the patient, and the patient’s family as well. It’s to everyone’s benefit to find ways to speed up the process and shorten the time required to resolve malpractice cases. Several suggestions for fast-tracking a resolution include creating special malpractice courts or implementing effective apology and disclosure programs.

If you enjoy reading the blog entries in "Solving Problems in the Medical Practice" you may want to check out all the great products at Greenbranch Publishing.

Monday, June 1, 2015

The Way to Market a Medical Practice Post-ACA

Marketing post ACA
Marketing practices
post ACA
There are really six marketing methods, but the reminder is that we still have work to do in the marketing/public relations department. Healthcare reform appears to some physicians as doom and destruction looming on the horizon, but it’s not the first time the demise of private practice has been predicted. (The doom-and- gloom accompanying the passage of Medicare back in 1965 comes to mind.) To be sure, we believe that ACA causes serious disruption for providers, employers, insurers, and government agencies! But we also believe in the creativity and adaptability of American business leaders.

Medical Practices are sorting it out. There are some casualties, and additional circumstances will bring additional pressures. For example, the growing physician shortage will peak during the years the healthcare market tries to adjust to ACA.

Some physicians clearly believe it’s time to plan exit strategies, early retirement, and practice sales. Bailing out would certainly be one way of “adapting,” but we remain convinced there will still be opportunities to run thriving practices in the future—even physician-owned practices. Branding, outstanding service, and high-quality medical care won’t go out of style.

Physicians may actually believe that marketing their practices in 2015 could bring in more patients than they could possibly handle. But marketing is about more than trying to increase volume— an effective strategic marketing plan can help a practice attract a “desirable patient base” from the new, larger patient pool.

Even if there are more insured patients out there shopping for a physician, not every patient is a “good fit” for your practice. An effective marketing plan does more than attract business— it differentiates the practice, making it stand out against the competition.

Here are six strategies that will continue to be effective. Here are six of them:
  • Establish yourself as the expert in your field.
  • Well-known clinics (like Mayo or Cleveland) have leveraged their expertise into unassailable reputations in the marketplace.
  • Brand your practice. Highlight individual physicians’ areas of interest and expertise, and find ways to communicate them. Don’t be afraid to use logos, Web sites, and consistent marketing to make your practice recognizable among the public.
  • Attract the patients you want. Determine your best patient mix, and allocate marketing resources accordingly.
  • Announce new physicians and services. Make a big deal out every practice expansion.
  • Build relationships with other doctors. With ACA emphasizing team-based care, cultivating referrals will be more important than ever.
  • Build a better patient experience. Patients don’t usually know enough to judge a physician’s medical skills. They do, however, know how they’re treated by your staff and whether the office is warm and inviting. Features like these motivate patients to return and to send referrals your way. Embark on a strategy of constant quality improvement in every area of “customer service.”
If you enjoy reading the blog entries in "Solving Problems in the Medical Practice" you may want to check out all the great products at Greenbranch Publishing.

Saturday, May 2, 2015

Establishing, Managing, and Protecting Your Online Reputation

physician reputation
How's your online reputation?
We read dozens of articles from month to month about how doctors should use their Web sites and social media outlets to promote their practices more effectively. The advice, however, tends to be highly generalized and often fails to address the fundamental, practical challenges facing physicians and practice administrators who struggle to understand this brave new world.

That’s where this popular book, Establishing, Managing and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices comes in. It offers both a beginner’s course in understanding Internet professionalism and extensive resources for even the seasoned doctor or manager. Even New York Times blogger Pauline W. Chen, MD, heralds this book as a “social media manifesto for physicians” at

We don’t overtly endorse very many books here in Solving Problems in the Medical Practice, but every once in a while, one comes along that clearly deserves the attention of every practicing physician and administrator in the country. And considering the fact that most doctors have thus far tried to avoid the risks and ignore the opportunities of a strong online presence, you have no more time to waste. Most of your patients (and potential patients) are already looking for you out there in cyberspace.

Wednesday, April 22, 2015

A Tool to Help Practices Compare What Insurers Are Paying

RVUs as a Tool
RVUs - The Right Tool
Physicians and their staff members have to slog through a quagmire of disparate payment schemes offered by a variety of third-party payers. Those differences make it challenging to compare contracts: Which ones are valuable? Which ones aren’t even worth the effort it takes to jump through the payers’ hoops to get paid?

Analyzing your own data—based on RVU data—not only helps you compare contracts, it can give you greater negotiating leverage when talking to payers who want to empanel your physicians.

The RVU (as defined by Medicare) has almost taken over the healthcare world as the primary measure of physician productivity, and it has by default become a standard way of measuring payment value. That’s because many managed care contracts offer reimbursement schedules based on a particular iteration of the Medicare fee schedule, which is driven by its Resource-Based Relative Value System.

Friday, April 10, 2015

Get the Most Out of Your Patient Portal

According to the Department of Health and Human Services’ Office of the National Co- ordinator for Health Information Technology (ONC), a patient portal is a secure online Web site giving patients 24-hour access to personal health information via the Internet.

Its Web site ( lists a half-dozen basic types of information available to patients this way:

  • Recent doctor visits; 
  • Discharge summaries; 
  • Medications; 
  • Immunizations; 
  • Allergies; and 
  • Lab results. 
ONC’s Web page goes on to list another eight services that a complete patient portal may offer. Many sites allow patient to:
  • Exchange secure email with their healthcare teams;
  • Request prescription refills; 
  • Schedule non-urgent appointments; 
  • Check benefits and coverage; 
  • Update contact information; 
  • Make payments; 
  • Download and complete forms; and 
  • View educational materials. 
Why care about the ONC’s patient portal description? Because the ONC has the responsibility and authority under the HITECH Act to build “an interoperable information system promoting widespread, meaningful use of healthcare technology.” In other words, the ONC defines “Meaningful Use,” on which your potential bonuses (and threatened penalties) are based.

Monday, March 30, 2015

The New Definition of Telemedicine

Buoyed by its pilot project’s success, UCLA’s Center for Inflammatory Bowel Diseases plans to expand its testing of a telemedicine system based on Apple’s iPad. The app allows doctors, nurses, and patients to communicate and track symptoms and care in an ongoing dialogue.

The latest generation of physicians is driving this type of technology—younger doctors tend to prefer wireless devices over older forms of communication. According to the American Telemedicine Association, some 10 million patients today are already benefiting from such technology—a 10-fold increase over the previous year alone!

The broadest understanding of “telemedicine” includes the growing use of patient portals that allow patients to access to their medical records and communicate more directly with doctors and nurses. Effective use can measurably reduce unnecessary patient visits.

Sharing data, including complex diagnostic images (x-rays, MRIs, electrocardiograms, and more), speeds up consults and expands the team providing care for patients. In fact, diagnostic consulting is moving to the next level: New York’s Sloan-Kettering Cancer Center has already started using the already-famous artificial-intelligence capabilities of IBM’s Watson megacomputer to help diagnose and treat cancer.

Sorry for the Pause

Been busy with Greenbranch Publishing business, plus a little time off for fun. Now, back to the blogging and helping medical practices solve problems!


Tuesday, February 17, 2015

Checking Your Vendors’ References: Don’t Cut Corners

When your medical practice is considering a major purchase, don't be confined by the vendors reference list alone. You should also use these two proven strategies for expanding the reference list beyond the vendor’s control:
selecting a medical practice vendor
  • Ask around. Use your personal network to discover other practices that use a given vendor’s services or products. Call other physicians or managers. Ask around at your next conference or seminar. Ask, “Do you know anyone who has used XYZ Product? Do you know if they’ve had a positive experience? Have they dropped that vendor or product?” Ask your personal friends and acquaintances to help you contact the ones you don’t already know.
  • Ask the competition. As you narrow your field of vendors, ask each for specific references that include clients they’ve won over from the others. For example, if you’re shopping for a new EMR, ask Vendor 1 if his or her company has a client that used to be with Vendor 2, and vice versa. When you contact that reference, ask specific questions about why he or she left the previous service-provider. This way you can hear some of the “bad news” about each vendor.
Make the Most of Your Reference Calls

Press your vendors to provide relevant references. Insist on a list of medical practices that resemble your own in size, medical specialty, payer mix and patient volumes. If you’re looking at technology to deploy over multiple practice sites, talk to a multi-site practice using the same technology.

Pay attention to subtle differences, too. For example your 55-year-old physicians may not agree with a reference’s thirty-something doctors regarding a high-tech product’s “user-friendliness.” Ask about market conditions, patient types and local competitors. Do your best to achieve an “apples-to-apples” comparison.

Depending on the product or service you’re reviewing, try to speak with more than one person at each practice. Remember that physicians and managers often have a very different view about a product or service than the workers in the trenches. A less-than-optimum configuration looks like a minor annoyance to an administrator, but it can become a major pain for the staffer who deals with it day in and day out.

Don’t settle for written references—while somewhat useful, they don’t compare to personal interviews. Telephone calls are better, but don’t implement systems or equipment without making at least one site visit arranged by each of your vendor-finalists. Nothing compares to seeing the product in a real-world setting and talking to the people with daily experience.

Wednesday, January 14, 2015

Why Your Practice Should Use YouTube for Branding and Marketing

YouTube in the Medical Practice
Effective use of YouTube
in the medical practice.
(image courtesy of Dr. Neil Baum)
The goal for using YouTube for marketing is attracting and engaging the patient who is the best fit for your healthcare practice. The goal is not to develop a video that goes viral.

How is this accomplished? Think of using the video format to give your potential patients digestible bits of credible and compelling content that helps solve their problems or helps to answer their most important questions. For a medical practice, a video could be something like an overview of psoriasis diagnosis, physical therapy guidelines for shoulder pain, vaccine guidelines, flu season patient education. A great example of a physician who fully (and appropriately) uses the power of this new media is Dr. Neil Baum, a urologist in New Orleans. His YouTube channel can be found here

Make sure your expectations are reasonable. Do set up your own YouTube channel and plan on a continuing series of videos. One video will not change your business. Each video, however, increases the probability that you will be discovered by a prospective patient, to attract them to your practice, and to convert them from a prospect to a patient. 

YouTube, Bing, Google, Yahoo, Facebook and AOL are all search engines that patients use, so make sure you include key words in your video (and as tags around your video) that are the terms your patients are searching. Make sure patients can “find” your video. And for SEO (Search Engine Optimization), YouTube videos regularly appear at the top of Google and Bing search results. YouTube has a huge following; only Facebook exceeds YouTube in reach.

In addition to the search engines, drive additional traffic to your video through appropriate social media platforms such as Twitter, Facebook Google+, blogs, LinkedIn, Pinterest.

In each video, set up suitable “calls to action” so you can drive patient traffic to your website or portal, where you can further explain your mission and explain, in detail, what your practice offers.

YouTube needs to be a component of your ongoing and regular marketing activities, an important tool for your online marketing presence.

If you enjoy reading the blog entries in "Solving Problems in the Medical Practice" you may want to check out all the great products at Greenbranch Publishing.