Can a Physician Run a Business???

Physicians have run small businesses for years with varying degrees of success.  Success can be identified multiple ways: 1. Financial; 2. Personal Satisfaction- being a good doctor; 3. Psychologically Rewarding- ego gratification; 4. Etc.; 5. Etc.

Physicians are excellent at providing good medical care and excellent at thinking that this automatically translates into productivity, process improvement, patient satisfaction, financial reward, and efficiency.  They mold their practices, so that everything works reasonably well, according to their personal vision of how it ought to function.

With the continual addition of more rules, the Affordable Care Act, meaningful use, and higher costs of keeping practices open, many offices are closing.  Whereas, the application of some sophisticated guidance from outside consultants could help.

Physicians may consider hiring such consultants, and often their first recommendation is to create a "Business Plan" representative of the physician's, or practice's goals. Such a plan is corporate-speak for an organizational strategy to achieve those goals, and is customarily laid out on paper.  However, many doctors, if they have a structured overall plan, often maintain it solely within in their own minds, if maintained at all.

Decisions always have to be made for that plan, and therefore always evolving to keep up with the ever-changing practice environment.

Examples include:

1. What Electronic Health Record works for this practice?
2. Is the meaningful use incentive funds worth it?
3. What computers to purchase?
4. How many providers are necessary- physicians, NP, PA, medical assistants, voice activated technology?
5. Do we staff to demand- right number of people at the right time of day?
6. What malpractice to choose- my bias is the least expensive with the lowest limits of coverage acceptable-?
7. Should we perform labs and x-rays in-house or partner?
8. Should we do our own billing?
9. What about ICD 10?
10. Do we accept Medicare and/or Medicaid?
11. How do we get credentialed with payers?
12. How much do we market or advertise?
13. Do we rent, lease or purchase space?
14. Should we sell out to the hospital to eliminate 1-8- what happens after the 2- year honeymoon period?

These are complex questions with no easy answers.  Best decisions in this regard are always made when time is taken to get sufficient data and advice before making adjustments.  But even if decisions are made to change practices, changing behaviors is not so easy, no matter what the facts, or realities of the particular care setting say.

Wisdom is not always easily acquired, and one should carefully listen to those both within and outside of the particular workplace in question.  Optimizing one's practice through small incremental steps with limited investments can be richly rewarding.

Using an EHR to Expand Your Urgent Care Practice

In a world where you have to document in a specific way, one should take advantage of the data accumulated in the EHR to accentuate your practice.

1. Auto fax all appropriate documentation to the primary care provider or appropriate specialist the patient has been referred to: a) PCP will consider you an adjunct to their practice rather than competition; b) encourage the PCP to send patients to the UC rather than the ED, if they are confident of your capacity and capabilities; c) create a specialist list that wants and appreciates your business; d) patients will appreciate the cohesiveness of care without having to repeat more tests and spending excess time explaining what might have happened.
2. Select an EHR that gives condensed summary of events rather than 10-15 pages that nobody will read.
3. Use your practice management reports to keep track of where your patients are coming from: walk-in, after hour referral, overflow referral, Google search.
4. At the end of every quarter send every referral provider a report of how much business you are sending and/or returning to them.  Most surgical specialists do not realize the direct impact you may have on their bottom line.  This can dramatically help when favors are needed that do not necessarily have to be solved in the ED.
5. Your practice management system's ability to keep up with real-time authorization, coverage, co-pays, and payments dramatically speed up the front-desk leading to more satisfied customers.  If one can eliminate 15-20 minutes of the office visit, which is a great bonus and encourages repeat business.

Conclusion- make sure to purchase a software suite (Practice management and documentation) that improves your bottom line!

Ditch, Switch and Migrate!

This article has many interesting statistics on the demand of the provider to find an EHR that works for them.  When and if you switch-we advise you have a "Migration Plan" carefully created with your new vendor to avoid starting from ground zero. 

 

EHR users ditching systems, trading up - Dissatisfaction with current EHR systems have many providers turning to new vendors 

Erin McCann is Associate Editor at Healthcare IT News. She covers physician practices, ambulatory care and social media in healthcare. Follow Erin on Twitter @EMcCannHITN

2013 has been billed as the year of EHR dissatisfaction, with up to 23 percent of physician practices reporting they were trading in their current EHR system for a new brand altogether, and, according to a new Black Book Rankings report, there were only a handful of vendors that came out on top. 

 

The survey finds that providers switching to new EHR systems were turning to Practice Fusion, Care360 Quest, Vitera, Cerner, Greenway, ChartLogic, GE Healthcare and athenahealth — all vendors who have risen to the top of the replacement market satisfaction polls, officials note.  

 

"Regularly, at least two of these eight vendors were on the short lists of 88 percent of the current replacement market buyers surveyed," said Doug Brown, managing Partner of Black Book, in a news release. 

Seven others — Allscripts, AmazingCharts, eClinicalWorks, Kareo, McKesson and NextGen — also received top rankings in six of seven 2013 Black Book client experience surveys, Black Book officials note. 

 

"EHR system shifters now position to reallocate more than $5 billion in sales as the unstable vendor marketplace begins to get agitated," said Doug Brown, managing partner of Black Book, in a news release. 

 

Eighty-one percent of survey respondents who indicated they were ditching their current systems said they were on track to replace their EHR within the next year; some 11 percent said they were unsure, according to the report. 

 

The study is a follow-up assessment on the status of electronic health record users, all of which indicated deal-breaking dissatisfaction with the current vendors.

 

EHR users polled in the original survey had cited numerous cases of software vendors underperforming enough to lose crucial market share, with vendor solutions often struggling to keep up.

 

Most concerning to current EHR users were unmet requests for sophisticated interfaces with other practice programs, complex connectivity and networking schemes, pacing with accountable care progresses and the rapid EHR adoption of mobile devices, the original survey found.

 

Out of those EHR users considering a system switch, 80 percent said the solution does not meet the practices' individual needs; 79 percent indicated that the medical practice had not adequately assessed the group's needs before choosing the EHR; 77 percent of respondents cited solution design as ill-fitted for their medical practice or specialty; and 44 percent said vendors have been unresponsive to requests. 

How Medical Consumers Can Get More “Bang for the Buck”

One of the more interesting interactions between patient and provider occurs when the patient is asked, “What is the problem?”  The patient responds with “You’re the doctor,” or “You’ve got my records.”

This scenario highlights the opportunity the consumer has to achieve their goals in a quick, efficient, and potentially inexpensive way.

What can the patient bring to the interview to help the provider “GET IT RIGHT” the first time.

1. Express your motivation for your visit. Such as:
• I'm worried about a "stroke" or a "heart attack"
• I need a work excuse
• I'm out of meds
• My spouse/relative made me come
• I need a routine check-up
• My concern "runs in the family"
2. Provide a list of medications – best kept in wallet
3. Provide a list of allergies
4. Provide a list of past medical history and surgeries
5. Share what has worked for you in a similar situation
6. Don’t be afraid to say… “After Googling my symptoms, I got concerned about X…”
7. Share your expectations
8. Write a list of questions you have
9. Be straightforward with your goals -- it saves a lot of time and money
10. Reserve the right to say NO THANK You—I just wanted an educated opinion not a lot of tests and consultants.

All that said - and going back to our brief introduction of “you’re the doctor” -  what if you really don’t know.  That is, perhaps something is indeed bothering you, something is not right, but you cannot put your finger on it. 

Don’t be embarrassed.  

Doctor’s love these sorts of challenges, but they need to work alongside you to be effective at discerning the issues.  Just say it that way.  “Something is bothering me, something is wrong Doc, but I cannot put my finger on it.”  Then, you and the doctor can work together to figure it out.  And both of you feel like you have a partner in the discovery process.