• What to do with all of those paper forms
• Don’t reinvent the wheel - stay up-to-date with your EMR software’s updates
• The structure of your training process and implementation rollout

Ask Bob where we try to stump our seasoned practice administrator - what if a star employee shows up wearing a tongue ring?

Preview of our upcoming Expert Teleseminar Series - DIsaster Recovery & Business Continuity Planning

This Issue (length 11:20)

(click on the Play Now link below then the play button or Download the file. You can also right-click on the AudioMP3 button to save to your computer)

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A recent blog on ZDNet mentions a survey of Dutch citizens who are generally happy with their form of health care, which is primarily a government-sponsored system with some private carriers (similar to the system implemented in Massachusetts). All people are required to carry insurance, in some cases with government subsidies, relieving employers of the burden of insuring their employees. This is paid in large part by higher taxes, which are skewed more towards the wealthier citizens (read owners of same businesses).

The term “socialized medicine” has a relatively negative connotation among physicians here, although many experts will note that Medicare is just that - and in most cases, it is the best-paying insurance carrier. Some doctors are dropping managed care plans altogether and accepting only Medicare. They find that the initial drop in revenue is followed by increased profitability (less staff needed for pre-authorization) and decreased stress levels.

Meanwhile, the total U.S. expenditure on health care last year was $2.3 trillion. By the way, about 1/1000 of that goes to pay the salaries of the top ten insurance carriers’ CEOs - yes, ten individuals (from the 2007 New York State Ophthalmological Society Meeting).

How long can the system continue on its present course? As we see the government trying to parse out coverage to middleman entities (Medicare advantage plans, etc), who probably are going to “save” money by squeezing physicians, it gives us cause for being wary. On the flip side, we need only look across the Atlantic to see what true socialized medicine can become.

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Sean Teare is president of InnovationRx, a Massachusetts-based unit of a British company which aims both to cut the cost of nagging people to take their meds and improve the rate at which they do.

Will this new service work?

As to their business model, “We’re a subset of disease management. If you don’t improve adherence you can lose the impact of other changes. Health plans are looking for short term ROI, and we can show that.”

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Someone (a Fox News follower) said, “There must have been a reason that those senators voted against it.” Well, yes, apparently there was. It seems that without those cuts to physicians the cuts would have been to Medicare Advantage programs, and this would affect “seniors’ access to privatized health care.” After all, we don’t want “socialized health care”, do we? [Note: Socialized health care = Medicare]

This is another example of why physicians should be careful about blindly voting along party lines. Neither of the major parties is necessarily going to do what is in the best interests of the practice of medicine.

So, in effort to control runaway health care costs, the government wants to “privatize” Medicare by paying Medicare Advantage plans a premium to manage costs by cutting physician reimbursement. That makes a lot of sense.

And just to give you an idea of what these companies are like to deal with, let me tell you about one dirty tactic in particular: the Health Plan Update.

(First let me preface this by saying that we use a consultant to negotiate all of our managed care contracts - and if you email me I can give you the info - and even he was surprised by this method)

The health plan company will send you a Health Plan Update which may state that your new reimbursement will be 10 or 20% less than what it states in your contract. At the bottom of the letter it reads: If you do not submit in writing your objections to the plan update [within 30 days], you are essentially agreeing to the proposed action.

The real dirty part is that this letter can be addressed to the practice, one of the doctors (looks like junk mail), the administrator, or the business office. So if the letter is accidentally thrown away, you just approved a cut in your reimbursement schedule - Congratulations!

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If you don’t think do-it-yourself electronic health records is going to be big in the near future, take note that none other than Google and Microsoft are getting into the act. True, they currently offer free resources for consumers but already there are companies looking for ways to make a buck off of the EHR industry.

Medical practices in competitive niches may want to consider some type of portal, either as part of their EMR system or in conjunction with their website, in order to communicate more effectively with their patients. This could be anything from offering email communication with physicians to allowing patients to access their medical records, just like Google.

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Another drawback to this type of system is that the staff needs to keep track of multiple phone numbers - this can get chaotic when you start adding multiple locations. If you needed to get hold of a particular doctor, for example, first you would need to find out where he or she is working that particular day and time. Then you would have to figure out which phone number to call. We have laminated cards that have all of the phone numbers we need to know. These “little” cards were getting quite large.

Fast forward to today. We now have five locations including an ambulatory surgery center and about 140 employees. Our newest location is a completely remodeled building which houses a clinic, our administrative offices, our call center, and our information technology department. So when it came time to choose a phone system for the new building, continuing to add more individual telephone lines was not going to be the right solution in the long run.

But before I tell you what system we chose and why, let’s discuss how you can decide what phone system is best for your needs, for today and the foreseeable future. First, start with a plan. A little forethought and answering a few simple questions will help you to select both the correct phone service (where the dial tone is coming from) and the correct phone system.

• How many people and devices at each location need to be on the phone at one time? Don’t forget to include your fax machines, modems, credit card machines, postage machine, security system and fire alarm systems.

• How many calls at each location do you need to receive at one time?

• How many phone numbers, both public and internal, do you need?

• How many physical phones do you need at each location?

• Do you need call accounting? (The ability to track and report on incoming and outgoing calls)

• Do you have a call center for patient appointment scheduling? If so, do you need contact center features, like ACD (automated call distribution) and operator reporting/monitoring?

• Which features are important to your business? Transferring a call to another location? Caller ID, both inbound and outbound? Voicemail? Call forwarding, probably to an answering service?

In Part 2, I’ll show you how to use the answers to these questions to select the phone service and phone system that’s right for you.

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I have always said that if somebody puts the word “Doctor” before his or her name on a sign or business card, it indicates that this person is not a medical doctor (or as one of my partners puts it, not an R.D. or Real Doctor). Conversely, when I first came to town, my medical colleagues cautioned me against telling contractors that I was a physician lest I incur the ‘medical tax’ - doctors are routinely up-charged since “they can afford it.”

Oh, and early in my medical career (not that I’m that old, mind you) I would inwardly feel slighted if I were not addressed as Doctor. But over time, I found that in most situations it is far less complicated not to let on that you’re a physician - you know, solicitations for different causes, spontaneous curb-side consults, etc. But heaven forbid if you don’t call a psychologist, or a chiropractor, or an optometrist “Doctor Jones”.

More ominous, however, than the mere name game is constant legislation to allow pseudo-professionals to perform beyond their scope-of-practice. Here in Florida it is a perpetual battle. So now there is a bill coming up for debate that would allow optometrists (sorry, “Board Certified Optometric Physicians”) to inject medications into the eye. Yes, intravitreal injections for the treatment of wet age-related macular degeneration. After all, pharmacists are now allowed to give flu shots, so a “shot in the eye” is no different, right.

Now, many insiders don’t really think that optometrists really want to specifically perform intravitreal injections, what with all the hassles associated with a sterile procedure like that. But perhaps they would be willing to settle for something less invasive like, say, laser vision correction - lasers are, after all, “just lights”.

If experts are correct about the failure of medical training programs to keep pace with the future needs of this country for physicians, then perhaps this is the shape of things to come. And when we are older and joking about getting our “pipes” cleaned out, it won’t be by a cardiothoracic surgeon but by a plumber.

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Nevertheless, an article on Software Advice offers some more reasons to consider making the switch to paperless, including

1. Savings on chart pulling costs. Several studies have calculated that it can cost as much as $4 to pull or create a paper chart. Beth Israel Hospital in Boston estimates it can save as much as $6 million annually.
2. Reduction in malpractice insurance premiums. For example, Midwest Medical Insurance Company is offering its clients a 2-5% credit for using an EMR system.
3. Enhance reimbursement by eliminating downcoding. Since most physicians aren’t especially confident about coding visits, most will err on the side of under-billing. EMR templates can help justify proper coding – the difference can be significant.
4. Pay for Performance (P4P), or as we like to call it, “Performance for Pay”. Physicians can get a bonus for submitting quality-control guidelines for managing certain chronic diseases. EMR systems can help streamline the process and ensure these guidelines are met.
5. Subsidizing of EMR systems. Depending on your specialty and location, local hospitals or labs may be willing to subsidize a significant portion of the implementation costs associated with EMR. In addition, this relationship has been given an exemption from Stark and anti-kickback legislation.

So, if you happen to be the evangelist for the adoption of EMR for your practice, it helps to be armed with some useful information when confronting the naysayers.

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According to a study by executive search firm Korn/Ferry International, one of the most common mistakes that executives make when joining a company or making changes is failing to properly read the existing corporate or office culture. An example would be a control-oriented manager coming into a company with a collaborative culture, leading to tension and resistance.

Taking time to properly plan a project and making minor tweaks along the way can help to avoid having to pull the plug completely on an EMR system, often with significant financial consequences for a practice. This is also important in the planning of the computer network which will be used in the office, regardless of which software is used.

A useful tool to employ in making any significant transition is the concept of change management, which is essentially making changes in a planned and systematic fashion. The following 10 principles of change management can be adapted to the implementation of an EMR system.

1. Address the Human Side - Jobs will change and there will be anxiety. If employees don’t “buy in” to a new system it will probably fail.

2. Start at the top -It’s important for key staff, including the physicians and administration, to be on board. A physician “champion” is needed — one of the doctors with a strong commitment to see the project through to the end, preferably someone facile with technology but realistic and not overly optimistic.

3. Involve every layer - Everyone needs to feel that his or her contribution is important. Form a committee of employees to evaluate different systems and let them make proposals to the physicians. These should be people who will be using the system: administration, business office, and medical assistants.

4. Make the formal case - People will always question the need for change. Have a written vision statement. You need to be able to explain to the organization the what, how, and why this process is taking place. Prove that an EMR system is better than the existing paper process or else it won’t be used.

5. Create ownership - Appoint leaders who will have ownership of the project: they have more credibility with their subordinates than the doctor. Train these core people and then use them to train the rest of the practice.

6. Communicate the message - Keep channels open. Encourage constant feedback. Lay out a plan and sequence of action. Keep staff informed and involved in the process.

7. Assess the cultural landscape - Identify core values, beliefs, perceptions, and sources of resistance. People get set in their ways: the employee who doesn’t know how to use a mouse or the doctor who can’t check e-mail.

8. Address culture explicitly - Take baby steps if necessary. People should gradually learn to use a computer, a mouse, e-mail, and more sophisticated programs like practice management software (EPM), then finally EMR. Keep less enthusiastic physicians involved, otherwise they’ll be resistant.

9. Prepare for the unexpected - There will be problems. Hurricanes Charley, Frances and Jeanne resulted in a changing target for our “go live” date of conversion to the new system, with significant ripple effects which were manageable because of proper planning and flexibility by our EMR committee.

10. Speak to the individual - Be clear in what is expected of each person. Be confident, but not unrealistic - allay employees’ fears, particularly when there are problems.

Many “failures” of EMR systems have as much to do with poor planning and implementation as with deficiencies in the software itself. This is especially true when it comes to the changes that occur on the human side. Planning how a new EMR system will integrate within a specific practice before actually installing the software will be time well spent and, ultimately, will benefit the bottom line.

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Many educated people confuse marketing and advertising, so it is important to distinguish the two. We all know what advertising is: billboards, magazine ads, radio or tv commercials, etc. But this is just a part of marketing. According to the American Marketing Association, marketing is defined as “the process of planning and executing the conception, pricing, promotion, and distribution of ideas, goods, services, organizations, and events to create and maintain relationships that will satisfy individual and organizational objectives. ” But what does that really mean?

Effective marketing should make the process of “selling” to a customer redundant. Effective marketing compels the customer to desire your product. Really effective marketing can sell a product without the “sales pitch.”

Marketing is everything that comprises the messages that your practice puts out: your advertising message, the local reputation of the practice, the training of the physicians, the practice slogan or tag-line, brochures or pamphlets, etc. These types of things, known as “external marketing” are obvious.

But what about the more subtle things known as internal marketing? The physical condition of your building, how friendly the staff answering the phones are, how clean the waiting room is, etc. These factors can have as much of an impact on your practice as advertising.

John Pinto, a leading ophthalmic practice management consultant, refers to this as the “coffee stain” syndrome. If you saw a coffee stain on the rug of your doctor’s office the first time you visited, you would probably give him a pass. But if it was still there on subsequent visits, you may think twice about letting him perform a procedure on you (”if he doesn’t keep his rugs clean, maybe he never washes his hands”).

So, now that we have established what marketing is, let’s turn our attention back to the original issue: should you cut back on marketing when the going gets tough, or ratchet things up a notch? Is there any evidence to support either case?

There are actually several studies, including some from Penn State’s College of Business and McGraw-Hill Research, that have shown that businesses that maintain or even increase their marketing efforts during a recession are rewarded with significantly more business when the economy improves compared to their cohorts. There is also a corresponding increase in market share.

This doesn’t necessarily mean that your medical practice should start running television commercials day and night. But there are many cost-effective ways to get the word out about your business, such as health fairs, direct-mail promotions, community lectures given by the physicians, or hand-delivering welcome packages to new physicians who may be referral sources, to name a few.

Now, stop feeling sorry for yourself and get out there!

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