medical practice management Articles - Medical Practice Trends

IT Services for Your Practice – In-House or Outsource?

April 4, 2012 By Peter Polack 1 Comment

Previously I wrote about outsourcing your IT services support as well as how to hire an IT director. But one question that I am commonly asked is, “How do I decide whether to keep IT services in-house or whether they should be out-sourced?”

Electronic medical records systems have become an integral part of the practice of medicine and having someone with IT expertise in your corner is no longer a luxury but a necessity. But for most medical practices, this decision is strictly a monetary one. Still, there are more issues to consider than just budget.

Why you should have IT in-house

You are completely clueless about technology and need someone at your beck and call
You want someone with particular expertise in your specific EMR software
You want someone who has specific knowledge of your medical specialty
The physicians in your practice want their daily IT needs handled on an expeditious basis
Your practice can afford to pay a market salary and benefits for a full-time IT person

Why you should outsource IT services

You cannot afford to hire a full-time IT person
You have a small practice and you consider yourself ‘tech-savvy’
You are using a web-based EMR system and have a minimal IT infrastructure
You need or require 24/7 support
The complexity of your practice demands redundancy in the support services
There is a large volume of basic, mundane tasks that have to be handled on a daily basis

Why you should do both

Another option to consider: the hybrid model. Whether you decide to out-source IT services or bring in your own full-time person, a concern in either case is the transfer of knowledge. If you have a full-time IT employee, that person’s fund of knowledge – about your practice, about your EMR system, about your processes – walks out the door with him or her. Even if they are meticulous about documenting all of their processes, this can still be a devastating loss. While this risk can be lessened with an out-source firm, there is still the potential for loss if their services are terminated and you have to hire another firm.

By having both, you could build in enough redundancies that your practice can be protected in the event of a staffing change. The out-sourcing can provide around-the-clock monitoring of your IT infrastructure and handle basic, day-to-day operational issues such as computer trouble-shooting, password resets, and printer repairs. Your IT employee can oversee the out-sourcing firm while at the same time looking out for the best interests of the practice, providing physicians with prompt, personalized attention, and concentrating his or her efforts on more specialized work such as EMR templates, Meaningful Use issues, and the like.

Medical Practice Trends Podcast 38: Saving Money on Medical Practice Office Expenses

March 27, 2012 By Peter Polack Leave a Comment

MPT Podcast 37 - Saving Money on Medical Practice Office Expenses, from 101 Ideas to Increase Revenue & Decrease Costs – Part 4, with guest Mary Pat Whaley of ManageMyPractice.com. Ms. Whaley shares more of her many suggestions for increasing profit for your medical practice.

This Issue (8:29):

Are the Yellow Pages an expensive dinosaur?
Could your postage machine encourage petty theft?
What are group purchasing entities?
Why office supplies may be sneaking out your back door

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Medical Practice Trends Podcast 37: Getting a Handle on Your Staff Expenses

March 8, 2012 By Peter Polack Leave a Comment

MPT Podcast 37 - Getting a Handle on Your Staff Expenses, from 101 Ideas to Increase Revenue & Decrease Costs – Part 3, with guest Mary Pat Whaley of ManageMyPractice.com. Ms. Whaley shares more of her many suggestions for increasing profit for your medical practice.

This Issue (6:55):

How can you reduce overtime abuse?
Should you send staff home when things are slow?
How using volunteers can be a good recruiting tool

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Running Your Practice Like a Business

February 28, 2012 By Peter Polack 1 Comment

Yes, your practice is a business. And your patients are like customers. Some colleagues don’t like to use terms like ‘customers’ when they are talking about patients, but that is exactly how you need to treat them if you want to have a growing, thriving business.

This is particularly true if you are just starting in your own solo practice or have joined a group and need to build your own practice within it.

I have always said that one of the best ways to learn about running a business is to take the best ideas from other industries outside of your own, in this case medicine. Read business magazines, management books, consulting blogs; study retail advertising, newspaper layouts, tabloid headlines; talk to business owners who have been successful.

One resource I have used over the past several years is Dan Kennedy’s GKIC world of marketing and business books, newsletters, and conferences. Every imaginable type of business is represented there. He says he has a plaque on his office wall that mocks everyone that doesn’t think his principles apply to them: “But My Business Is Different!”

If you want to get a taste of what his followers get from his words of wisdom, CLICK HERE for a video where he explains why it is important to be spending a significant portion of your time developing new customers or leads (this means patients to you).

Obviously if you are in a group practice, you would have an administrator or even a marketing director dedicated to this activity. But if you are new to the practice of medicine, then the onus is on you. Yes, some of this content is a little over-the-top and is aimed primarily at people in a variety of businesses outside of medicine, but there are always some great pointers that you can adapt specifically to your situation.

CLICK HERE for the Dan Kennedy video on building a business even in a tough economy.

Paperless Registration – What You Need To Know

February 13, 2012 By Peter Polack Leave a Comment

Guest Post, William McClain, MBA

If you are a practicing physician today, your world is being buffeted and reshaped by a dizzying confluence of disparate external forces. The federal push for EMR adoption, HIPAA security rules, practice needs for greater operating efficiency and productivity, “retail consumerism”, increasing market competition and the steady advance of medical and information technology are just a few of the influences changing the profession as you know it. Practicing the noble calling of medicine has never been more complex or challenging.

These forces of change touch virtually every aspect of how your practice operates, including how patient information is captured, entered, stored and exchanged. The combination of federally mandated security rules, Meaningful Use requirements, the need for greater productivity, efficiency and patient convenience, plus innovative new software technologies is now making the age-old clipboard and paper registration process a dinosaur. Add to that list the fact that 90 million e-consumers in our country are projected to be tablet users in the next two years, as reported by eMarketer.com.

So what does all of this “background noise” mean for you and your practice? Clearly, there are compelling, manifold reasons for migrating your practice from the risk-laden and inefficient pen and paper registration process to a secure, integrated electronic solution.

Paperless registration can provide substantial benefits, including: secure and exchangeable patient information; elimination of costly, redundant and error prone data re-entry; HIPAA-compliance; and enhanced patient convenience for initial registration and periodic updates.

Virtually all paperless registration software programs offer benefits for your practice. However, it is important to understand that not all paperless systems are created equal. Your evaluation of the software options available today should be as evidence based as your clinical decision making.

When you consider a paperless registration system for your practice, be sure to look for key “differentiators” that will optimize functionality and value to you, your staff and your patients.

Below are some important attributes you should look for:

Is the software “system agnostic”, i.e. can it interface seamlessly with any existing electronic medical record (EMR) system, or are you forever tied to a single EMR product?
Is the software totally customizable to your practice, i.e. can it precisely replicate the paper registration forms you use now, or must you and your staff change your normal processes to accommodate the software’s “cookie cutter” template?
Does the software provide your patients with the convenience of secure off-site registration from home, office or laptop to reduce their time in the waiting room?
Is the registration software internet independent, i.e. can it continue to function smoothly during internet failures, or does it fail when your internet service fails?
Does the software provide secure data encryption both at rest and in flight, i.e. while stored and while being transmitted or exchanged?
And finally, does the software provide additional functionality that can add value to your practice and your patients, such as in-office flat screen messaging to your patients and revenue-generating promotional capabilities to attract paid advertising by commercial interests such as pharmaceutical companies, retail drug stores and home medical equipment providers?

The clipboard and paper registration process is outdated, and will inevitably be replaced by more streamlined and cost-effective and secure paperless systems. Therefore, it is essential to conduct appropriate due diligence to make the best decisions for your practice and your patients going forward. Hopefully, the ideas offered here will help you to frame your evaluation process most effectively.

(William McClain, MBA, is in Marketing & Corporate Relations for DigitalPatient™, Inc. , a Dallas-Ft Worth practice-centered medical software company dedicated to providing effective, cost-saving solutions for today’s medical providers. For more information go to Digital-Patient.com)

Medical Practice Trends Podcast 35: 101 Ideas to Increase Revenue & Decrease Costs Part 2

January 24, 2012 By Peter Polack 1 Comment

MPT Podcast 35 - 101 Ideas to Increase Revenue & Decrease Costs Part 2, with guest Mary Pat Whaley of ManageMyPractice.com. Ms. Whaley shares more of her many suggestions for increasing profit for your medical practice.

This Issue (7:30):

Some useful tips on obtaining Meaningful Use incentives
Why you shouldn’t purchase an EMR just for the incentives
How do PQRI and E-Prescribing come into play?
Are there any other financial incentives or grants you can qualify for?

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EMR – Is It Worth It?

January 17, 2012 By Peter Polack 1 Comment

If you comb through the blogosphere on the topic of electronic medical records, you may find a surprising amount of negative commentary. And if you mention the financial incentives for meaningful use implementation, things get downright testy: anti-government sentiment, conspiracy theories, and a call to resist the temptation to go paperless. They site studies that show that EMR has failed to improve practice efficiencies or control costs, as well as high failure rates leading to many doctors losing money. Why all the controversy now?

I think what we are experiencing is the high middle of the market adoption curve of these systems. There are many early adopter practices that have been successfully using EMR for years but now we are starting to see the more conservative and skeptical practitioners jump into the game, with very mixed results: failed implementations and abandonment, multiple purchases leading to significant write-offs, or incomplete implementations which are barely limping along. The culprit, according to these unfortunate practices, is conveniently the software itself.

But the high failure rate of EMR system implementation (30-50% in most studies) is not so much a reflection of the technology as a lack of knowledge of basic change management on the part of physicians. We don’t learn anything about business in medical school and we certainly don’t learn how to integrate complex technologies such as EMR into a small business. But it is a people management issue not a tool management one.

I disagree that EMR systems are by definition inefficient and that they don’t improve productivity. We have not found this to be the case in our own practice after 3 1/2 years of EMR use – and we have only begun to realize its full potential. But what most practices don’t realize is that it is just part of an overall sea-change in the way you practice medicine. Even the best EMR system cannot fix poor workflow processes – if anything, it will make them more obvious. Our EMR implementation was planned for 3 years before we went live and the software wasn’t chosen until half way through this process. Most doctors run out and buy the first EMR they fall in love with and then make their administrator try to implement it in three months – this is like buying a new tool and then trying to figure out how to use it.

Some feel that the financial incentives from the government, with complicity on the part of insurance companies, will ultimately prove to be a clever way of controlling physicians through the lens of promoting ‘better’ healthcare delivery. And true, any time that the government and private carriers agree on something, you have to pause and think. Rather than having to cull through stacks of paper charts, auditors can now make you upload your entire file set for their bots to search through.

But EMR systems are here to stay. Electronic practice management systems replaced paper scheduler and pegboard ledger books and paper medical records will soon be a thing of the past. Physicians can be resistant and be dragged kicking and screaming into the 21st Century. Or they can get educated and informed, perform their due diligence, and realize that this will be the most expensive and difficult thing they will have to do in their career – besides raising kids.

Medical Practice Trends Podcast 34: Process or Technology – What Provides The Most Bang For The Buck?

January 10, 2012 By Peter Polack 1 Comment

MPT Podcast 34 - Process or Technology – What Provides the Most Bang for the Buck?, with guest Mike Meikle of Hawkthorne Group Consulting

This Issue (6:55):

Can technology trump poor processes?
How critical is the human factor?
Should you adapt to your EMR or should it adapt to you?
Why your security plan might be more important than the tools you choose

Click the play button to hear the podcast

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Doctors Going Broke

January 6, 2012 By Peter Polack 1 Comment

Although most of us in medicine know the struggles of running a private practice, it is still disconcerting – albeit not surprising – to hear that some doctors are having to file for bankruptcy.

In an article on CNNMoney.com, some physicians talk about having to get business loans or use personal funds to keep their practices afloat. In some cases it is a matter of sudden changes in reimbursement policy, such as cuts in oncology pharmaceuticals; in others, it is the slow death of decreased revenue in the face of increasing costs.

For the rest of practices that are in a somewhat better situation, the annual drama in Washington DC over Medicare reimbursement has led to a paralysis in strategic planning of any kind. Doctors cannot plan for growth, for expansion, or for investment in new technology with the spectre of 30% fee cuts constantly looming over their heads.

Debunking The 7 Myths of Concierge Medicine

January 2, 2012 By Peter Polack Leave a Comment

Guest Post, John T. Kihm MD

Myths abound concerning concierge medicine (CM). Unfortunately these myths prevent good doctors from converting their practices to CM. Let’s look at those myths—maybe you need to work on yourself and your own beliefs. If you practice quality medicine your patients will value you and your work and will pay a fee to join your CM practice. CM is a value story. If you provide solid value, you needn’t believe these myths–value trumps myth.

The myths:

My patients are not wealthy/can’t afford CM. I have a lot of Medicare/Medicaid patients.
My patients will not like this concierge idea.
My patients can’t do without me.
I have bad practice demographics. I am rural. My patients are too old. My patients are too young.
24/7 coverage sounds too hard.
Is this legal? What are the ethics?
The conversion process will overwhelm me.

My patients are not wealthy. If your patients value you and your work, you can devise an affordable program. Patients will find the money to keep you if they value you. Be creative with pricing if necessary. You can make it work. Amazingly, I have patients who live in housing projects who joyfully belong to my practice because they see the value. Conversely, all of us in CM practice have wealthy patients who say the fee is too high, do not see the value, and do not join. Patient income generally does not predict CM success or failure. Perceived value predicts success. Focus on value and the rest will follow

My patients will not like this concierge idea. Do not project onto patients negative beliefs, as those beliefs may become unnecessary self-fulfilling prophecies. Patients’ enthusiasm will mirror your own. Patients possess a survival instinct and will recognize your opportunity for better care, along with your belief in providing that care. Moral: be enthusiastic! Believe in yourself and your patients will follow. Above all, emphasize value and opportunity in your CM practice.

My patients can’t do without me. Primary care doctors are famously codependent. Get over it. Patients not seeing the value in your practice can and will vote with their feet. You do not decide who can live with or without you—patients decide. Patients who truly “can’t live without me” will see the value and stay with you. There is nothing unethical about letting patients decide who they need. Do not project your own needs onto your patients. Patients who do not wish to stay with you are responsible for their own lives. Let go of your codependency.

I have bad practice demographics. You can overcome demographic obstacles by providing great value to your patients. Patients of all stripes, ages, and locations will stay with you if you take excellent care of them. For example, farmers in my practice understand, respect and value hard work. All of my farmer patients signed my contract. The elderly do tend to value their care more that the youthful, but the health-conscious young will sign-up as well. Meet demographic challenges by making sure your patients see value.

24/7 coverage sounds too hard. 24/7 sounds impressive, and it does demonstrate value. Taking call has never been easier for me. First, with fewer patients in the practice, the calls decrease in proportion to number of patients. Second, the very patients who respect and value me enough to contract with me demonstrate discretion in calling after hours. Mutual respect is the norm in CM. Inappropriate calls come few and far between, so 24/7 call is not hard.

Is this legal? What are the ethics? Concierge medicine is legal and is ethical. In CM, you provide a service for which patients pay. If you elect to file insurance, your CM practice needs to provide a non-covered service. Some argue that by charging a fee, you limit access to patients, hence CM is not ethical. Your response should be, “I need to see fewer patients to practice a high level of care. I cannot take care of all patients who need a doctor. It is not my responsibility to see all patients or attempt to cure all of society’s ills. I just focus on my own patients.” Explain this truth to your patients. They will understand you. It is ethical for you to stay alive and in business by practicing concierge medicine.

Conversion process will overwhelm me. Conversion to a concierge practice is do-able, and challenging. You have one chance to do it right. We do not recommend going it alone. Conversion need not be overwhelming. Simply ask for help.

If you know in your heart that you need a better alternative than hamster treadmill high volume medical practice, consider concierge medicine. Do not shoot-down CM based on any of the above myths. Focus on value. If you can provide value to your patients and if you want a better life for your patients and yourself, bust these myths and get going. Contact us, we can help.

Dr. John T. Kihm blogs on ConciergeMedicineDirect.com – the original article can be read at Debunking the 7 Myths of Concierge Medicine