Medical Industry News

A keystroke or two opens the door to hundreds of sites on many practice areas - a generous representation of what today's practitioners need to know. Regardless of the specialization, these sections offer in-depth industry info, news, technical support and business tools geared to keeping physicians professionals conversant and current in their disciplines.

• How to Choose Medical Software
  

  By Adam Uzialko

  Finding the right medical software – both electronic medical records (EMR) systems and medical practice management software – is an important task for every healthcare organization. For new practice owners, considering the options can be difficult, especially based on the number of medical software vendors out there.

  Medical practice management software not only includes your scheduling tools, which govern how you organize your patient appointments and keep track of which providers are booked at what times, but also helps your staff manage your billing cycle. EMR systems cover the clinical side of the house, allowing providers to document patient encounters, prescribe medication, order lab tests and review medical history.

  To ensure your practice is successful, it’s critical to choose the best software for your staff and workflow. In this guide, we’ll examine what practice management systems do and walk you through the decision-making process.

  What is medical practice management software?

  Medical practice management software is designed to help medical facilities run more efficiently. It’s a technology solution that can be used for scheduling appointments, tracking appointment times, managing billing cycles and organizing patient information.

  Medical practice management software is an essential component of any modern medical facility, as it allows healthcare organizations to stay organized and ensure high-level patient care. By consolidating all information related to patients and doctors into a single platform, medical professionals can easily navigate important details about patients and other information. Without this software, organizing any medical practice would be labor-intensive and subject to significant human error.

  Key takeaway: Medical practice management software covers all the administrative tasks a healthcare organization requires.

  What are the top features of medical practice management software?

  Intuitive and effective practice management software is essential to a practice’s workflow. These are some features to look out for and why they’re important.

  Patient information tracking

  The most basic and arguably most important feature for medical practice management software is the ability to maintain up-to-date information on patients, including medical history, family history, medications, allergies and recent lab results.

  You can also use medical practice management software to verify the status of a patient’s insurance, confirming whether it is still active and estimating copayments, out-of-pocket expenses, and prior authorizations.

  Most medical practice management software includes a calendar tool that allows front-office staff to schedule patients by location and provider, making it quick and easy to review patient information prior to a visit.

  Centralized billing

  Good medical practice management software will allow you to process payments and record billing history all on one platform with built-in credit card processing capabilities. Front-office staff can capture out-of-pocket expenses upfront when a patient arrives for an appointment, and back-office staff can code claims for reimbursement and submit them to payers (such as insurance companies), managing those that are denied or rejected.

  Reports

  Clinicians and other medical professionals need patient data to be effective at their jobs. Medical practice management software allows you to generate important reports on your patients for other doctors. This can improve patient care and ensure your practice gives patients and doctors accurate, useful information.

  Similarly, medical practice management software should be able to generate financial reports that help you track the profitability of your business. These reports include information like accounts receivable (A/R), the days claims spend in A/R, and total reimbursements versus expected reimbursements.

  Key takeaway: Medical practice management software covers patient information tracking, billing and reporting, which are all key functions of running a healthcare business.

  Why do you need medical practice management software?

  The first step in selecting practice management software is understanding what roles you need it to play. Here are a few of the benefits of having the software.

  Coordinated operations

  Medical practice management software allows you to coordinate vital financial and logistical aspects of your practice, including scheduling, billing and financial analysis. Handling each of these functions in one piece of software helps your staff become nimbler and more organized.

  Automation and efficiency

  Medical practice management software expedites tasks that could otherwise slow down your day-to-day operations. For example, a patient portal takes some of the burden off of your front desk, allowing patients to request appointments and fill out forms online. Appointment reminders reduce the number of no-shows, and insurance eligibility verification ensures a patient is covered for a provider’s services before they arrive. The system that best matches your specialty and workflow will play a big role in your clinical and financial success.

  Integration with EMR systems

  Medical practice management software and electronic health records (EHR) systems, which cover clinical operations, should work together seamlessly. These two components of your practice’s healthcare IT suite need to share a great deal of data, which is why many practice management software companies offer built-in electronic medical record (EMR) solutions.

  Billing and financial analysis

  If you decide to keep your billing in-house instead of outsourcing it to a medical billing service, your practice management system will help ensure your claims are submitted to payers (such as insurance companies or Medicare) in a timely and proper manner. In tandem with a diligent staff, medical practice management systems can increase the number of claims that are accepted by payers on the first pass, quickly collecting reimbursements for services rendered.

  Staff members can also use the software to respond to denials and rejections, generate financial reports, and pull data to analyze your practice’s fiscal health. (Note that you’ll also need a certified medical coder on staff if you intend to bill through your medical practice management system, especially with the recent change to ICD-10 and upcoming change to ICD-11 coding standards.)

  Patient communication

  A medical practice management system can also be a tool to generate and send patients their balance statements and to predetermine whether patients will owe anything out of pocket before their appointment, making it easier to collect payments at the point of care. Engaging patients and granting them influence in their healthcare is not only a priority in the evolving healthcare industry, it also makes for a better patient experience overall.

  Additionally, patients can communicate directly with the practice and providers through a secure patient portal, many of which offer telemedicine capabilities. Patients can update their information in the portal, including their address, insurance information and preferred pharmacy. Practice staff can review and accept these changes prior to the patient’s next appointment.

  Key takeaway: Medical practice management software helps coordinate administrative operations, keep patients engaged with the practice and ensure the practice’s financial performance is meeting expectations.

  EMR systems vs. medical practice management software

  Electronic health records (EHR) systems, also known as electronic medical records (EMR) systems, are clinical software tools that help providers capture notes during a patient visit, prescribe medications, order lab tests, generate superbills that can be turned into claims by the billing team and monitor patient medical histories. They are distinct from but related to medical practice management software; these two types of software are typically integrated as a unified healthcare IT platform.

  It is best to think about medical practice management software as the administrative tool for a healthcare organization, covering front-office tasks like setting appointments, verifying insurance eligibility, and updating patient demographics, as well as back-office tasks like medical coding and billing. In the middle is the EMR system, which communicates with the practice management software to display provider schedules and information about patients prior to a clinical encounter.

  During the encounter, a clinician documents information about the patient and any diagnoses. Once the clinical documentation is complete and the patient encounter ends, the EMR system feeds that data back into the medical practice management software, allowing coders and billers to go to work.

  Most healthcare organizations require both medical practice management software and an EMR system, and many vendors sell these software solutions as a package. Generally, the best option is to use unified EMR and medical practice management software from the same vendor, as these solutions are guaranteed to work well with one another. It is possible to connect software from different vendors via API, but this is only recommended in unique circumstances. See Business News Daily’s best picks page for more information about the best EMR systems and medical practice management software.

  Key takeaway: EMR systems work in tandem with medical practice management software to support clinical operations and track patients’ medical histories over time.

  How to choose medical software

  While physicians rarely need to interact with their medical practice management software directly, it is an indispensable daily partner for staff members. Between engaging with patients and supporting your revenue cycle, the medical practice management system you choose plays a large role in the success or failure of your practice. When selecting medical practice management software, you should keep several important factors in mind.

  Cost

  The cost of any practice management system is highly variable depending on your needs, the features you select and the size of your practice. There are often hidden costs and optional features that could quickly increase the base price.

  Generally, a unified medical practice management software and EMR system costs between $300 and $1,000 per provider per month, not including any setup fees, implementation costs or add-on feature fees. Some vendors include everything in a monthly subscription, while others offer a la carte menus of certain features or tiered pricing plans.

  Go into the conversation with the vendor knowing what you need and what you don’t. Your top priority through this process should be to obtain a written list of which features you will be getting for exactly what cost before you agree to partner with any vendor. Without clear, written confirmation, it can be tough to know what’s included in the regular price and what costs extra, and you might end up paying an additional fee for a feature you could live without.

  Ease of use

  Implementing a new system and adapting to it is difficult enough as it is, so make sure ahead of time that the people who will be using the new software are comfortable navigating it. Everyone works differently, so consult your staff and include them in the decision-making process. They should at least be moderately comfortable with the system, and, ideally, the vendor will offer you a company representative to guide them through the learning curve.

  Medical software can vary in structure depending on the vendor, so it’s imperative to know what your staff is looking for. For example, some systems use a central dashboard to organize the software’s different features, while others employ a lot of dropdown menus and multiple popup windows. Knowing what is most effective for your practice’s workflow is key to a successful transition. Any new system will naturally slow productivity a bit at first, but it shouldn’t derail your entire practice.

  Experience with specialties

  You’ll also want to ensure that the medical software you choose is widely used within your specialty. There are nuances to different specialties that a general medical system won’t reflect, so you’ll need to know whether the vendor took your specialty into consideration when designing the system. Otherwise, you might end up with a barebones system that is not optimal for the functions you require. A general practitioner’s needs vary greatly from those of a dermatologist, for instance.

  To find out just how well each company performs in that regard, it might be worth reaching out to other physicians you know in your field to ask how they like their practice management software.

  Interfacing

  Another huge consideration for your practice management software should be how well it will interface with the EMR system your practice uses, as well as the medical software used by other healthcare providers your patients visit. Interfacing is the capability of the two systems to communicate with one another and share relevant data.

  Two systems that interface well reduce the time it takes you and your staff to enter and transfer data. If you’re scheduling patients and recording demographic information, that data should automatically be entered into the EHR system when the patient comes in for a visit. Likewise, after a patient has been taken care of, the EHR system should automatically send the practice management system the relevant billing information based on the services provided. This should also apply to your communications with other practices, specialists and hospitals.

  Reporting and data analysis

  You’ll want a medical software system that can create robust reports and analyze data, showing you exactly where your practice stands financially. Simply managing your revenue cycle is not enough for your practice to remain viable; detailed reports and analyses can go a long way in helping you project and even improve your cash flow. For example, you’ll be able to identify which physicians are the most productive for your practice, or what neighborhoods most of your patients come from.

  By identifying what works and what doesn’t, you can keep your practice on a sure-footed path to success and profitability. If your medical software allows you to share those reports with other members of your practice electronically, that’s even better.

  Training

  Even if the system is incredibly easy to use, there will always be a learning curve. Also, consider the varying degrees of technical aptitude among your staff members. When your staff is adapting to a new piece of software, no matter how intuitive it is, they’re going to need some guidance now and again. A truly committed vendor will offer comprehensive training, either onsite at your facility or one-on-one online.

  It’s important to receive a written breakdown of the training process the company offers and any additional costs for staff training during the implementation period. With good training, your staff will become accustomed to and comfortable with the practice management system quickly, and it will minimize the amount of productivity lost in the transition from your previous system.

  Vendor support

  Your vendor partner should be there for you when something goes wrong with the software. It’s inevitable, as with all complex systems, that you will eventually encounter a problem, and the company should be available to help you recover from any issues. Further, if an issue arises on the vendor’s end, you need to know that it’ll be responsive and accountable for the error.

  In some cases, a company might assign your practice a direct liaison. This is a useful resource for any practice, as this individual will be familiar with your particular system and the way your practice works. Other companies simply have a tech support call center; it might be more difficult to solve a problem if the person who takes the call is unfamiliar with your medical software platform’s setup. Moreover, it’s important to know whether support services operate 24/7 or if you can only contact tech assistance during normal business hours.

  Key takeaway: Medical software platforms are sprawling systems that should be chosen based on cost, ease of use, features, integrations and interfacing, reporting capabilities, and available customer support.

  Matt D’Angelo contributed to the reporting and writing in this article.

  Source: Business News Daily, October 6, 2020  (https://www.businessnewsdaily.com/8787-choosing-medical-software.html)

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• 6 Ways Physicians Can Close the Gender Pay Gap
  

  By Rebekah Bernard, MD

  According to a recent report from the New England Journal of Medicine, female primary care physicians generate 10.9% less revenue from office visits compared to male physicians, despite spending 2.6% more time in the office with patients. Although female physicians had a lower volume of patient visits, they spent almost 16% more time with each patient. During this additional time, researchers found that female physicians placed more medical orders and discussed more medical diagnoses and preventive care than male physicians.

  This begs the question: Why are women not being paid for their additional labor? According to the study, the answer seems to be that male physicians are simply better at billing for their work than female physicians, including billing based on time. Also, female physicians in procedural fields like radiation oncology were less likely to bill for “lucrative procedures” than male physicians.

  Here’s the good news: This is one type of gender pay difference that is easy to fix. Female physicians can either opt out of a broken health care system that rewards short visits and high billing codes and enter into a direct primary care (DPC) model, or they can invest some time learning how to work the system to their advantage. As a female family physician, I’ve done it both ways. Although I advocate for the former (DPC has been a life changer for me), I was also able to out-earn many of my male colleagues in traditional practice by learning how to outsmart the system.

  What follows are my top tips on how female physicians can close the gender pay gap in a practice using the relative value unit model.

  Don’t give away your time

  Unlike attorneys, a physician’s billing clock only starts ticking when we have a face-to-face encounter or formal telemedicine session with a patient. Phone calls and emails reviewing lab results are not compensated. Medication refills, prior authorizations, insurance forms, disabled parking passes, jury duty excuses, school medical excuses — physicians are not paid for any of these services, even though they may take a considerable amount of time (family physicians spend nine hours per week on uncompensated labor).

  The reality is that in a fee-for-service insurance model, the only way to be fairly compensated for work as a physician is to see patients in the office. So rather than calling or emailing lab results, schedule your patient to return for a visit to review results together. If a patient calls with questions, concerns or clarifications, ask them to schedule an office visit. After all, an office visit is almost always the best way of evaluating your patient and providing the best medical care.

  In addition, every time a form appears on your desk to be filled out, forward it to your office scheduler with a note to bring the patient in for an office visit. Doing paperwork while the patient is in the office not only allows you to bill for your work, it also saves you time: The chart is ready for you, the patient can directly answer many of the questions on the form and you have the opportunity to address medical concerns that relate to the paperwork, such as changing a medication or requesting prior authorization for a medication that is medically necessary but not covered by the patient’s insurance.

  Be available for your own patients

  Don’t miss out on quick, easy visits like urinary tract infections or minor skin infections because you lack schedule availability. With the current system of coding, a minor issue that you can attend to in five minutes is reimbursed just a bit less than a visit that takes you 30 minutes and loads of cognitive effort. The best way to ensure availability is to block several slots per day for urgent, acute care visits. These can be dispersed throughout the day or reserved during certain intervals, such as the last hour of the morning or the end of the day.

  Schedule frequent follow-up visits

  It is simply impossible to attend to every single problem that a patient has in one visit, along with addressing preventive care, although it’s clear from the New England Journal of Medicinestudy that female physicians certainly try their best! We need to accept that we can’t do it all, and instead, prioritize the most important issues and ask our patients to schedule follow-up visits. This can be difficult, as many of us are “people pleasers” and fear letting down our patients. We also worry about patients’ schedules and causing an additional copay. However, we need to accept that one of the keys to quality health care is developing a long-term relationship with a patient. Having the same physician over time reduces patient mortality by allowing more opportunities for us to explore our patients’ health and intervene in their lives. Remember: You cannot address a lifetime’s worth of problems in a single 15-minute visit, and you must not expect this of yourself.

  It’s especially important to schedule frequent follow-ups with patients who have serious chronic health conditions or underlying psychological conditions like anxiety disorder. Some of these patients are prone to showing up without appointments, often in crisis, and can severely impact the day’s schedule. By scheduling frequent follow-up visits, you eliminate some same-day, “urgent” appointments. Frequent visits are reassuring to patients, many of whom fear abandonment. It also helps to tell your patient how much time you have scheduled for them at their appointment, to help them prioritize what is most important.

  Capture add-on codes

  When families come into the office together, “surprise” visits can cause a strain. You know the situation. You’re in the exam room seeing a well child when Mom points to a sibling and says: “Can you just check his brother’s throat? He’s been complaining that it hurts.” Or you’re seeing a husband and wife together, but just one is scheduled for an appointment. Inevitably, the conversation turns to a concern about the other spouse’s health.

  This creates a dilemma. Although you could ask the “add on” patient to schedule an appointment to discuss their issues, it may be quicker and easier to address the problem directly. However, don’t forget to capture a billing code for your work. Even if you spend minimal time, you are likely to garner enough information to capture at least a level 99212 code for the work you did.

  Also don’t forget to ensure that you properly bill for wellness visits and screening codes. The most efficient way to do this is to create a template or form. I also recommend including the dates of your last preventive screening in your problem list, where you can see at a glance what services are due.

  Don’t sell yourself short

  Female physicians must take the time to learn how to code accurately to be fairly paid for their work. Often, we underestimate the amount of work we’re doing and undercode. Yes, it seems unnecessarily complicated, but a few steps can make it easier. First, remember that billing codes are driven by the extent of medical decision-making. If a patient has a new problem, requires additional evaluation like blood tests or needs a prescription medication, they are likely going to warrant a higher level of service. If a patient has a life-threatening condition, you need to call 911 or you are going to really worry about the medication you must prescribe, then the level of service increases to the maximum. To ensure that you are checking all the right bullets, consider posting a chart of coding requirements for history, physical and medical decision-making next to your computer.

  As a physician, you should never be coding a 99211, which is a nursing code for an evaluation ordered by a physician, like a blood pressure check. If you take a quick look at a patient and make a straightforward recommendation, you have earned at least a 99212.

  Don’t forget to use time-based documentation when you spend the bulk of your visit “counseling or coordinating care.” For example, time-based coding will likely come into play with the patient who comes in severely depressed or has a stack of forms for you to fill out. While you don’t have to do lots of documentation for history or physical, you do have to document the time spent, both total and counseling time, and the details on the counseling/coordination of care activity.

  Don’t be afraid of procedures

  Our current system rewards interventions more highly than cognitive services. Primary care physicians should take advantage of this to serve patients. The key to success is having proficiency in your procedural skills and developing an established protocol for each procedure that you perform in the office.

  If you didn’t have the opportunity to practice many procedures in your residency, many courses are offered at continuing medical education conferences. Another way to gain expertise is to find a physician mentor who does procedures in the office. Of course, be sure to know your limitations, and when in doubt, refer the patient to the appropriate specialist.

  Before performing a procedure, break it down into individual steps. Create an organized list of supplies and actions required. Be sure that you have all the proper equipment ahead of time, and get the best equipment that you can afford. Develop a plan for follow-up and a patient handout, if necessary, for after the procedure. Using your prepared protocol, your medical assistant should be able to quickly ready the exam room for the procedure. Also make sure that your patients know that you offer office procedures so they can contact you if they need help, rather than visiting an urgent care or specialist.

  Source: Medical Economics, February 2, 2021  (https://www.medicaleconomics.com/view/6-ways-physicians-can-close-the-gender-pay-gap)

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• 3 Steps to Protect Your Practice from Ransomware
  

  By Willy Leichter

  Ransomware is perhaps the greatest cybersecurity challenge facing the healthcare industry right now. A recent survey found that 73 percent of health systems, including hospital and physician organizations, reported their data infrastructures are unprepared to respond to attacks. The survey estimated that healthcare providers with 500 or more records are a staggering 300 percent more vulnerable to data breaches.

  Numerous hospitals and medical centers have had operations severely impacted, or even halted from attacks, which is challenging under normal circumstances, but nearly insurmountable in the midst of a pandemic. In the instances reported, files and systems became infected, forcing practitioners to use manual pen and paper systems to keep operations from shutting down completely.

  Attackers use a wide range of techniques to break into systems, find sensitive data, deploy encryption tools to lock data, and then demand a ransom in exchange for retrieving encryption keys. By employing the measures outlined below, healthcare practitioners can help protect their business, their patients, and their data from ransomware attacks in 2021 and beyond.

  Invest in An IT Staff

  One key thing that makes a healthcare system an easy target is an understaffed IT department. For all the advanced medical technology and expertise hospitals and medical centers have in spades, they are frequently less prepared in the IT department. Technical staff and security funding tend to be in limited supply, and bad actors will schedule their attacks on weekends or off-hours, when they know IT staff is scaled back from the regular workweek.

  Investing in a professional IT staff will ultimately save practices valuable time and money. Organizations need to shift to a “prepare and prevent” mindset, rather than “deal with the cleanup after-the-fact.”

  Another reason healthcare systems are easy targets is because they tend to have a mix of older, legacy equipment and systems, as well as cutting-edge technology. If the older systems are not properly maintained, updated and/or patched, they become vulnerable.

  Older medical devices, such as MRI machines or machines with databases built into them, have vulnerabilities that are well known to seasoned ransomware attackers, such as password-related backdoors due to weak manufacturer-set passwords or poor password security practices.

  Future-proofing information systems and the application infrastructure against ransom attacks is essential whether or not the practice has suffered an attack. Practitioners must assume that the precursors to the next attack are already inside the system. Once inside a system, ransomware and associated malware are designed to look like normal operations. This is how they are able to dwell inside networks for weeks and months, executing undetected.

  Advanced cybersecurity solutions enable visibility into essentially every application function during runtime, with real-time insight into performance. The aim is to stop exploits as soon as they occur, before any significant damage is done. These solutions designed to detect and stop any code that deviates from normal.

  Educate All Employees

  All employees, from doctors to front office staff, must be on high alert. Cyber criminals are using increasingly manipulative exploits during the global health crisis. It’s important for every practice to educate their staff about phishing email and other potential risks to avoid. Research states that nearly 93 percent of attacks infect systems from a phishing email with a malware-laced link. “Drive-by downloading” is another method where a user accesses an infected website and becomes infected.

  Particularly with an increase in remote work, medical networks are even more vulnerable, and staff need to be extra cautious. Oftentimes medical staff need to access critical data from remote laptops, some of which may be personal laptops or devices that have users other than the employee. Without remote work, server workloads would mainly only be exposed to private networks. Now they are exposed to remote workers’ unsecured devices, further exposing practice networks.

  Staff should enable two-factor authentication on network devices and systems and follow a password management policy that enforces regular updates and strong passwords. Implement a reliable backup and recovery system protected from network access. Regularly update all software, operating systems and anti-virus solutions. These small steps in everyday practice workflow can ultimately be the first barrier of defense from a ransomware attack.

  Regardless of how much practices prepare, hackers will continue to hack successfully. The question healthcare systems face now is whether their network is prepared to handle better and more frequent attacks without shutting down completely. Healthcare organizations are critical infrastructure, providing essential services for the public. Their many vulnerabilities leave them exposed, but by implementing these key steps to protect their organization, practitioners can strengthen and fortify their security stance.

  Source: Physicians Practice, December 18, 2020 (https://www.physicianspractice.com/view/3-steps-to-protect-your-practice-from-ransomware)

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• What You Need to Know about Forming a Medical Super Group
  

  By Daniel B. Frier, Esq.

  The increased emphasis on cost, quality and compliance in the delivery of healthcare has simultaneously promised to save our healthcare system, while adding immense complexity to the private practice of medicine. The advent of MACRA and all of the intricate payment methodologies proposed by CMS will inevitably trickle down to commercial payers, providing opportunities for well-prepared physicians, but leaving most small, unsophisticated medical practices ill-equipped to survive in the new data-driven environment.

  As hospitals have scrambled to form captive practices, co-management relationships, ACOs and CINs in an almost scattershot attempt to garner marketshare, small medical practices will likely be faced with take-it-or-leave-it payor contracts that virtually guaranty a smaller piece of the overall reimbursement pie. These market forces have caused physicians to increasingly see the need to become part of larger networks of physicians which are able to engage as a group in alternative payment arrangement with CMS, commercial insurers, self-insured employer plans and hospital organizations. These networks must be sufficiently integrated to avoid federal and state anti-trust violations, and be able to monitor and enforce compliance among its physician participants in order to enter into meaningful fee arrangements with payors.

  The gold standard for integration is a clinically and economically integrated group practice operating under a single Taxpayer Identification Number (T.I.N.). Commonly referred to as “Super Groups,” these practices have proliferated over the past several years because, if formed properly, they provide many advantages over traditional practice structures in the face of the paradigm shift that is occurring in the delivery of healthcare.

  Structure

  Super Groups are commonly formed as limited liability companies (LLC) owned exclusively by qualified physicians licensed in the state where the Super Group is located, with each physician owning one membership unit of the LLC. In general, all of the partners/owners of the practices joining the Super-Group will become members, and all associate physicians will become associate physicians (non-members) of the practice, and be required to enter into associate employment agreements directly with the practice.

  Although a Super Group is a single group practice operating under one T.I.N, one of the frequently used methods to organize the Super Group involves using separate “Care Centers,” each of which constitutes a separate “satellite” office location or group operated by those physician members of the Super Group who are affiliated with that particular Care Center. Each formerly independent medical practice will cease to practice medicine as a separate company, and the physicians will comprise their own separate and distinct Care Center of the Super-Group. In general, a Care Center’s professional collections will be distributed to the Care Center, after subtracting its direct expenses (e.g., rent, payroll, insurance), and the Care Center’s allocable share of common overhead. This Care Center model allows the former groups to retain a great deal of autonomy while still enjoying the benefits of the Super Group.

  Benefits of Super Groups

  The basic theory behind the formation of a Super Group is that physicians will generally be in a better position to face the ever-changing and complex healthcare environment if they are part of a larger group of like-minded practitioners. Super Groups hold a number of advantages over smaller practices, and the following list provide some examples of the advantages of Super Groups.

  Super Groups are in a better position to implement alternative fee structures such as bundled payments, episodes of care and shared savings because of their size, access to more sophisticated information technology and level of clinical integration.

  As a Super Group, physician members may be in a better position to implement quality and efficiency initiatives that will enable it to negotiate with third-party payors than would a much smaller practice. For instance, Super Groups have the opportunity to accumulate substantial data that may be used to implement quality and cost-saving measures that, because of the increased number of physicians in the practice, can result in substantial absolute dollar savings that can be used as a tool in pro-competitive negotiations with insurance carriers. Such programs are already in place through larger payors and ACO projects.

  A Super Group may be able to invest in ancillary services (e.g., lab services) and treatment modalities without violating the federal prohibition against self-referrals (Stark).

  A Super Group may have increased leverage to negotiate lower medical malpractice premiums and other costs typically incurred by medical practices. This “group buying power” may also enable the Super Group to negotiate more favorable deals for products and services such as bank financing, EMR and Practice Management software and medical supplies and equipment.

  Time consuming practice management functions, such as billing, accounts payable, credentialing, negotiating with vendors, pension administration and human resources administration, will be performed by a management company, allowing the Care Centers to focus on patient care and practice building.

  The Care Centers will have the ability to share coding and billing practices in order to optimize collections.

  Depending upon the geographic scope of the practice, the formation of a Super Group may provide the practice with the ability to negotiate more effectively with local hospitals.

  Formation

  Forming a Super Group usually involves three phases of steps. The steps do not necessarily have to be followed in the exact order listed below, but these are generally the steps which a group must follow to properly and fully form the group. When practices are ready to form a super group, the practices should engage the services of an attorney who is familiar with the Super Group formation and who understands the various legal restrictions and requirements which must be met. He or she will be able to help you walk through these steps listed below.

  Phase One

  Initial meetings to discuss short-term, medium-term and long-term goals and compile list of potential members;

  Draft a letter of intent and confidentiality agreement by and among prospective members; and

  Form Limited Liability Company, obtain federal tax identification number and state employer identification number.

  Phase Two

  Form an Implementation Committee;

  Establish a meeting schedule for the Implementation Committee and other members;

  Implement a due diligence process through the collection and analysis of critical financial and legal information from prospective owners;

  Prepare an Operating Agreement and other organizational documents, which detail, among other issues, management structure, compensation formulas, committee structures, officer responsibilities, etc.; and

  Evaluate legal issues including Federal Stark, Anti-Kickback, antitrust issues and state law issues.

  Phase Three

  Work with the attorney to draft “care center” agreements;

  Establish board of directors based upon mechanism described in Operating Agreement;

  Select officers and form committees (e.g., credentialing, Benefits, Information Technology);

  Create policies and procedures to ensure legal compliance (e.g., billing compliance, HIPAA compliance);

  Review and negotiate vendor contracts (e.g., practice management systems, EHR contracts);

  Review and negotiate banking agreements (e.g., line of credit, term loan); and

  Legal review of managed care contracts.

  While it may seem like a big change from a small practice, becoming a member of a Super Group can bring many advantages to a practice and its physicians. It can provide a great deal of leverage in contracting and allow the physician members to participate in a number of endeavors they would not have otherwise been able to do. Super Groups can be an excellent way to stay competitive within the ever-changing landscape of healthcare.

  Daniel B. Frier, Esq., is founding partner of Frier Levitt.

  Source: Medical Economics, December 4, 2020 (https://www.medicaleconomics.com/view/what-you-need-to-know-about-forming-a-medical-super-group)

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• Rationing Vaccines: What is fair?
  

  Drs. Christine K. Cassel and Molly J. Coye

  Most of us are excitedly anticipating the arrival of new vaccines against the novel coronavirus that causes COVID-19. With Food and Drug Administration emergency use authorization of the first two vaccines and the very promising efficacy and safety data on which the EUAs are based, we can hope to prevent many thousands of deaths and begin to return to more normal life over the course of the coming year.

  But it will be a long time before there is enough vaccine for everyone who wants and needs it. In a culture where threats of "rationing" have been enough to stymie many innovative health policies, we now find this term widely used in public discussion about allocation of the early and limited vaccine doses. Of course we have to ration, because there are so many people at risk and so little vaccine.

  But who should be first? Authoritative national bodies such as the National Academy of Medicine and the Centers for Disease Control and Prevention have issued clear opinions about the ethical guidelines for vaccine allocation, and it appears most states and regions are adopting these general frameworks. There appears to be wide agreement that "healthcare personnel" should be the first group to be vaccinated.

  The CDC and the independent Advisory Committee on Immunization Practices, or ACIP, define healthcare personnel as "paid and unpaid people serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials." CDC guidelines include a wide range of healthcare workers, and the actual decisions will be made at the local level. It is easy to say "put healthcare workers first," but the decisions about relative priorities may not be obvious.

  We see vivid images of hospitals and especially intensive-care units in the news about COVID-19. Doctors and nurses are working hard in those tough environments, but so are respiratory and physical therapists; and the people who clean the rooms, transport patients, transport bodies or work in the morgue when a patient dies. There are many nonclinical workers who may be at risk of encountering contagion, such as intake workers in emergency departments, urgent-care centers and laboratory settings who are wearing only minimal protective gear, i.e., a mask and perhaps gloves.

  Less visible are the many people outside of hospital settings to be considered in these ethical frameworks. Almost 10 million people each year receive care in nursing homes, assisted-living residential settings, hospices and at home. At least 1.5 million staff are involved in direct care, but this doesn’t even include administrative staff, food and environmental services workers, and an unmeasured but critically important cadre of volunteers.

  In addition to nursing home workers, there are many personal care workers who face the same challenges of public transportation, family demands and child care that are faced by minimum-wage workers in other sectors of the economy. They are exposed to contagion by the nature of their work and by the struggles of their daily lives, and if they become infected they are at risk for worse outcomes.

  Of all these millions of workers, who should receive priority in these first critical months?

  The ACIP based its priorities on four ethical principles: Maximize benefits and minimize harms; mitigate health inequities; promote justice; and promote transparency. The first three would all seem to point in the direction of more emphasis on workers who are in the community rather than in the hospital. Their numbers are greater, and their potential to expose others is greater because they do not have the elaborate protective gear used in hospitals. The third principle, promote justice, invokes the notion of fairness—that people who are most disadvantaged in confronting this risk should receive special consideration.

  While all healthcare workers deserve our respect and admiration, and it would be ideal if all could be vaccinated right away, tough decisions must be made. And the minimum-wage workers face much more difficult personal challenges than the traveling nurses who are earning twice normal pay and staying in hotels.

  A rigorous approach to mitigating health inequities and promoting justice would take into account not only the risk of infection but the risks of the devastating consequences to minimum-wage workers who have no support for child care, no options except for public transportation, and family members who face exposure in their own work. These workers do not have the public face of hospital workers rightly honored in the media, but the risks to themselves and their families may be just as great or greater.

  For both lower-paid workers in healthcare settings and essential workers in the community, the question should be how to apply first three principles of the ACIP framework. And because of the far fewer resources that lower-paid workers bring to their risk of contracting COVID-19—and its outcomes for them—we should consider elevating our assessment of their need and ensure that we rapidly extend vaccination beyond traditional health settings to most essential workers in the community.

  We applaud all the ACIP principles, especially their commitment to transparency. We all wish that everyone who needs it could be vaccinated immediately. But we are faced with deciding who "needs it the most," and that deliberation is worth some reflection. The specifics of these decisions will be interpreted and implemented at the state and local levels. If we endorse the ACIP ethical principles of mitigating health inequities and promoting justice, we should include consideration of the social determinants of risk as we select the first in line for the vaccines.

  Source: Modern Healthcare, December 18, 2020 (https://www.modernhealthcare.com/opinion-editorial/rationing-vaccines-what-fair)

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• Cost Effective Design Changes Medical Practices Can Make
  

  By Joanna Terry

  The COVID-19 pandemic has had a significant effect on almost every medical practice in the US. Many have had to limit delivery of care or find new strategies to keep patients and staff safe. Interior design and furniture can play a role in infection prevention, often using items already in place. Here are some suggestions to consider that are effective and cost sensitive.

  Expand telehealth

  Many practices are investing in expanding their telehealth capabilities during this time, which especially fits the needs of patients who have chronic conditions or need follow-up care and are uncomfortable leaving home and risking infection. Telehealth services offer greater safety for both patients and staff – they also save time, resources (including PPE) and have a positive impact on the environment.

  Carefully consider what types of patients can safely be seen and monitored remotely and ensure that any temporary telemedicine spaces meet current HIPPA requirements. Staff will need appropriate equipment – monitors, cameras, microphones, workspaces and a stable internet connection. Investing in expanding your current telehealth programs can increase patient satisfaction, ensure that non-COVID health conditions are treated safely and a continued revenue stream for your practice.

  Manage patient flow

  Waiting and common areas have the potential to be a calming, comforting space, but daily use by multiple individuals mean they are also a place where infections can be passed from person to person. Managing the flow of patients in your facility is critical to keeping everyone safe.

  Set clear policies on arrival times, mask compliance and visitors/companions and ensure that patients are notified in advance of their visit. Making sure that patients do not enter the facility until close to their appointment time limits capacity and lowers risk. Unless absolutely necessary, visitors should not be permitted into the facility. Make sure that hand hygiene supplies are easily accessible and that masks are provided when needed.

  Some practices are eliminating waiting rooms during the pandemic and escorting patients directly to an exam room to wait for a caregiver. If that is not possible, ensure that your waiting space supports infection prevention. That may mean removing chairs, or blocking off seats to preserve social distancing. After a chair has been used, consider placing a laminated tag on the seat notifying others that the chair should not be used. Once the seat has been sanitized by staff, the chair can be returned to use. Portable dividers can be an effective method of creating separation and offering privacy—and can be reused in other office spaces once they are no longer required in the waiting area.

  Technology can help make waiting more enjoyable and have long-term benefits for your practice. Offering a guest WiFi network gives patients the chance to work, decompress and stay entertained while they wait for care. Consider installing self check-in kiosks or offering the option to check in for appointments digitally. This eliminates a point of infection and saves on staff time.

  Use the right materials

  Consistent and thorough cleaning is critical to infection control. That applies to furniture and fixtures as well. Using harsh disinfectants can take a toll on materials like wood and fabric, causing them to degrade quickly and fail. When cleaning, follow the manufacturer’s instructions (paying attention to dwell times needed to eliminate bacteria) and be sure to rinse with clean water afterward to remove chemical residues and help prolong material life. Ask if the cleaners you are using can safely be applied to your chosen material.

  Standard upholstery and wood can add a warm, welcoming look to your space, but both are porous and cannot be disinfected effectively. Fabric in particular can trap and hold bacteria deep within fibers, making this material a real challenge to clean between uses. It is worth considering replacing wood or fabric items with more durable, cleanable options made from vinyl and metal. These materials are far more durable, can be easily cleaned and have a higher resistance to chemical disinfectants, ensuring a longer useful life.

  Take care of the front line

  This pandemic has been very stressful, especially for healthcare workers. Ensure that your team has dedicated spaces to rest and recharge during long and demanding shifts. Provide comfortable seating, along with tables and chairs for a quick meal. These areas should be completely separated from patient care spaces, with access to a restroom, a place to store personal belongings and a place to take a break and eat.

  Giving staff a welcoming space to decompress and rest helps prevent burnout and fatigue – and can help prevent medical errors. If possible, provide natural daylight and access to the outside, which can help users relax. Don’t forget to include all staff. Maintenance, office workers and cleaners (among others) are working hard to keep spaces clean, safe and functioning during this stressful time.

  Managing a medical practice during a global pandemic is a challenge – there is a responsibility to ensure safety for your patients, your employees and the community. Making small, inexpensive changes now can have a large payoff down the road in increasing patient and staff satisfaction.

  Terry is director of healthcare sales at National Business Furniture with more than 20 years of industry experience.

  Source: Medical Economics, December 9, 2020 (https://www.medicaleconomics.com/view/cost-effective-design-changes-medical-practices-can-make)

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