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All Things EMR | Practice Management

How the Small Independent Provider’s Role Has Come Full Circle


Stephen Bien, MDWhen I came to the rural Maine town of Farmington 30 years ago, the independent private practice was the norm, and I fell right in. After all, our mentors back then — certainly mine — were all independents. They all had a hospital practice where they went through the requisite rhythms of in-patient care before retreating to the office they could almost call home.

Hospital practice was more an extension of office life than a discipline of its own, but it was a public space, unlike the office, and there was a light touch of regulation from the functions of committees and peer influence. The physicians’ offices by comparison were utterly empires unto themselves where physicians were free (almost expected) to practice as they saw fit according to their training, experience, and whims. Patients were more often than not subject to their physicians’ judgments and inclinations without much question or recourse as relatively few, in my experience, comparison shopped or moved around.

Lest I be considered a romantic, retrograde fool, let me make clear that there is much from those old days that is better left behind. Physicians were almost exclusively men, a patriarchy whose authoritarian nature did not leave much room for patient involvement. Physicians could be arbitrary and foolishly idiosyncratic. For instance, I had an OB attending who did not allow any infant suctioning in the delivery room. Another chose to deliver babies as breeches. Needless to say, there is plenty that I am happy to see in the rear–view mirror.

The emergence of ‘family practice’ as a field was meant to be antidotal to the lack of science and organization in primary care. The doctor–patient relationship was recalibrated to become the partnership it needed to be, body and psyche were woven together in new behavioral health models, and an emerging primary-care science was developed to help inform what we did. This was the banner our generation of family doctors marched under in the 1980s, and we flew that flag over our small, private offices. So, when I started practice here in 1982, as one of ten family physicians and a half-dozen internists, we were all in this type of private practice. Jump ahead ten years and everyone seemed to be running for the exit doors. Fast forward another decade or so, and I was one of only two primary-care docs left. What happened?

In my view, a great souring occurred as the fundamental paradigms of medicine shifted under the influence, which still operate powerfully today, of consumerism and cost containment. The profession’s noblesse oblige and, its flip side, arrogance, had to give way to external oversight and patient demands. These were and are entirely appropriate influences but many physicians ended up wanting cover from the demands of the consumer movement and the increasing power of insurance companies to call the shots and constrain practice. Cost containment paradigms, complicated insurance arrangements (and their administrative burdens), our collective financial insecurity, and the desire for a comfier career — financial and otherwise — all worked to lure many providers away from private practice. Hey, why not trade long hours and shrinking reimbursement for regular hours under a roof where one was taken care of?

Well, you don’t know what you’ve got until it’s gone, and working for a hospital or care network was not all wine and roses. Some doctors worked longer hours and the doctor–patient relationship — the heart of medicine’s satisfaction — was at best weakened and, at worst, seriously eroded by the dynamics of the physician employment model. But there was another result: People like me seemed to be getting a second wind and thriving. Smiling even.

I stayed the independent, small-practice course, more from being stubborn than possessing any business savvy, but I did see changes and opportunity coming. I saw that my weaknesses — small size, isolation, independence — could be played as assets. Patients, some of whom left to try out the hospital network, came back because they liked the personal, small approach of a private office. Suddenly I had a new niche. And soon discovered, quite by accident, that innovation was pretty easy, fun, interesting, and good for business.

Five years ago, because our practice is small and self-directed, we were asked to participate in the first e–prescribing pilot in our community. That was our entry into computers and a new way of thinking about tasks and the management of information. We then took another leap and were among the first participants in our state’s medical home pilot. This allowed us to re-tool and re-invigorate our primary–care vision while enriching the care of our patients. Association with other practices in the pilot gave us access to outside resources and expertise. Now, we had the best of both worlds: independent, but no longer isolated.

We then implemented athenahealth’s cloud-based EMR because it seemed a natural fit for our medical home model and ongoing independence. Before long, we were the first primary–care practice in Maine — yes, the very first — to receive a Meaningful Use incentive check.

At one time, using the physics of their day, entomologists concluded that bumblebees could not fly. This was not quite the evidence of their senses, but of their study. In like manner, my office, with its weighty overhead and apparently flimsy finances shouldn’t fly either. But new practice models and technologies that value both time and care, have made the old mode sustainable again. This is my hope and my bet.

To learn more about athenaClinicals, athenahealth’s cloud-based EMR, and how it guarantees Meaningful Use payments, visit here.

Dr. Bien is an independent physician at Wilson Stream Family Practice in Farmington, Maine and an athenahealth client.


Healthcare Policy & Reform | Practice Management

My Prognosis for Health Care in 2014


“The only constant is change.”

Sure, it’s an old cliché that’s been around for about 2500 years, but it’s true. And the sentiment has never been more relevant for the health care industry than right now.

Upcoming initiatives like ICD-10 and Stage 2 Meaningful Use demand a lot from medical practices, and have driven us at athenahealth to fill 2013 with plenty of planning, education and focus on behalf of our clients. But the view even further ahead portends massive change, and has led to some hard-working speculation about what’s to come.

Beyond mandates and programs that affect everyday operations throughout health care, there are conditions in play that are changing long-time processes and expectations about how and where care is delivered, and how caregivers are compensated for delivering that care. As the Chief Operating Officer at athenahealth, it’s my responsibility to see where the industry is going, ease the enormous pressures on our clients, and determine what we must do to uphold our vision of helping make health care work as it should.

What are the major factors for us to consider in determining and understanding what’s ahead?

  • A huge increase in health care spending as the population gets older, with total spending on the way to becoming 20% of the U.S. GDP (Gross Domestic Product).
  • The $575 billion incentive known as health care reform.
  • A scramble for patient volume, marked by hospitals acquiring hospitals and physicians acquiring physicians.

Dr. Jason Hwang, acclaimed co-author of The Innovator’s Prescription: A Disruptive Solution for Healthcare, said:

“It’s not that health care is doing a poor job, it’s improving, but it just doesn’t change the way we want it to.

For that change to happen, what disruptive innovation theory tells us, is that it’s almost always a new entrant, or, in this case, many new entrants to the industry that figure out a better way of doing things.”

This Wednesday, November 20th at 12:15 p.m. ET, I’m hosting a webinar to discuss these new entrants, my health care “prognosis” for 2014, and how “a better way of doing things” can affect our shared health care future.

Hope you can all make it!

Register today for this exciting webinar event with Ed Park and learn what your practice or organization can expect from health care changes.


ICD-10 | Practice Management

ICD-10: Views from a Practice Manager


As a practice manager who oversees a staff of nine including three clinicians, one billing supervisor, one lab tech and one medical home care coordinator, I clearly understand how a health care regulation like ICD-10 can stir up trepidation, and lead to the obvious questions: How will this affect care delivery and my practice’s bottom line?

In speaking with our providers about ICD-10, these concerns have surfaced. While they feel ICD-10 will provide a more descriptive documentation of diagnoses, they also wonder if clearinghouses and payers will have their systems configured to accept ICD-10 and avoid improperly denying submitted claims. Dr. Peter Masucci, my husband and principal physician of our family-owned practice, is most concerned with being able to identify a proper ICD-10 diagnosis code within a manageable time frame for each patient visit.

Hesitations aside, the main focus now needs to be on successfully making it through the ICD-10 transition with as little disruption to the day-to-day of your practice as possible. So, here is what I’m doing —and planning to do — as a practice manager to ensure we’re ready for October 1, 2014.

What We’re Doing Today

I recommend that all practices start small and get your ducks in a row before tackling more of the specific technological and procedural aspects of a transition as large as ICD-10. For our practice, we began by identifying an ICD-10 team. This includes Dr. Masucci, me, and our billing supervisor. Among the three of us, we will create the roadmap for educating, training, testing and implementing ICD-10 at our practice.

As part of this roadmap, one of the first actions is to upgrade the software for our in-house lab information system (LIS). We were notified by our LIS vendor that this upgrade would be a requirement in order to be ICD-10-compliant—this is not the case with our athenahealth practice management services as their technology platform does not require or demand our practice to manage software upgrades. And as part of our partnership with athenahealth, their service teams helped us connect with our LIS vendor to ensure not only a smooth transition without lab downtime. This kind of co-partnering support is unprecedented in the industry, and we value and depend on it—especially through times like these.

At 12 Months Out

Once this LIS upgrade is successfully completed, we’ll begin seeking out the best tools and programs to educate our office staff for the larger ICD-10 implementation for the clinical side of our practice. With the additional documentation and coding requirements inherent in ICD-10, I will be researching tools and seminars to help train our providers and support staff. I’ve already begun leveraging resources from the American Academy of Pediatrics organization so we can adequately prepare for and navigate the ICD-10 training process.

Having a close relationship with our electronic health record (EHR) vendor is crucial to our success: We’re heavily relying on athenahealth to guide and educate us throughout the transition ICD-10. And I rest easy knowing they are guaranteeing ICD-10 success by putting their own revenue on the line, and protecting clients against any significant cash flow interruptions as a result of the transition.

Knowledge is Power

Having the resources and support of our EHR vendor, peers and physician group organization provides that power—and, frankly, gives me confidence—that we will ably survive the ICD-10 transition, while continuing to care for our patients at the highest level possible.

Donna Masucci, RN, is an athenahealth client and office manager for Peter E Masucci, MD, PC, based in Everett, Massachusetts.


Practice Management

Marketing Your Medical Practice in the Digital (Social) Age


Michelle Mangino, Senior Manager, Social Media ManagerOn Saturday, June 30, Tweeters, Instagramers, Pinners and the like will gather to celebrate the fourth annual Social Media Day, presented by Mashable, a leading online source for news and information focused on the Connected Generation. And each year, social media plays a greater role in #healthcare and #HealthIT. Here are a few stats1 from recent months:

  • 51% of those surveyed say that digital health communications would make them feel more valued as a patient
  • 90% of adults 18-24 years of age say they would trust medical information shared by others in their social media networks
  • 41% of people say social media would affect their choice of health care provider

To raise awareness about the social media benefits for health care professionals, I asked Dr. Lawrence Rosen, an athenahealth client, social-savvy clinician, practice owner and influencer, about best practices and tips for marketing a medical practice on social networks.

When did you realize it was time to put your practice on Facebook? When was that ‘a-ha’ moment?

It happened the day I started my practice, The Whole Child Center, in 2008. I recognized that savvy parents were using Facebook to gather and share information about their kids. They not only wanted to post photos of their one-year-old’s birthday party but also wanted to interact with their health care providers. I thought it would be great if we could develop this online community to build on the brick-and-mortar community we developed within the four walls of our practice.

The Whole Child Center Facebook Page

To create an effective Facebook strategy, it’s key to know your audience and what you’d like them to do. Who are your Facebook target audiences? Are you surprised by any groups that you’re reaching?

As a pediatrician, my primary target audience is easy—moms. And for Facebook, that’s a key demographic. Recent insights showed that 80% of our Facebook audience is women with more than 60% ages 25-44.

The most surprising demographic? Other health care practitioners interested in the unique integrative and eco-sustainable approach we take to medicine.

Discuss the types of content you have generated and how you personally grown your Facebook presence and, in essence, your practice.

Initially, our content was mostly health information, current articles and trends in the news. I then realized that photos and videos garnered much more interest, so we developed a space for parents to post photos of their kids having fun in our office. With HIPAA concerns, we are really careful to never post patient information directly, but parents can certainly share information about their own experiences, and they love sharing these pictures. Also, I’ve found videos of my media appearances or webinars, when posted on seasonal or topical issues, always get a lot of likes and shares.

What are examples of online content that have increased visibility or engagement for your practice?

The most gratifying and widespread content has been related to our response to the 2012 Hurricane Sandy tragedy in New Jersey and New York. We posted a call for new or gently used baby equipment—strollers, car seats, high chairs—for one of our practice’s moms to deliver to a devastated section of Queens, NY. In one week, we gathered enough donations to fill a box truck. This mom, who had family in the damaged area, was so thrilled to partner with us, and it really helped raise awareness in our area of the plight of young families.

Are there any rules of the road, things people should remember when marketing their practice on a social network?

Don’t post private information. Don’t pester your audience by posting 40 things a day. Be strategic, know your audience, pay attention to what people like and share, and keep your content relevant to hot topics and local or regional health issues. In general, stay away from divisive political or religious issues.

What you post is going to be seen as a reflection of your organization’s values and will positively or negatively affect your reputation. Recognize the power of your social network to engage and build your community.

Dr. Rosen, an athenahealth client, is an integrative pediatrician practicing at The Whole Child Center in Oradell, NJ. Follow him on Twitter @LawrenceRosenMD.

This article originally appeared on EMR and HIPAA.

113 Stats Every Healthcare Marketer Should Know in 2013 (and Why)– Fathom, 01/2013.


Patient Engagement | Practice Management

A Pediatrician’s View: Improving Revenue and Care through Patient Communication


Jeff Drasnin, MDOperating a small business in today’s economy is difficult. Small, privately owned physician practices must have their financial house in order to provide high-quality medical care. The truth is most physicians are ill-equipped to survive in a very tough business environment. We spend years training to take good care of our patients, but have no idea how to balance a budget or run a practice effectively. How can we best improve practice management, delivery of care, patient communication, financial health… all at the same time?

What’s required to make it all work?
A stable practice needs to do two things: Control costs and maximize revenue. Obvious, right? But it’s true.

Controlling costs is difficult but manageable—and with the right staff, it can be done. I’d like to discuss that second part, but with an added challenge: Maximizing revenue while simultaneously improving care.

In today’s ever-changing economic environment, small practices must continually look for ways to increase revenue stream. The system demands it.

Reimbursement rates are, to some degree, out of our control. We can negotiate but are often left with whatever insurance companies or the government is willing to pay. Since most of us still operate within the fee-for-service model, the vast majority of our revenue comes from office visits. Some practices can try to charge for additional services, but most fees aren’t reimbursed by major payers and end up falling to the patient. This is a pattern we’d like to avoid.

So, with fixed reimbursement rates and overhead, how can you increase your bottom line?
With schedule density. By increasing patient flow through your office. There are two ways to accomplish this: 1. Gain new patients; and 2. Increase the number of visits from current patients. Word-of-mouth is the best way to achieve that first goal, but growth doesn’t happen overnight. That second goal is what’s really worth focusing on. And it’s more beneficial for everyone.

Seeing patients more often can be not only financially rewarding, but it also promotes better care—it is far more cost-effective to keep people healthy than to treat them when they’re sick. Insurance companies know this and will often reimburse better for a health maintenance exam than an acute illness visit.

Let’s get healthy patients into the office and keep them healthy.
And let’s get patients with chronic illnesses into the office so their illnesses can be managed. This approach can cut overall costs, improve the general level of health across a population and result in better financial success. It is a classic win-win.

How can we get this done?
Our office has found that athenaCommunicator, athenahealth’s patient communication solution, can be a great driver of both health and revenue. By using athenahealth’s reporting features, our pediatric office has been able to sort through our population to identify patients who have not been in recently for well-child exams, and contact those with chronic diseases such as asthma.

We started by running reports and placing “ticklers” into the computer to have athenaCommunicator call and e-mail families, to remind them of any routine health maintenance visits. We also used the patient communication system to contact all asthmatic patients during the fall, to encourage them to come in for their flu vaccines.

With these two automated actions, we both increased our schedule density (to just short of capacity) and did “the right thing” by improving care for a specific at-risk population—and our patient population in general.

The next step—to enable us to see patients more often—occurs on an ongoing basis. Here’s how we do it: When a patient checks out, if their next appointment is not made on the spot, a tickler is automatically placed into athenaCommunicator to remind the family of the next recommended visit.

For well-child care, this is timed to call and e-mail the family in 10 months, so they can set an annual-visit appointment. For asthmatics, that reminder is set for every 6 months.

We use a similar process for other acute illness states and well-baby exams. In the two years since we started this process, open appointment times at our practice are rare, and we’ve received a tremendous amount of positive feedback from our families.

Good care and financial stability, together. What a novel concept. It may sound cliché, but the athenahealth message is true: Our practice really is “Better Now.”

Dr. Drasnin is an athenahealth client specializing in pediatric medicine at Englender, Sper, Drasnin, MDs, in Cincinnati, Ohio.


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