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Monthly Archives: May 2016

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5 Tech tools to boost financial performance

Most physicians are already using EHR systems to record patient encounters, track clinical progress, and report on outcomes. But fewer are taking full advantage of them as a tool to improve financial performance, according to practice management experts Lucy Zielinski, vice president of The Camden Group, and Derek Kosiorek, a principal consultant with the Medical Group Management Association. While there are myriad technology features and add-ons that can help optimize workflow and bring in payments, a few are becoming essential to revenue cycle efficiency. They recommend starting at the front desk with these five tools that leverage the capabilities of your system.

Read more at Physicians



Keep on Top of These 5 Areas to Achieve Your Revenue Goals

Not meeting your revenue goals month after month? According to practice management consultants, it may because you’re not consistently measuring key processes in your business cycle and zeroing in on potential problems.  However, you don’t have to bury yourself in hundreds of reports. Here are 5 key areas to focus on to keep on top of your financials and reverse a cycle of declining revenues. Read More at Physicians


Building New Systems for Stroke Care

ACPH logoHow Should Hospitals Respond to Updated AHA Guidelines on Endovascular Therapy For Stroke?

New findings about stroke therapy prompted the American Heart Association to update its clinical guidelines late last year. The AHA/ASA called for hospitals to develop regional networks to ensure that qualifying stroke patients have rapid access to endovascular therapy following severe stroke. Some larger hospitals already have such systems in place but putting the necessary infrastructure in place will be a challenge for many smaller community hospitals.

I reported on the development for ACP Hospitalist magazine. Following is an excerpt from that article, in which I interviewed leading stroke care experts about how hospitals should respond to the new guidelines. They provide some important insight into the logistical and cost implications of delivering this type of care.

You can read the full article on the ACP Hospitalst website, but here are some of key points:

  • The updated guidelines are based on 5 studies—MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, and REVASCAT. While earlier trials had failed to report any significant benefit of ET over standard care with intravenous tPA, these studies achieved betteStroke image MRIr results by using advanced imaging to select patients and retrievable stents to remove clots.
  • The studies emphasize the importance of using advanced imaging techniques, including CT angiography (CTA) and magnetic resonance angiography (MRA), in the initial assessment of stroke patients. The tests provide a more detailed view of blood vessels than non-contrast CT, allowing physicians to assess whether a patient has enough salvageable brain tissue to benefit from reperfusion.
  • Timing is tricky: According to David Likosky, MD, director of the stroke and neurohospitalist programs at EvergreenHealth Medical Center in Kirkland, Wash.: “You have to be careful not to divert patients too far away, considering that the bulk of patients are not candidates for endovascular therapy and would benefit more from faster access to IV tPA. At the same time, picking the right patients for ET and transporting them as quickly as possible has huge potential benefit.”
  • Strategies being developed at stroke centers include: Telemedicine units that link ambulances with ED physicians via television monitors (see this recent study in JAMA Neurology); mobile stroke units  with advanced imaging and a specialist on board (see my previous article that discusses this model); Telestroke networks where specialists at major stroke centers assist ED physicians at a network of smaller hospitals in evaluating stroke patients via telemedicine connections.
  • Continue to prioritize tPA: “All patients with ischemic stroke should get tPA while you are making plans about whether they also need embolectomy,” says S. Andrew Josephson, MD, medical director of inpatient neurology and head of the neurohospitalist program at the University of California San Francisco. “The best way to maximize resources and minimize transfers is for all hospitals to also perform rapid vessel imaging to identify patients who might be eligible for endovascular therapy.”
  • The new emphasis on endovascular care is likely to increase demand for hospitalists at both smaller and larger centers.

Revenue Cycle Management: 7 Steps to Improving Patient Collections

Many small and mid-size medical practices are leaving money on the table by failing to develop a strategy for collections, experts say. The most common problem is lack of monitoring and accountability, according to Reed Tinsley, CPA, a Houston-based practice management consultant. You need to collect copays at the time of service and keep on top of overdue accounts. Read more in this article I wrote for Physicians Practice.


How to Select a Medical Practice Management System

Prior to implementing a practice management system that automated its billing operations, the staff at Tri-County Eye Physicians and Surgeons in Southampton, Pa., often waited weeks before learning that a claim had been denied due to mismatched diagnosis and procedure codes. Since going electronic, the practice has not only eliminated that wait but prevented errors from occurring in the first place.

Although costly, practice management systems are becoming essential for efficiency, experts say. Physicians can cut costs and boost revenue by automating everyday tasks like claim submissions and insurance authorizations. Read more about how to select the best system and take advantage of new features in this article I wrote for Physicians Practice.


Designing Your Medical Office For Efficiency

The way you design your medical office or clinic has a big impact on staff teamwork and patient satisfaction, experts say. Innovative practices are using technology to improve patient flow; tearing down barriers between staff and patients; and creating team workstations. Read on for tips on how to use layout and design to make your practice more efficient and patient-focused. Read more at



Finding the Right Fit as an Employed Physician

Key Point for Physicians: Find A Supportive Work Environment Where Your Opinion Still Matters

Many physicians are abandoning the headaches associated with running a private practice for the security of a steady paycheck with a hospital or large group. According to a survey by Merritt Hawkins, only 35% of physicians described themselves as independent practice owners in 2014, down from 49%in 2012 and 62% in 2008. These physicians are ready to let someone else deal with the ins and outs of new delivery models and the ever-changing billing and coding landscape, and spend more time actually practicing medicine. physician careers

But as with everything good in life, there are trade-offs. As an employee, you may have less control over when you come and go from the office and who’s on your care team. And after years on your own, you may not fit easily into a corporate culture that has a say in the patients you see and the decisions you make.

I reported on this issue recently for Medical Economics. According to the physicians and career coaches I spoke with, finding the right fit is crucial to your future professional happiness and success. That means doing your research, talking to prospective colleagues, and addressing areas of concern upfront with potential employers.

Fortunately, there are some forward-thinking employers out there who see the wisdom of making sure physicians are happy in their new working environment. Seek those employers out by asking about their process of on-boarding employees, their ongoing support for physicians, and exactly how much control you’ll have over decision making in your new job.

The full article appears this month in Medical Economics

Robert Bailey, MD, had been in private practice for almost 15 years when he was recruited to lead a urology division in the employed physicians group owned by Phoenix Children’s Hospital in Arizona in 2011. Although he might not have entertained the idea a decade earlier, Bailey decided that joining a larger system made sense from both a clinical and financial perspective. Read more

Switching to a Direct Primary Care Medical Practice

Read about family physician Bruce Jung’s transition from staff physician at a community health center in Corbin, KY, to running a solo direct primary care practice. Jung says he’s never enjoyed practicing medicine more since adopting the DPC model, in which doctors typically opt out of working with insurers and charge patients a flat monthly fee for primary care services.  Read more at


Always Trust A Mother’s Hunch: My Experience With a Sick Baby and an Untrusting Doctor

A recent post on caught my eye. The piece was written by Niran S. Al-Agba, MD, a pediatrician, who was reflecting on a distressing moment during her third year of residency. On a busy night in the hospital, a mother requested a re-do of her 6-year-old daughter’s blood work, which had come back normal the previous day. Al-Agba ordered the new test at the advice of her attending but remembers feeling like the mother was being overprotective. Exhausted, she wasn’t feeling very compassionate that night.

However, the mother’s hunch that something wasn’t right proved correct. The lab had missed something in the first test and the girl actually had leukemia. Al-Agba, understandably shaken, returned to her patient to break the bad news.mother child-1298137_1280

“It was during this trying time I learned one of the most important lessons of my career: the value of trusting a mother’s intuition,” she writes.

That really struck a chord in me, and triggered a memory of an experience I had years ago after the birth of my youngest son. I was living in San Francisco at the time and my son was barely a month old. When he started vomiting after eating, I recognized the signs immediately: pyloric stenosis. My oldest son, then 5, had experienced the same symptoms and underwent surgery to fix the problem when he was 6 weeks old. The condition was in my husband’s family; his brother had the same thing 30-plus years earlier.

Pyloric stenosis is a narrowing of the opening leading from the stomach to the small intestine. The enlarged muscle surrounding that opening prevents normal digestion and often leads to projectile vomiting. It is sometimes hereditary and usually develops in boys in the first couple months of life. Surgery involves making a small incision in the enlarged muscle so food can empty into the intestine. While it’s traumatic to witness your newborn undergoing surgery, the procedure is almost always successful nowadays and resolves the problem permanently. But it has to be diagnosed and treated right away.

The whole experience was fresh in my mind when I went to the doctor with my youngest to get a diagnosis. My husband was away at the time and I had my other son in tow. Like any new mother, I was sleep deprived–perhaps more so due to dealing with the vomiting. I explained the issue to the doctor on duty, including the genetic link, but her response was noncommittal. “Babies spit up,” she said. “This could be just normal spitting up. Why don’t you try ipecac and come back in a few days if it gets worse.”

Her attitude infuriated me. I felt patronized and dismissed. I knew the difference between spitting up and projectile vomiting–babies with intact digestive systems don’t project the contents of their stomach halfway across the room, landing with a loud splat against the wall. Plus, I had been through this before.  The doctor wouldn’t budge, though, seeming to regard me as another overanxious new mother. So I asked to see another doctor. I was, she reluctantly admitted, entitled to a second opinion.

The upshot is that my son received the diagnosis and was admitted to the hospital the same day. (Remembering the sight of his tiny body hooked up to IVs and the sound of his desperate cries still makes me feel physically ill, but it all worked out in the end). I know now that this doctor was probably just young, and perhaps in a similar state of exhaustion as Al-Agba during her residency. But I’ve never forgotten the experience and it has colored my interactions with doctors to this day.

What I learned that day was to trust my instincts, ask questions, and demand answers. While I’ve encountered some thoughtful, intelligent physicians over the years, I believe that taking care of my health is ultimately up to me. I do my research and seek out facts. The doctor’s opinion is one voice of authority to be weighed along with others.


My sons: all grown up.

So, when something “just doesn’t seem right” about my children or me, I pay attention to that gut feeling and tell my physician in a spirit of shared decision making. That shouldn’t undercut the knowledge and expertise of my doctor but actually help him or her make a correct diagnosis. Isn’t that what patient-centered care and shared decision making–those frequent buzz words in medicine–are all about? Reflecting on her experience that day, Al-Agba says she learned the “importance of listening to the person who knows their child best, their parent.” I couldn’t agree more.

Becoming a Patient-Centered Medical Home

In 2011, one of Kansas-based St. Luke Medical Group’s major payers approached the 18-office multispecialty group about joining a new quality initiative. The insurer would pay participating practices a monthly per-patient fee for coordinating the care of its members provided that each practice qualified as a Patient-Centered Medical Home (PCMH).  Read more at Physicians Practice…

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