Category: Uncategorized

How Do You Know it’s Time for a New EMR?

EMR (Electronic Medical Record)

I read this blog from Seth Godin (New Times Call for New Decisions) and it struck a chord.

Remember when you bought your first EMR? Perhaps you’re still on it, or you may have changed. Each has its reasons. Here is what Seth wrote:

“New times call for new decisions
Those critical choices you made then, they were based on what you knew about the world as it was.

But now, you know more and the world is different.

So why spend so much time defending those choices?

We don’t re-decide very often, which means that most of our time is spent doing, not choosing. And if the world isn’t changing (if you’re not changing) that doing makes a lot of sense.

The pain comes from falling in love with your status quo and living in fear of making another choice, a choice that might not work.

You might have been right then, but now isn’t then, it’s now.

If the world isn’t different, no need to make a new decision.

The question is, “is the world different now?””

— Seth Godin

Nothing has changed more than Healthcare and in particular, Healthcare IT, EMR, and EHR. We persist because Change is Fear!

In the world of EMR/EHR, implications are more than just fear. They have to do with real costs of change – the cost of moving data from one system to another.

Cost of Change

  • Cost of Training Everyone
  • Cost of productivity – (it takes an average of 3 months before a practice becomes productive on one EMR/EHR system)
  • Cost of Transition – moving data from one system to another

Cost of No Change (Status Quo)

How do you determine if you need to change your EMR/EHR? Here are things that determine if you need to change your system:

  • Seeing less patients per day than you did before EMR/EHR
  • Drop in Revenue (not because of overall healthcare changes)
  • Unhappy staff. Listen to everyone, even if you are happy with the system
  • Inefficient workflow

How do you determine the cost of the Status Quo?

This may require some detailed financial analysis. Compare the cost of change and the cost of no change. If this cost is just incremental, do not change. Think of the analysis you do when you think of re-financing a house. Money saved per month versus the cost of re-financing.

But most important, do not remain stagnant.

Wrong Reason Not to Choose Cloud EHR

A Doctor mentioned today he does not want to use cloud EMR.

Reason? A colleague ‘lost data on the cloud’.

I’m not really sure what that means, but I have a sneaky suspicion that the vendor of that particular cloud EMR system did not provide data when the doctor wanted it, or that the EMR vendor was holding data hostage for a large fee.

In fact, client/server systems are more prone to losing data in the traditional sense. The solution to that problem of not getting the data from a cloud EMR vendor is not to use client-server systems but to do a better job of negotiating upfront and incorporating associated data extraction fees into the contract.

I have seen too many cloud EMR vendors holding doctors’ data hostage and demanding a large sum of money if the doctor wants to switch their EMR system.

What should you do?

Don’t jump from the frying pan to the fire. If you think cloud systems are a problem with your data, client-server systems are even worse – unless you spend a lot of resources managing the infrastructure internally.

Apple and Healthcare IT – Fuzzy Scary Lines

Apple and Healthcare IT

“Apple Could Lead In Healthcare. Here’s Why It Won’t.”

— Dan Munro, Forbes

In his Forbes article, Dan is very clear – Apple will NOT lead in Healthcare.

The choice of words is important. He uses ‘healthcare’, not ‘health’ as in hundreds of health, fitness, and wellness apps such as Fitbit. Real healthcare is in the realm of health monitoring such as blood glucose.

Once we understand this distinction, the implication becomes apparent. Healthcare is highly regulated. Just ask traditional healthcare players how difficult is the environment when it comes to providing products and/or services.

I think Apple is getting heady by trying to control and ‘own’ an entire ecosystem rather than being a part of it and facilitating the system.

What Happened to My Family Doctor?

Bonefide Physician

I had an interesting conversation with a friend of mine. He is (was) a solo practitioner in New York. He is a Pulmonologist / Internist. 5 years ago he started his own practice, getting away from a group practice. I have to mention, that he’s my family doctor too. He was skeptical but entrepreneurial.

Suddenly he decided to go and work for a hospital. What happened?

He was very successful in his practice. Successful in the sense that patients loved him, he had no problem attracting patients and he was busy. So what was the problem?

He was plagued by problems with rising co-pays, co-insurance, and deductibles, he was not collecting enough money. His insurance payments were fine though. With rising patient responsibility, he saw declining revenues. Just at that point, a local hospital he was affiliated with called him and made an offer.
Should he accept this offer or continue to enjoy his freedom with a good practice where not only his revenues were declining but more importantly, his wife was going nuts trying to get patients to pay their outstanding balances?

He found out that the hospital had come to him bypassing other providers in his neighborhood because they knew he was a good doctor who had a great asset – happy patients who referred others to him.

He did his homework of course. He was part of the ‘second wave of recruits’ to the hospital. A few years ago, the hospital approached and hired some good doctors away from their practice. 80% of them were still working there. So, he felt the odds were good. Hospital administration (which he knew) can’t be that bad as goes popular wisdom. So his chances of success would be at least 80%.

Here’s the most important thing – the hospital made a very good competitive offer that was close to what he was netting at his practice.
So, he took the offer. I’m sure his wife had a role to play – she wanted peace and more time to themselves.

Is this the trend? Are we losing independent practitioners? Are we losing our family doctors to the ‘Walmarts’ of medicine?

EMR Differentiator / EMR Success – It is All About Implementation

EMR Differentiator/EMR Success

For those of you who are looking for an EMR software, the number one question you should ask the vendor is, ‘Why is your EMR software different’?

For those of you who have already chosen an EMR software, do you consider your implementation successful?

By various counts, anywhere from 50-70% of clinics are considering switching their EHR software. Some Electronic health record implementations are on schedule with all stakeholders of the practice fully involved in achieving their set goals. Others struggle at the onset and eventually stall; leading to partial or no success.

What is the reason for Failure?

Is it the people involved or the implementation process, or is something wrong with the product? My extensive experience working with providers and clinics for the last 18 years has taught me – it is not that simple.

People, Processes, and Tools

Processes are the binding agent. You need to have the right people, starting with leadership in the practice and having the best Tool (EMR software) for your clinic. Best EMR Software is one that works with your workflow, and technological comfort.

Where it fails most of the time, however, is Processes. I am not going to write in detail about how to do implementation here, but I am going to point out a very important aspect of the Implementation process.

Vendor Involvement.

Too many times, vendors allow practices to dictate the process, whereas practices look for guidance and best practices from the vendor. Vendors should be leading this. I was speaking with a company recently that had decided to take this head-on by putting money where its mouth is. They decided to refund part of the implementation fee if the practice works with the vendor to do proper implementation within an agreed-upon time frame. This simple assertion means that people and tools have to be excellent and someone is willing to take the bull by the horns to project-manage the entire process.  I like this proactive approach and will be eager to learn the outcomes.

How to Select the Perfect EMR / EHR Software?

When you want to select an EHR System or EMR system for your practice, don’t get tied up into small details of functionality, features, etc.

There is really only ONE thing you need to evaluate all systems against.

WILL THIS SYSTEM ALLOW ME TO GO HOME – HALF AN HOUR, 45 MINUTES, ONE HOUR  EARLY EVERY DAY?

Of course, it goes without saying that going home early does not mean taking work home.

There are 3 reasons why providers have to stay back.

1.       Finish Charts – paper or Electronic

2.       Financial worries – pending accounts receivables, accounts aging. … and third

3.       Staffing worries and stress.

Of course, we can’t do much about staffing issues, although, some vendors will be able to help you with that – which you should keep in mind.

So, benchmark all your EMR software systems with respect to this simple criteria – can I go home early?

Practice Marketing – What is Your Address?

When someone – a potential referring physician – asks “What is your address?” your immediate response is perhaps a street address, name of town or general area. Rarely do you blurt out a .com address. You are not alone. You may think you are a physician and the digital address does not matter. But you must make that mind shift, paradigm shift now.

Practice Marketing – What is your Address?

When someone – a potential referring physician – asks “What is your address?” your immediate response is perhaps a street address, name of town, or general area. Rarely do you blurt out a .com address. You are not alone. You may think digital address does not matter. But you must make that mind shift, paradigm shift now.

Make the Shift – Be a Leader

This way of thinking will work in your favor. Your practice may be in a prime desirable location in your city or town. Of course, you are not an ‘online business’ and patients have to physically come to your practice, and yet, so many more existing and prospective patients will visit you online every day. If you are not present online, the same patients will visit the next specialist that is just ‘one click away’.

It is this new-age thinking that matters; it is the virtual web address that counts. This is where your efforts to ‘market’ your practice must begin – with your website.

How do you create a website that is primed to inform, and educate both patients and referring providers?

You have to begin by spending some time defining, refining, and differentiating your ‘Brand’ as a Specialist. Your Brand building begins by translating your strength as a caring Physician who is ahead of the curve in treating patients.

  • Define your Practice in 160 characters or less, leaving medical terminology behind, and speak in layman’s terms.
  • Identify your practice’s three greatest strengths.
  • List the keywords that patients are most likely going to use when searching for the types of services you provide, focusing on the symptoms and ailments they encounter.
  • Describe how you will portray various symptoms and diagnoses in words, images, and videos.
  • Get your patients to describe their experiences on your website.
  • Identify why your patients love you.

What is your Special Sauce?

What makes your practice unique? What makes you unique? Why do patients prefer you versus another Specialist in town? You and your team of clinicians must hash out what makes your practice special. Involve your entire team including the front desk that speaks and connects with patients at a personal level every day. Factors can include:

  • Providers’ deep experience and special education
  • Awards and accolades
  • Staff that builds close, interpersonal relationships with patients
  • References and testimonials from patients as well as referring physicians.
  • Affiliations with Universities, Hospitals, research institutions
  • Media coverage

Videos

Practice Videos and provider videos that show a ‘personal’ and human face to your Clinic are vital in building long-lasting trust and relationships.

You should also put together a plan to get as many patient testimonials as possible – get them on a video if possible.

Finally – don’t ignore Social Media

Social media is sometimes considered a taboo in the healthcare industry. There are reasons for that, and we won’t go into the pros and cons in this blog (I’ll cover that in a future blog), but suffice it to say, executed properly, it becomes a powerful connector with your patients – existing and future.

Patient Centered Front Desk Collections

Customer service, or Patient service in Medical Practices is gathering more prominence. This focus creates confusion and a sense of confusion among practice owners and providers. 

Does Patient Centered service mean not focusing on patient collections? Will patients be unhappy with you? Will you lose patients if you ask for outstanding balance?

Data has shown the exact opposite. Engaging patients in meaningful financial conversation actually creates a positive image of your practice and it’s patient service.

Customer service in Medical Practices

Customer service, or Patient service in Medical Practices is gathering more prominence. This focus creates confusion and a sense of confusion among practice owners and providers.

Does Patient-Centered service mean not focusing on patient collections? Will patients be unhappy with you? Will you lose patients if you ask for an outstanding balance?

Data has shown the exact opposite. Engaging patients in meaningful financial conversation actually creates a positive image of your practice and it’s patient service.

I know you work very hard to take care of your patients and in fact, coach your staff to do the same. Somehow, conversation related to money is left out and avoided at all costs. Everyone feels it inappropriate to talk about money when a patient is in pain. Ironically, if you don’t engage in a comprehensive conversation with a patient including financial terms portrays the wrong image of your practice. Practices that engage in a holistic approach of 360 conversations including money show that you actually care about the overall well-being of a patient.

Consider this all to common scenario:

  1. You fail to collect copay and/or outstanding balances at the front desk.
  2. Patient receives a bill which is generally delayed because you wait for the insurance to pay their part first. By this time, a patient had forgotten about the visit.
  3. When they get the bill after a month or two, they are surprised for two reasons. One, they did not think they owed anything, and second, the staff did not mention that they would get a bill after some time – or better, provide some kind of estimate.
  4. This means the patient did not ‘budget’ for this and spent money elsewhere.
  5. This leads to frustration – they may call their health plan which generally does not help. This leads to frustration. They take it out on – you guessed it, your practice – the front desk person, the biller, and sometimes, even the provider.

We all hate dealing with uncertainty. Spending a little time talking to patients about money goes a long way in patient satisfaction and in the process, keeping your patient aging or patient account receivables low.

In summary, you should engage in and alert patients about statements, and their financial responsibility and even educate them a bit about how their insurance plan works if possible. This is one of the best services you can do for them to maintain a healthy relationship.

How to Tackle Rising Patient Balances

Patient outstanding balances are on the rise. Patient A/R is at it’s highest ever. I am not talking about self-pay patients. Sometimes self-pay patients can be good at paying.
One of the main reason why patients owe you money is because of healthcare plans in force.

There are two main reasons why this situation arises. Both have to do with insurance plans that may be provided by employers.

How to tackle Rising Patient Balances?

Patient outstanding balances are on the rise. Patient A/R is at its highest ever. I am not talking about self-pay patients. Sometimes self-pay patients can be good at paying.
One of the main reasons why patients owe you money is because of healthcare plans in force.

There are two main reasons why this situation arises. Both have to do with insurance plans that may be provided by employers.

  1. Increasing deductibles and
  2. Increasing ‘per-visit’ co-pay amounts

You would think practices have a collection plan in place, but you will be surprised. I have seen established practices that just ‘wing’ it and leave it to the whims of staff and providers to tackle patient balance receivables.

In a recent conversation with a provider whose patient A/R over 90 days was 46% of all outstanding, he was afraid of pursuing ‘collections’ for the fear of losing patients.

It does not have to be an all-or-nothing approach. You need a well-thought-out and effective collections plan and process in place that involves your entire staff.

Here are 5 effective steps you can consider.

  1. At the time of scheduling appointments for patients on the phone, make it a practice to check that patient’s outstanding balance. Of course, this task becomes easy if your integrated EHR/Billing systems allow you to quickly look it up. If patients owe money, they should be politely reminded to pay at that time with a credit card or bring payment at the time of the visit.
  2. When patients check in, check for outstanding balances again and try to collect past balances along with the co-pay for that visit.
  3. If available, take advantage of an automated system of sending patient statements. Good systems allow you to set up ‘rules’ for sending statements. For example, send statements to patients with a balance of $25 or more. Send statements on a monthly basis automatically and monitor how many statements have been sent.
  4. If you have a very large over 90-day A/R, set up a plan including making phone calls to collect the money. This can be a short-term focused campaign to bring down the aging.
  5. Send patients to external collections. This is one of the toughest decisions for a provider. One reason why it is difficult is because there is no plan and system in place. A well-thought-out plan removes subjectivity.

A good internal process coupled with an integrated EHR / Practice Management system can make it seamless to pursue patient collections and reduce A/R.