tag:blogger.com,1999:blog-86259729937373880042024-03-18T05:45:11.611-07:00The Executive SuiteProvides general business tips for small business owners and medical practices.Kelly Schaeferhttp://www.blogger.com/profile/05126811343470643576noreply@blogger.comBlogger3393125tag:blogger.com,1999:blog-8625972993737388004.post-86187406004570074392024-03-18T05:32:00.000-07:002024-03-18T05:32:55.121-07:00Healthcare staffing and reimbursement challenges: How automation and AI can helpAmbulatory surgery centers (ASCs), which proliferated post-pandemic, are a booming business. With the increasing trend towards ASC-based treatments, <a href="https://www.ascfocus.org/ascfocus/content/articles-content/articles/2023/digital-debut/sg2-2023-annual-report-forecasts-significant-growth-in-asc-volume">forecasts</a> predict a 22% rise in ASCs and an 18% increase in outpatient surgical and cardiovascular procedures over the next decade.<br /><br />The<a href="https://www.insiderintelligence.com/insights/aging-population-healthcare/"> increasing population of individuals aged 65 and older</a> is creating a higher demand for ASC and general healthcare services. Currently, this age group accounts for 34% of the demand for physicians, a figure expected to rise to 42% within the next decade. The implications of America’s aging population on healthcare spending are significant. In 2022, healthcare spending was estimated at<a href="https://www.kff.org/health-costs/press-release/updated-health-spending-explorer-features-the-latest-national-data-on-how-much-people-spend-and-who-pays-the-bills/#:~:text=The%20tool%20captures%20just-released,of%20health%20spending%20experiencing%20growth."> $4.5 trillion</a> , but it is projected to<a href="https://www.cms.gov/newsroom/press-releases/cms-office-actuary-releases-2021-2030-projections-national-health-expenditures#:~:text=The%20report%20finds%20that%20annual,annually%20over%20the%20same%20period."> soar to nearly $7 trillion by 2030</a>.<br /><br />Growing demand for ASCs presents both opportunities and challenges, especially in terms of revenue cycle management (RCM) and workforce.<br /><br />Given these challenges, the questions arise: How can RCM departments cope? How can ASCs and other healthcare providers alleviate their reimbursement and staffing pressures, lower operational expenses, boost efficiency, and support future growth to increase profitability?<br /><br />The solution lies in addressing staffing and reimbursement issues through automation and AI.<br /><br /><br /><div><h2 style="text-align: left;">Complexity and claims denials pose a significant challenge</h2><br />Before exploring why automation and AI are the future, let’s size up the challenges.<br /><br />Healthcare administration is becoming increasingly inefficient. About <a href="https://www.aha.org/news/headline/2023-02-02-report-health-care-administrative-transactions-cost-18b-more-last-year">$60 billion was spent on healthcare administration in 2023 – $18 billion more than in 2021</a>. The cost of claim submissions also rose by 83%. This isn't the fault of healthcare providers; it's due to the increasing complexity of systems.<br /><br />Reimbursement has been a persistent issue for RCM departments since the inception of the provider payer system, and it continues to be a growing problem. Claims denial rates are rising by 10% annually. If your denial rate is 10% or higher, you are in the danger zone.<br /><br />The added work and write-offs associated with denials significantly impact your margins and can hinder your ability to manage claim and patient appointment volumes. Each denied claim adds <a href="https://www.beckershospitalreview.com/finance/denial-rework-costs-providers-roughly-118-per-claim-4-takeaways.html">$118</a> to your overhead – that’s $8.6 billion a year for the healthcare system at large.<br /><br />This is in addition to the costs of servicing and processing your existing claims!<br /><br /><br /></div><div><h2 style="text-align: left;">Staffing shortages continue to add cost and introduce errors</h2><br />Healthcare organizations are facing a workforce gap, which is growing exponentially.<br /><br />Employee turnover in RCM is as high as 40%, significantly greater than the overall employee turnover rate of around 3.8%. Frequent departures from RCM roles mean that existing employees have to take on more work, or healthcare providers must consistently invest resources to recruit, hire, and train new staff.<br /><br />The constant cycle of recruitment, staffing, and training incurs significant costs. Replacing an employee can cost up to twice their annual salary. New and overloaded employees are more likely to make errors. Furthermore, 80% of healthcare professionals believe that labor shortages can negatively impact patient experience.<br /><br />The double blow of staffing and reimbursement challenges is hitting healthcare providers hard<br /><br />Healthcare providers often attempt to tackle either reimbursement difficulties or staff shortages separately. However, these two challenges are closely interconnected.<br /><br />An increased RCM backlog results in an overwhelming workload for your team. This puts pressure on your staff, leading to decreased job satisfaction and increased turnover.<br /><br />Insufficient staffing exacerbates reimbursement challenges. Overworked staff members are more likely to make errors and struggle to keep up with the volume of work.<br /><br />Increased reimbursement difficulties, such as a rise in denied claims due to more errors, require even more staff.<br /><br />Historically, the solution was to hire more people to handle the increased workload. However, given the current labor shortage, this is no longer a viable solution. It only perpetuates a downward spiral.<br /><br /><br /></div><div><h2 style="text-align: left;">Automation and AI are the solution</h2><br />Automation and AI offer speed, infinite scalability, and efficiency, which can enhance both customer and employee experiences, making your business more efficient and profitable.<br /><br />Our experiences with customers have shown that AI and automation can perform the same tasks while reducing operating overhead by 80-95%. They can make each employee ten times more effective, retain top talent, enhance patient experiences and outcomes, and eliminate the need for hiring for administrative jobs.<br /><br />From a reimbursement standpoint, AI can improve Days Sales Outstanding (DSO) and cash cycles by over 50%, reduce claim denials by up to 75%, and provide unlimited transparency and reporting (as AI can self-report). This can further improve providers' RCM processes.<br /><br /><br /></div><div><h2 style="text-align: left;">Path to scalability, profitability, and better outcomes</h2><br />To determine if your organization is a good candidate for automation, evaluate your employee headcount and business revenue. If you have at least 20 people working on RCM, automation could yield significant return on investment. If your business generates $100 million in net patient services, this also suggests that automation could be highly beneficial.<br /><br />Begin by identifying tasks that could be easily automated. Eligibility verification is often a prime candidate for improvement due to the substantial amount of human labor it requires. Automation can also significantly enhance claims processing efficiency.<br /><br />Find a partner with the resources to continually invest in research and development. This will allow you to collaboratively improve and grow. Opt for a provider that offers end-to-end automation, uses predictive models to provide insights, gives you an edge in running your revenue cycle more effectively, and is committed to customization and adaptation.<br /><br />Adopt a comprehensive approach to automation to tackle both staffing and reimbursement challenges. 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These studies are always startling due to the confusion associated with how the people living in the wealthiest nation find themselves in such a position and, more concerning, why we aren’t more aggressive in reversing these trends. For me, the answer is simple: we continue to turn to the same solutions that continue to misidentify and misvalue the true drivers of health. Oddly, this brings me to Michael Lewis.<br /><br />I recently listened to an episode of the <a href="https://protect-us.mimecast.com/s/pW0TCxkmBmSRvn5RTvBjlG?domain=freakonomics.com/">Freakonomics Radio Podcast</a> featuring author Michael Lewis. The episode, revisits his bestselling book, “Moneyball.” In the book, Mr. Lewis writes, “If gross miscalculations of a person’s value could occur on a baseball field before a live audience of 30,000 and a television audience of millions more, what did that say about the measurement of performance in other lines of work? If professional baseball players could be over or undervalued valued, who couldn’t?”<br /><br />Well, Mr. Lewis, let me tell you about primary care physicians.<div><br /><h2 style="text-align: left;">The scoreboard</h2><br />Just as was the case in baseball, our health care system is prioritizing and investing in the wrong things. As a result, we aren’t winning games. In fact, we are losing games at an alarming rate. One recent analysis shows per capita spending on health care increased even while new data from the Centers for Disease Control and Prevention show that life expectancy continues to decrease in the United States. Not to mention the proliferation of chronic disease and our alarming maternal mortality rates.<br /><br />These two studies aren’t outliers. Each year, the Commonwealth Fund publishes a report that shows the same two distinct results: the U.S. underperforms in most categories associated with quality and patient outcomes; and we spend far more money on health care than any other country – in some cases, twice as much.<br /><br />Our health care marketplace and those who design benefits continue to grossly misvalue primary care and, some would argue, overvalue other disciplines of medicine. In the United States, on the best of days, we spend about 5% of our health care resources on primary care. Despite research demonstrating that communities who invest in primary care have better health outcomes we continue to operate a benefit structure that disincentivizes the utilization of primary care. This approach has consequences, and those consequences are poorer health outcomes and excessive per-capita spending on health care.<br /><br />In “Moneyball,” Mr. Lewis explains that the main reason many baseball players were misvalued or overvalued was “vividness bias,” “the tendency to overweight the vivid and prestigious attributes of a decision and underweight less impressive issues.” Vividness bias is widely present in health care as well, we just don’t talk about it.<br /><br />At risk of upsetting many people, I get it. The work done by primary care physicians isn’t always “exciting.” In fact, primary care is to health care what the sixth pitch at bat is to baseball – slow, methodical, not flashy yet fundamentally consequential to long-term, sustained success. In our case, long-term, sustained success is better health. As individuals and as a society, we glamorize actions we perceive to be heroic. We celebrate those actions that produce immediate results and have a visible risk/reward calculation. These are the home run hitters in medicine, and we need them. They do amazing things that produce immediate results and benefit patients.<br /><br />However, what we don’t celebrate is the 40-minute visit during which a primary care physician methodically works with a patient to discuss their four chronic conditions, makes certain they are up to date on cancer screenings and vaccinations, takes the necessary steps to ensure the patient has housing and food security, and counsels them on how to deal with a challenging life situation that is making their health conditions worsen. This is primary care – slow, methodical, and foundational to the health of the individual and our communities.<br /><br />Comprehensive and continuous primary care has been proven to facilitate better health, but we continue to focus our spending on the homerun hitters of medicine. This may seem appropriate to some, but there is a cost being paid. That cost is the health of our fellow citizens and our communities.<br /><br />Mr. Lewis noted in the interview that over the past two decades there have been endless efforts to “Moneyball” every industry in our economy. However, he also noted that there are people and industries that “are finding better data, analyzing it in different ways and coming to pretty radical different conclusions about how this should be done.”<br /><br />This describes primary care perfectly. We have found better data, we have analyzed it differently, and we have come to radically different conclusions about how health care should be provided and financed. An ongoing, continuous relationship with primary care increases life expectancy and reduces health care costs. Primary care is associated with reductions in health disparities and a more equitable health care system.<br /><br />The hero of Moneyball is Billy Beane, the former general manager of the Oakland Athletics who challenged the legacy model in baseball to pursue a different approach. The good news for primary care is there are a lot of Billy Beanes out there pursuing a better, more patient-centered approach to health care. 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I have a new favorite secret weapon, and it’s an app. Never thought those two phrases would go together. It combines the best of patient/<a href="https://www.physicianspractice.com/view/staff-salary-survey-results-2023">employee surveys</a> and focus groups, and I am using it to help with <a href="https://www.physicianspractice.com/view/how-to-use-pay-transparency-to-improve-employee-retention-and-recruitment">employee retention</a>, market differentiation, and planning.<br /><br />This app is called SEEQ, and it is the creation of the team at ShareMoreStories. As a beta user, I am using it to test my theories about care differentiators and to capture insights into what we are doing swell and what we can do even better.<br /><br />I will use one of my patient projects to show how it works. I started with a question: What Differentiates Us? We have four cornerstones – 1) a staff who is happiest making others happy; 2) private rooms; 3) heated infusion recliners; and 4) a cost about half of hospital infusions. I wanted to know what is most important to our patients.<br /><br />The old way of getting this information would be to ask them to rank those four options and maybe give them a fifth ‘other’ option. I would get the prioritization, but none of the emotion or insight tied to the ranking. That’s where SEEQ comes in. Patients share their stories, in their own words. It brings depth, it brings ‘aha’ moments. The SEEQ app uses AI to bring further insight into these stories along several emotional continuums. It is amazing.<br /><br />Here are some of the things I learned in this little project:<div><ol style="text-align: left;"><li>Patients value consistency in their care and find it increasingly rare. Our consistency is a core differentiator.</li><li>Patients really appreciate that we get prior authorizations. Other infusion sites do not, putting the patient in the middle all too often. We take on the hassle for them, and they notice.</li><li>Patients confirmed what I suspected: our staff is the biggest differentiator. Private rooms and heated chairs are certainly unique in our marketplace, but what elevates us is our team.</li><li>Handwritten thank you notes remain in style. Since no one writes them anymore, they carry extra specialness with patients.</li><li>Cost is a differentiator. Referring providers are telling patients that Infusion Solutions is not only better, it’s also less expensive. That’s music to my ears.</li></ol><br />Everyone worries about employee retention, yet too few employers use patient feedback effectively as a retention strategy. I use patient stories to reinforce our mission – One Happy Patient At A Time – and have had some amazing conversations with my team talking about the difference we are making in patients’ lives. They like to know they are making a difference. Guess what? We have much less turnover than most healthcare providers.<br /><br />Back to SEEQ: I play a flat monthly rate and am able to create as many projects as I want. How can I learn from referral coordinators what we can do to make their jobs easier? What do my teammates enjoy most/enjoy least about working at Infusion Solutions? I think SEEQ would be very effective in garnering insights from employees by role in a larger organization. Would extending our hours differentiate us? If I have a hypothesis, I can test it quickly and get exceptional insights.<br /><br />All of us have conducted patient or employee surveys that provide one-dimensional quantitative feedback. Very few of us have conducted focus groups that provide one-dimensional qualitative feedback. SEEQ is the first product I have seen that combines both quantitative and qualitative feedback.<br /><br />I mentioned earlier that SEEQ is an app. The app is where folks answer a few questions (like old-school survey tools) and then share their stories. It is easy and intuitive, even for an old guy like me. You can learn more <a href="https://sharemorestories.com/seeq-app-overview/">here</a>; I think they can do a better job of explaining it than I have.<br /><br />I have been surprised that so many patients enjoy writing about their experiences. I have been very pleased with how the SEEQ AI distills and discerns common feelings, insights, and differentiators. I feel l know what matters most to our patients, our referring base, and my employees. Those insights are critical to shaping our future, one happy patient at a time.<br /><br />In the last stages of my career, I look back at when I was most effective or least effective, when my practices were most successful or least successful. The common denominator for the best times was that the patient came first. Margin followed Mission. The worst of times were when we had it backwards. SEEQ keeps my focus on the mission. If I focus on patients and employees, everything falls into place.</div><div><br /></div><div>________________________________________<br /><br />Lucien W. Roberts, III, MHA, FACMPE is a semi-retired practice administrator and long-time writer for Physicians Practice and Medical Economics. 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Indeed, <a href="https://www.bain.com/insights/2023-healthcare-provider-it-report-doubling-down-on-innovation/">KLAS Research and Bain & Company</a> found that 58% of health system leaders are working on an AI adoption strategy or already have one in place.<br /><br />Healthcare providers of all types have identified <a href="https://www.physicianspractice.com/view/5-ways-ai-is-different-in-health-care">AI use cases</a> across clinical, administrative, and other categories. According to KLAS and Bain, the top priority for IT investment at health systems and hospitals is revenue cycle management (RCM), which also ranks as the second-highest priority for physician groups. This category rises to the top because of its direct <a href="https://www.physicianspractice.com/view/7-ways-coding-automation-is-vital-to-capturing-reimbursement">impact on revenue</a> and cost as well as its near-term ROI realization.<br /><br />Given the momentum behind AI for RCM and other categories, how can providers position themselves to reap the benefits? The first step is to establish effective AI leadership.<br /><br /><h2 style="text-align: left;">3 ways to develop AI expertise</h2><br />With the pace of change and the proliferation of offerings, staying on top of AI opportunities can feel like a full-time job. Indeed, some organizations have started setting aside part-time or dedicated roles focused on AI. However, there are other options for providers to stay informed, identify opportunities, and implement AI successfully. Here are three reliable ways to develop AI expertise for provider organizations with varying goals and sizes.<br /><br /><b><u>1. Chief AI Officer (CAIO):</u></b> Health systems are catching on to the necessity of having some form of <a href="https://www.beckershospitalreview.com/innovation/viewpoint-why-health-systems-should-have-a-chief-ai-officer.html">AI leadership</a>, with the role of <a href="https://www.nytimes.com/2024/01/29/technology/us-jobs-ai-chatgpt-tech.html">Chief AI Officer growing in popularity</a>. As AI efforts expand, more organizations will likely install a Chief AI Officer or similar executive over time.<br /><br />Some of the largest health systems, including Mayo Clinic, UC Davis Health, UCSF Health, and UC San Diego Health, appointed CAIOs in 2023, responding to the dramatic pace of change with AI. According to Becker's Healthcare, Dr. Bhavik Patel, CAIO at Mayo Clinic, believes that the <a href="https://www.beckershospitalreview.com/digital-health/how-chief-ai-officers-can-benefit-health-systems.html">position will foster inter-departmental collaboration</a>, keep organizations abreast of trends, and maximize the health system's use of resources. He explained: "While AI brings forth myriad benefits, it also carries inherent risks … a CAIO provides the necessary oversight to ensure that the implementation of AI is ethical, responsible, and in line with regulatory guidelines."<br /><br />As the CAIO role is relatively new, there isn't yet broad consensus on the responsibilities or ideal profile. But some of the first systems to appoint CAIOs have chosen leaders with a unique blend of both medical and technical expertise, such as doctors with data science backgrounds.<br /><br /><b><u>2. AI governance group:</u></b> An AI committee or other oversight group has the advantage of keeping multiple people engaged, allowing for a well-rounded approach to AI. When building a committee, organizations should include several functions and departmental voices, such as IT, security, finance, and clinical leadership.<br /><br />For example, UNC Health's chief analytics officer, Rachini Ahmadi-Moosavi, <a href="https://www.hcinnovationgroup.com/analytics-ai/artifical-intelligence-machine-learning/article/53073629/unc-health-developing-a-responsible-ai-governance-model">told </a><a href="https://www.hcinnovationgroup.com/analytics-ai/artifical-intelligence-machine-learning/article/53073629/unc-health-developing-a-responsible-ai-governance-model">Healthcare Innovation</a>, "When we really started to think about AI … the need for ensuring that we are doing that build responsibly and we are providing the best possible solutions to our healthcare system — whether we build it ourselves or we purchase it from a vendor — comes into question." This desire led to UNC Health developing a multi-disciplinary group whose goal is to define and operate a "responsible" AI framework.<br /><br /><b><u>3. In-house point person: </u></b>An organization may also opt to choose an existing employee to become an expert in all things AI. In this case, the company needs to budget adequate time for the employee to build familiarity with the technology. Moreover, some investment in this expert's professional development – such as including them in conferences like the <a href="https://ai4.io/vegas/">Ai4 Conference</a> or the <a href="https://ent-gen-ai-summit-west.com/events/enterprise-generative-ai-summit-west-coast">Enterprise Generative AI Summit</a> to stay informed – is likely needed.<br /><br />What model makes sense for your organization depends on your goals, AI mandate, organizational structure, and resource constraints. For example, a health system with lofty ambitions for AI may opt for a CAIO, as a high-profile leader is needed to drive a large new agenda. In contrast, many physician practices may start by tapping an in-house AI expert. This path requires the least investment upfront, enabling providers to gain expertise despite tough budget conditions. Organizational structure plays a role too. Top-down organizations may benefit from the centralized authority of a CAIO. In contrast, a decentralized structure may function better with an AI committee representing a broad stakeholder set.<br /><br /><h2 style="text-align: left;">Impact of AI competency on practices</h2><br />Regardless of the model chosen, making a deliberate effort to build AI expertise provides the leadership needed to guide organizations through a fast-changing market and to secure the first few successful applications of AI. The impact of this competency appears in at least three ways: clearer agendas, improved buying processes, and company-wide education.<br /><br />Given the plethora of use cases, the individual or group tapped to lead AI efforts will first aid the organization in aligning concrete priorities. Similar to how KLAS and Bain have surfaced the priorities for many providers' IT investments, the AI leader will deliver a set of focus areas to limit distraction. An administrative application such as AI coding or AI scribe will often rise to the top because of its clear ROI and non-clinical purpose.<br /><br />Besides clarifying priorities, the AI expert will enable stronger buying processes and more comprehensive vendor sets. As there are no universal standards for adopting AI, this expert's attention will adapt existing procurement processes for AI consideration, clarifying decision-making criteria and expectations. Moreover, by engaging in the industry and attending conferences, this AI leader will surface the most compelling vendors and solutions available.<br /><br />Finally, the individual or group dedicated to AI will help to foster company-wide education, acting as a sounding board or problem-solver for AI considerations. In tough labor markets, this visible commitment to innovation can provide an edge: <a href="https://www.bcg.com/publications/2023/how-to-attract-develop-retain-ai-talent">Younger candidates have higher expectations for technology</a> to improve their day-to-day experiences, as BCG notes.<br /><br /><h2 style="text-align: left;">Unleashing full potential</h2><br />Building AI leadership is no longer a choice but a necessity. Successful adoption of AI for providers requires more than just technological know-how; it needs strategic vision, effective communication, and a culture of innovation. 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Up until the 1970s, everyone pretty much agreed, and primary care was the anchor of our health system. But in response to new reimbursement rules put in place by the government and insurance carriers, hospitals began looking at <a href="https://www.physicianspractice.com/view/the-role-of-in-home-services-in-primary-care">primary care</a> as a loss leader to get the more lucrative referrals in the door so they could consume expensive services like imaging, cardio work-ups, and colonoscopies.<br /><br />So, hospitals <a href="https://www.physicianspractice.com/view/how-did-healthcare-get-to-this-point-">bought up</a> most of the independent primary care practices and layered on fee-for-service arrangements that compensated providers for volume but not value. A few decades into this test, everyone except the hospitals and the carriers are worse off. Americans are sicker and paying more than ever. Providers and health care workers are burned out and leaving the profession in droves. And fewer med students are electing primary care as their specialty.<br /><br />Terry Layman, MD, graduated from Indiana University Medical School back in the ‘90s, completed his residency in family medicine, and dutifully returned home to the small town of Marion, Indiana, where he had visions of becoming a physician superhero, ready to change the world. After 20 years of playing the game, his dreams were dashed. “My income was determined by how cleverly I coded, which was determined by how many procedures I did or how sick my patients were. The sicker my patients and the higher my code … the more I got paid. I was continuously battling the hospital, the insurance company, and even my own patients. It broke my heart to leave, but I knew there had to be a better way to practice,” Layman said.<div><br /></div><div><br /><h2 style="text-align: left;">A new model of care delivery</h2><br />The good news is there’s a new model of care delivery with independent primary care at its core that has the power to reverse all those trends. A care model where providers are encouraged to spend more time with their patients and where the scoreboard prioritizes health outcomes, not visits per day. The model is advanced primary care (APC) delivered directly through employers.<br /><br />APC is different than traditional primary care for three reasons. First, the primary care provider is the true quarterback of care and proactively manages a panel of patients to help them keep up on annual physicals, close gaps in care, and improve or prevent chronic conditions. Second, the care team provides steerage in the form of data-driven referrals for specialty care, and third, the APC provider puts their fees at risk to increase their accountability for driving meaningful health improvements.<br /><br />Think of it like an employer-sponsored accountable care organization (ACO). The two biggest health care payers in the U.S. are the federal government and employers. Nearly 150 million Americans get their health coverage at work and about 65% of those plans are self-funded, according to the Kaiser Family Foundation. So employers have some serious skin in the game to see their health economics change. Not only is it good for their business to pay less for health care, it’s also good for business when their employees feel better because it means less sick days and higher productivity. Employers are tired of waiting for the government to fix it, so they’ve begun partnering with employer-sponsored health companies to fix it themselves.<br /><br />Physician Assistant Steven Gilles worked in a university health care system for 15 years before departing for the employer model two years ago. “The continued pressure to produce and see more patients with less resources was – and is – a recipe for burnout. I want to be in an environment that allows me to provide full-spectrum primary care in the way patients deserve – unrushed, authentic, and easily accessible. I love the culture at our employer health center. Every single person I interact with says, ‘It’s better here.’”</div><div><br /></div><div><br /><h2 style="text-align: left;">APC in practice</h2><br />There’s a handful of companies today who deliver this type of employer health model. One of those is Marathon Health, where I serve as the CEO and cofounder.<br /><br />We founded Marathon Health in 2005 with the express goal of delivering independent primary care to save employers money on their health expenses. Today, we do that by operating dedicated and shared physical and virtual health centers exclusively for employers. According to a 2021 Worksite Health Center Study by Mercer and the National Association of Worksite Health Centers, 31% of employers with 5,000 or more employees offer a health center as part of their benefit package. And we staff our health centers with advanced providers, including MDs, DOs, nurse practitioners and physician assistants, behavioral health specialists, physical therapists, pharmacists, health coaches, nurses, and medical assistants. Each of those specialists working as an integrated care team is a critical part of our model. We also have referral teams that manage any specialty referrals outside of our health center. Our referral team is armed with the patient’s health plan design, and ratings and pricing information from Garner Health, to ensure that we recommend a high-quality, low-cost provider. The team even secures any necessary preauthorizations and schedules the appointment. That white glove service helps deliver a 60% close rate on all referrals, with all the outside data piping back into our electronic medical record (EMR) so our primary care team remains the quarterback of care.<br /><br />The other thing providers love about operating in this model is not having to deal with payer nightmares. “I don't have to click 100 buttons in my EMR because the payer is tracking my use and tying it to reimbursement,” explains Gilles. “And even if there is a payer situation, I don’t have to understand the quirks of 10 different payers because the employer only uses one.”<br /><br />Cleveland-based National Director of Physical Therapy Jon Strychasz is hooked. “Having the ability to take the time to work with patients so they are engaged and have a say in their health care journey is what makes this a different type of health care.”<br /><br />Fast-forward 18 years and we’re seeing incredible results. We’re far past the sandbox and driving toward real scale that can be the tipping point to reverse those trends we talked about earlier.</div><div><br /></div><div><br /><h2 style="text-align: left;">Empowering care teams</h2><br />We use the Quadruple Aim of health care to gauge our success which measures outcomes in four key areas – provider experience, patient experience, health outcomes, and financial savings. To create a great provider experience, we want to empower our care teams to build trusted relationships with their patients, so they feel inspired to make behavior changes. Our providers spend an average of 32 minutes with every patient. Because face it, you can’t fix the macro health care problems by only seeing acute cases or only spending seven minutes with a patient like in a traditional setting. To transform health care, we must catch disease early and manage chronic conditions better. Those extra visit times allow for true conversation to happen, for better questions to be asked, and for root causes to be teased out. In seven minutes, you’re not going to learn that a patient with diabetes is also depressed and lives in a food desert. Among annual visits, 65% are preventive, and we have 93% provider retention. “I’m able to be the provider I went to school to be,” says Elizabeth Timpe, a nurse practitioner in Port Charlotte,</div><div> Florida.<br /><br />Those empowered care teams are an essential piece to delivering a great patient experience. Getting the employees to engage with our health centers is critical. If we don’t do that, then we can’t make them healthier and we can’t save our clients – their employer – any money. So, we invest a lot in driving strong engagement and have developed a repeatable recipe for success. When employers adopt our best practices, they see engagement of 73%. We’ve got some employers with engagement higher than 90%! Patients that visit our health center come 3.1 times per year on average and report 96% satisfaction.<br />Aligning with employers<br /><br />Another reason this model drives such strong engagement is the close alignment our providers have with the employer population. Every workforce is unique – from the way they work to the way they consume health care to the biggest conditions that are driving their spending. Strychasz, the physical therapist in Cleveland, actually goes on the job site of his union laborers and electricians to understand how their physical work impacts their musculoskeletal health. Because of this intimate understanding, he’s able to develop tailored rehabilitation plans and preventive programming. That alignment also builds stronger trust between the employee and the provider. “They are certainly not accustomed to their health care provider taking such a vested interest in their workplace stressors,” explains Strychasz, who often parlays that trust into a successful introduction into the primary care provider.<br /><br />Gilles agrees. “This setting has more variety and offers more opportunities to interact with patients on a regular basis in what feels like a community. Rather than fighting with employer demands, you become part of the culture.”<br /><br />With strong engagement, we can drive great health outcomes. We use an 18-month look back to track longitudinal engagement. Through year-end 2022, 69% of engaged patients had improved on one or more biometric markers; 65% of engaged hypertensive members were at clinical blood pressure goals, and 55% of engaged diabetic members achieved their clinical A1C goal. We also saw a 19% reduction in emergency department visits among engaged patients.<br /><br />Improvements in those categories, in addition to the referral savings we drive, have delivered more than $1 billion in health plan savings for our employer clients. Every engaged patient costs their employer $2,000 less per year than employees who do not engage with our health centers. We’ve also helped them recruit and retain great talent because employees love this free health care benefit.</div><div><br /></div><div><br /><h2 style="text-align: left;">Too good to be true?</h2><br />Sounds too good to be true, right? It’s not. Our two biggest growth drivers are getting more employers to adopt the benefit and attracting more providers to deliver it. Today, about 30% of employers offer a health center. Our employer pipeline is bigger than it’s ever been, and we’re actively working to grow our infrastructure and talent pools to support all that demand.<br /><br />“The traditional system just wasn’t designed to incentivize long term health and wellness, but the employer health model aligns the interest of the patient, the payer (the employer in our case) and the provider,” says Layman, who’s been working in the employer model for 11 years. “I’ll never practice the old way again. 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Several new players, including CVS and Amazon, have stepped in to meet these expectations, thereby creating new competition for traditional health care systems and setting a higher bar for delivering care on demand.<br /><br />At the same time, revolutionary medical inventions, such as powerful <a href="https://cdn.sanity.io/files/0vv8moc6/medec/efefd0fba7cc0edaab1300a157123f2f1cc03c13.pdf/ME0723-ezine.pdf">AI-driven tools</a>, robotic surgery systems, wearable devices, hologram hospitals and 3D printing offer up seemingly endless new possibilities for advancing care delivery.<br /><br />To navigate this era of seismic change and disruption, health care organizations continually turn to technology, recognizing the power it has to deliver both better care and competitive advantage. A <a href="https://www.bain.com/insights/2022-healthcare-provider-it-report-post-pandemic-investment-priorities/">report</a> from Bain & Company shows that digital transformation has become a top-three strategic priority for almost 40% of health care organizations surveyed and a top-five priority for nearly 80%. This year, more than 95% of them expect to make new software investments, with one-third planning significant new investments.<br /><br />Before investing in technology, however, it’s important to understand which technologies will enhance health care delivery and offer the greatest benefits to patients, and then prioritize spending based on this information. Let’s look at key considerations for health care leaders as they invest in innovation in this new arena:<br /><br /><br /><div><h2 style="text-align: left;">Prioritize higher quality care with greater access and convenience</h2><br />With a staggering number of next-generation health care solutions entering the market each year and a persistent level of hype around their potential, health care leaders can become quickly overwhelmed by choice and “Fear of Missing Out.” More than 50% of those surveyed for <a href="https://www.bain.com/insights/2022-healthcare-provider-it-report-post-pandemic-investment-priorities/">Bain’s report</a> said they are struggling with the magnitude of offerings. For many, their technology infrastructures have become overloaded since the pandemic, and they’re confused about how new additions will fit.<br /><br />They are smart to consider which innovations align with actual organizational goals. For most health care practices, providing better care and making it easier for patients to access that care are among the top objectives. Technology can help by expanding what is currently possible and making care delivery more connected, convenient and accessible.<br /><br />The Joint Commission and National Quality Forum recently recognized a solution that exemplifies this sort of investment, Kaiser Permanente Northern California’s Advance Alert Monitor (AAM) program, an early detection system that helps care teams predict when hospitalized patients are at risk for clinical deterioration. Developed by physician researchers at Kaiser Permanente Northern California’s Division of Research, the solution uses a predictive algorithm to scan nearly 100 elements from patient health records, hourly, at 21 hospitals in Northern California. It provides clinicians a heads up 12 hours in advance of clinical deterioration, permitting early detection and intervention.<br /><br />Analysis published in The New England Journal of Medicine found that AAM was responsible for preventing on average 520 deaths per year in KP Northern California hospitals. Its use also showed a lower incidence of intensive care unit admissions and shorter hospital stays by equipping physicians with information and helping patients get faster access to care.<br /><br />Other ways AI-driven tools support both clinicians and patients include reading risk-related imaging biomarkers on screening images to predict cancer risk, predicting disease trajectories, and remotely monitoring vital signs to manage chronic conditions. New generative AI technologies offer support by freeing clinicians’ time for patient care. For example, by automating time-consuming tasks such as documentation, AI can enable physicians to focus more on patients instead of the computer screen during office visits. According to <a href="https://www.mckinsey.com/industries/healthcare/our-insights/tackling-healthcares-biggest-burdens-with-generative-ai">McKinsey and Company</a>, generative AI alone can unlock $1 trillion of improvement potential in health care.<br /><br />These powerful technologies, and others like them, are game changers for patients, for saving lives, and for the physicians and clinicians who use these resources to deliver better care.<br /><br /><br /></div><div><h2 style="text-align: left;">Embrace change, ensure agility</h2><br />Pursuing innovation requires health care organizations to overcome significant hurdles, such as siloed thinking and fear of change, as well as external factors including economic uncertainty, inflation and pressing workforce shortages. It may require changing how they currently prevent, diagnose, monitor and treat to enable breakthrough performance.<br /><br />Despite the challenges, health care organizations need to fearlessly pursue change that leads to higher levels of excellence. This requires incorporating innovation into business models by first asking important questions, including: How can we improve our operations? How can we make sure our patients are heard? How can we alleviate physician burnout? And how can we empower our physicians and clinicians to work together as teams to deliver next-level care?<br /><br />Continual improvement requires addressing these questions in a very intentional way, with a high speed of execution. For example, we can improve our operations, address patients’ desire for more convenient and accessible care and empower teams to deliver next-level care without burnout by delivering more care via remote patient monitoring and advanced-care-at-home initiatives.<br /><br />Technology will continue to evolve the health care industry, offering better ways of caring for patients and running the business of care. 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For example, the life expectancy gap between Black and white Americans is nearly <a href="https://www.kff.org/racial-equity-and-health-policy/report/key-data-on-health-and-health-care-by-race-and-ethnicity/">six years as of 2021</a> – 70.8 years compared to 76.4 years.<br /><br />This disparity is especially significant when it comes to heart health. Research shows Black Americans have higher age-adjusted <a href="https://www.kff.org/racial-equity-and-health-policy/report/key-data-on-health-and-health-care-by-race-and-ethnicity/#:~:text=Black%20people%20also%20had%20higher,people%20had%20lower%20death%20rates">heart disease death rates</a> than white Americans, American Indians and Alaskan Natives (AIANs), Hispanic Americans and Asian Americans. Black people in the U.S. also have disproportionately high rates of hypertension, which affects <a href="https://www.heart.org/en/health-topics/high-blood-pressure/why-high-blood-pressure-is-a-silent-killer/high-blood-pressure-and-african-americans">more than half of Black adults</a>.<br /><br />Several factors contribute to this imbalance, but one significant cause healthcare providers can help address is unequal access to medical services. In particular, the lack of cultural competency and even racism Black Americans <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-13122-y">experience in the healthcare system</a> may dissuade them from seeking lifesaving medical services. By working to deliver care in a more equitable manner, healthcare providers can help bridge the racial gap in heart disease prevention and treatment.<br /><br /><br /><div><h2 style="text-align: left;">Racial inequalities in heart health</h2><br />Black communities are more likely to face barriers to care. This can leave them at a greater risk for heart disease and allow serious health conditions to go untreated.<br /><br />Black people with atrial fibrillation are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3815541/#:~:text=Blacks%20are%20less%20likely%20than,minorities%20has%20had%20limited%20investigation.">one-third as likely</a> to know they have the condition as white people, due in part to lack of access to proper monitoring for conditions like hypertension and diabetes, which increase the risk of AFib. Black Americans are also <a href="https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.121.318243">more than twice as likely</a> to develop peripheral arterial disease (PAD), and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152619/">two to four times more likely</a> to undergo amputation after being diagnosed.<br /><br />Research suggests heart disease could be better managed in <a href="https://www.aeaweb.org/articles?id=10.1257/aer.20181446">Black patients who visit Black physicians</a>. Such patients are more likely to develop a relationship with their doctor and engage in health promoting preventive care. Another study conducted by NYU Grossman School of Medicine and NYU Langone Health reported patients with hypertension and symptoms of cardiovascular disease were more likely to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440568/">follow medication guidelines</a> if they were treated by doctors of the same race. It's even been found that <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2803898?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=041423">Black people may live longer</a> in areas with more Black primary care physicians.<br /><br />Despite the benefits, while Black Americans represent 13% of the population, only <a href="https://www.heart.org/en/news/2020/04/15/why-black-cardiologists-are-vital-and-rare">3% of cardiologists are Black</a>. This is even lower than the <a href="https://www.aamc.org/media/63371/download?attachment">rate of Black physicians</a>, which is about 5.7%.<br /><br /><br /></div><div><h2 style="text-align: left;">How physicians can address disparities in care</h2><br />Diversifying the medical field is one of the most significant ways we can address unconscious bias and systemic discrimination in healthcare, and it’s critical to ramp up recruitment and retention of underrepresented groups in the medical field. Early outreach, mentoring and tutoring will help Black students successfully pursue careers in health.<br /><br />But more immediately, healthcare providers can take steps today to ensure they are prepared to care for all patients equitably. One study found 10.6% of Black patients <a href="https://www.rwjf.org/en/insights/our-research/2021/03/perceptions-of-discrimination-and-unfair-judgment-while-seeking-health-care.html">reported experiencing discrimination or unfair judgment</a> while seeking healthcare in 2020, which reveals healthcare providers, like all people, are guided by <a href="https://pubmed.ncbi.nlm.nih.gov/25032386/">implicit biases</a>. To ensure compassionate, unbiased care, physicians should understand the impact of race on health and be able to communicate effectively with patients from different backgrounds. Cultural competency education should be required in medical school and continue with regular training for practicing professionals. Studies have found strategies like stereotype replacement, counter-stereotype imaging, individuation, perspective taking and increasing interracial contact can help <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406315/">reduce prejudices</a>.<br /><br />For many Black Americans, anticipated costs are a barrier to getting care, so another way to make healthcare more accessible is to ensure patients understand the best places to seek treatment depending on their needs. Healthcare providers can help educate the communities they serve about the services provided at primary care facilities, urgent care facilities and emergency rooms and the costs associated with each. For example, a greater emphasis on primary care can help reduce unnecessary specialist visits and reduce healthcare costs overall.<br /><br />Healthcare providers can also implement outreach initiatives and chronic disease management programs to help advance knowledge about heart health in affected communities. 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A good competitive analysis is a scouting report of the actual market terrain that your practice must navigate in order to be successful. While analyzing the competition is an essential component of your <a href="https://www.physicianspractice.com/view/planning-your-practice-s-2024-strategy">strategy</a>, most medical practices don't conduct this type of analysis systematically enough. However, a thorough competitive analysis is indispensable.<div><br /></div><div><ol style="text-align: left;"><li>Begin by compiling a list of your practice's competitors. Most of the time, such a list is comprised of who your practice considers to be its chief competitors. However, there may be other healthcare organizations that indirectly compete with yours, perhaps ones outside of your catchment area that offer services such as telemedicine or niche treatment modalities that are aiming for the same patients. You will also want to include information on healthcare entities that may be entering your market in the coming year. Once you have compiled the list, you can highlight those practices that will be the greatest challenge.</li><li>Analyze the competition's services in terms of features, value, and target patients. How do they market them? How do patients see your competition? How do referring physicians view your competition? Take an honest look at their offerings. Is your quality commensurate? Do you have similar offerings? What is the unique value you provide that competitors don't or can't? Emphasize these benefits in your marketing.</li><li>Compile a list of competitor strengths and weaknesses and remember to be objective. You'll do your practice no good if you allow bias toward your own physicians, staff, and services to cloud your judgment. Try to see the competition's practice as though you were them. What makes their practice so great? If they are growing rapidly, what is it about their practice that's promoting that growth?</li><li>Observe how your competitors market themselves through advertising, collateral material, and perhaps the use of physician liaisons. You will have to go to many different sources to get a complete picture. It takes practice and a little shrewdness on your part to piece together a complete picture of strategies and objectives, so the use of a qualified consultant may be to your benefit. Focus on the facts, be persistent, and trust your intuition to help you.</li><li>What are the market demographics for your practice like now? Is it growing? If so, then there are likely quite a few patients left to go around. If on the other hand the market is flat, then the competition for patients is likely to be fierce. Your practice will find itself scrambling to win market share. The outlook portion of your analysis may seem like forecasting, but it's really a measure of trends. By the time you've done most of your research, you'll have enough information to determine what the outlook really is.</li></ol><br />By <a href="https://www.physicianspractice.com/view/introduction-to-medical-practice-valuations">evaluating yourself</a> against your competition, you'll likely find new ideas for your practice. While compiling a competitive analysis is an interesting piece of work, it can indeed be challenging. Consequently, you may want to seek the help of a healthcare consultant to guide you through this process. 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Doctors spend up to 20 hours a week on <a href="https://www.medicaleconomics.com/view/top-challenges-2021-1-administrative-burdens-and-paperwork">paperwork</a>, often taking as much time to document patient visits as they do actually caring for patients.<br /><br />The burden of health care administration has put doctors and small medical groups at a disadvantage compared with larger players and insurance companies. The situation is so bad that doctors are <a href="https://www.medicaleconomics.com/view/primary-care-physicians-rank-high-for-turnover-from-2010-to-2020">leaving the profession</a>, and otherwise healthy small practices are deciding they have no choice but to be swallowed up by larger medical groups or to shut down.<br /><br />But there are solutions. This is what doctors and other health care professionals need to know:<div><ol style="text-align: left;"><li>Detailed prices are finally starting to become publicly available. Although you almost need to be a data scientist to figure them out, providers can now use some benchmarks to negotiate with payers on prices.</li><li>The floor price of procedures. It may be hard to believe, but many don’t know those prices. It’s hard to run a practice without this information.</li><li>The reasons for <a href="https://www.medicaleconomics.com/view/how-to-avoid-medical-necessity-denials">payment denials</a>. That’s so fixes can be made at the front end of the payment process to avoid denials and thereby reduce administrative work.</li><li>Process automation, including the use of <a href="https://www.medicaleconomics.com/view/artificial-intelligence-adding-to-business-threats-a-slideshow">artificial intelligence</a>, increases efficiencies and performs tasks at a small fraction of time and costs now devoted to them.</li><li>Transitioning to value-based care can save time and lead to better care.</li></ol><br />For health care providers, the headache tends to involve three interlocking problems. The first is what I like to call a “wild west” approach to pricing baked into America’s fee-for-service payment model. That’s where the cost of a procedure can vary widely.<br /><br />When a regulation recently took effect mandating that hospitals disclose their standard charges, the variations were stunning, and the presence of big government payers like Medicare only makes the situation more unstable. There are, for example, hundreds of procedures where commercial payers’ prices are <a href="https://centurygoal.com/the-wild-wild-west-of-healthcare-pricing/">tens or even hundreds of times more</a> than what Medicare reimburses.<br /><br />Pricing remains so opaque and complex that most providers are forced to offer the bulk of their services without knowing in advance what they will be paid, contrary to traditional business models. And this leaves aside the penalty that smaller providers face because of their limited ability to bargain with large payers.<br /><br />The second problem for providers is just making sure they get paid. Four years ago, about 9% of reimbursement requests by providers were <a href="https://www.medicaleconomics.com/view/claim-denials-15-ways-fight-back">denied by payers</a>. Today that number is closer to 12%, resulting in a hit of more than $100,000 to a practice with $1 million in billings.<br /><br />But that tells only part of the story, because the 12% of billings ultimately written off by providers is less than half the initial rate of such denials, meaning untold hours spent trying to limit losses.<br /><br />Third, growth in process automation may be leading to an even greater power imbalance in the administrative relationship between payers and providers. Well-resourced payers have begun to use artificial intelligence to find ways to deny bills submitted by providers.<br /><br />While process automation can help providers keep up with payers, what they often really need is better data about their own operations. Many find it difficult to understand the cost of the care they are providing.<br /><br />For example, knowing what it really costs to provide a hip replacement is crucial for numerous reasons. For one thing, it makes productive rate negotiations with payers possible. How can a doctor agree to perform hip replacements if the reimbursement being offered by a payer is below the cost of providing the service?<br /><br />Conversely, if a practice discovers it is efficient at performing hip replacements, it may choose to focus on performing more of them and negotiating higher prices for them than other similar procedures. Meanwhile, efficiently capturing all the different contractual rates in place with payers into a common dataset can make tools such as accounts receivable reports more meaningful.<br /><br />Over time, the American health care system may move from fee-for-service toward <a href="https://www.medicaleconomics.com/view/value-based-care-could-get-boost-by-new-bill-in-washington">value-based care</a>, in which providers are paid fixed rates to care for patients. Doctors would have the freedom to use that money for care as they see fit.<br /><br />But while such an evolution might help with our trillion-dollar admin bills, it could also force providers to shoulder even more risk, further pushing smaller practices to seek refuge in larger, more bureaucratic groups. That’s because doctors would have to pay for cost overruns.<br /><br />The best-case scenario would be if providers addressed the admin problem now rather than taking on a much bigger task that would further add stress. 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She is a billionaire; her concerts are sold out to thousands of Swifties often paying more than $1000\ticket; she has increased the female viewership of American football; and presidents and prime ministers are requesting that she perform a concert in their countries because of the potential economic impact of her concerts. So, how does Taylor Swift phenomenon apply to healthcare?<br /><br /><h2 style="text-align: left;">The power of over-delivering</h2><br />It has been said that it is best to under-promise and over-deliver in business and medicine. A Taylor Swift performance consistently over-delivers. Taylor Swift doesn't stand on the stage and sing one song after the other in the same vocal range, in the same outfit, with the same lighting and stage sets. She wears multiple outfits, has a perfectly choreographed dance routine, and displays a unique background representing the era. Taylor brings 100% of her energy to every sold-out arena for three hours as though each song was the finale. From the opening momentto the final scene Taylor Swift over-delivers.<br /><br />Now, consider your medical practice. Look at the patients, the staff, colleagues, and the community for whom you are performing. How are you over-delivering? What are the expectations of your patients, staff, and referring physicians? What would it look like at the zenith of what you do? What would it look like to outperform and overdeliver, to the point that any patient would tell ten people about their interaction with you and your practice?<br /><br />Over-delivering will force you to be creative and think differently than your competition. It will increase patient retention and foster viral word-of-mouth marketing, as in the case of Taylor Swift's concert. Give people more than they expect, and you can build nearly anything.<br /><br />Examples of over-delivering include answering the phone in three rings; the caller speaks to a human and does not have to navigate a phone tree; all calls and e-mails are returned within twenty-four hours. The patient has all their questions answered at the end of the doctor-patient encounter. A final example of over-delivering might occur when the patient receives a follow-up call from the doctor or the nurse to check on patients recently discharged from the hospital on their condition, their medications, and that they have scheduled follow-up appointments.<br /><br /><br /><div><h2 style="text-align: left;">The power of persistence</h2><br />Taylor had a heated dispute with artist Kanye West during the Grammy Awards. Taylor was vilified by him and the press.<br /><br />Instead of wallowing in her disappointments, she focused on what she could control. Between 2019 and 2022, she produced four albums and won a Grammy for Album of the Year. She then celebrated by launching the most successful tour in music history, grossing $1.4 billion in one year.<br /><br />Her persistence is a reminder that greatness does not come from one smash hit, but from taking one small next step toward her goal.<br /><br />Persistence in medicine and healthcare requires steadfast dedication and continuous effort to achieve positive outcomes for patients, overcome challenges, and advance medical knowledge. Remember that becoming a doctor requires twelve to fifteen years of education, and persistence is a necessary ingredient in the development of a healthcare professional. Doctors, nurses, and other medical staff require persistence in their daily work.<br /><br />Integrating technology into healthcare, such as electronic health records (EHRs), telemedicine, and, recently, artificial intelligence (AI) requires persistence in overcoming technical challenges, ensuring data security, and adapting workflows to new systems.<br /><br />These examples highlight the importance of persistence in overcoming obstacles, improving patient outcomes, and advancing medicine and healthcare.<br /><br /><br /></div><div><h2 style="text-align: left;">Taylor actively listens to her audiences</h2><br />Taylor Swift is known for her interactions with fans and for being attentive to their feedback. She interacts with her fans directly, responding to their comments, sharing their fan art, and expressing gratitude for their support.<br /><br />Taylor hosts fan events and meet-and-greets during her tours. This allows fans to meet her in person, ask questions, and share their experiences. These events showcase her commitment to listening and engaging her fan base.<br /><br />Taylor draws inspiration from the experiences of her fans when writing songs. Some of her songs are speculated to be inspired by specific fan interactions or stories, showcasing her ability to connect with her audience on a personal level.<br /><br />Healthcare professionals must also listen to their patients, staff, and colleagues. A practical method of listening is to survey your patients. This can be accomplished by giving patients a survey card when they check in and asking them to complete the six-question survey (A sample survey from my practice is shown in Figure 1) during every doctor-patient encounter. All positive and negative comments should be acknowledged to demonstrate you're listening to your patients.<br /><br />Now how does Taylor Swift impact an election? Imagine this scenario: There are four battle-ground states (PA, WI, MI, AZ)that will likely determine the results of the election. Imagine Taylor supporting one of the candidates for presidency. She agrees to a free concert in those battle ground states, and the only requirement is that the Swiftie must register to vote to receive a ticket. I can imagine that those votes from 18–36-year-olds will swing the election. Your thoughts?<br /><br />Bottom Line: Taylor Swift's makes it easy to be awestruck. But while she is an incredibly gifted artist and creator, her marketing principles are admired. She had to start at square one, like every healthcare provider. 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Monahan created a unique value proposition (UVP) by advertising in the college community.<br /><br />Their differentiator was, "You get fresh, hot pizza delivered to your door in 30 minutes or less — or it's free." Their primitive research determined that college students were looking for fast delivery service and for the pizza to be hot when it arrived at their front door. Dominos answered all the questions and concerns of its consumers by creating a simple, unique selling proposition, showing the value behind ordering Domino's over competitors. Today, there are 6898 Domino's Pizza, with sales in 2022 of $8.7 billion in the U.S. and nearly $8.8 billion internationally. What can we learn from Domino Pizza that applies to our medical practices?<br /><br />Every physician who graduates from medical school can take a history, perform a medical examination, order tests, and initiate a treatment plan. So, what makes your ability to do what every doctor can do more attractive to motivate patients to become part of your practice? As physicians, we are not comfortable <a href="https://www.physicianspractice.com/view/taylor-swift-healthcare-and-the-2024-election">tooting our own horn</a>. However, offering the same as everyone else will not make your practice unique and special and will not be a magnet for attracting more patients. The reason for <a href="https://www.physicianspractice.com/view/hiring-a-marketing-agency">standing out in the crowd</a> is the most critical thing you must focus on in your practice.<br /><br />A medical practice must distinguish between its practice and that of the competitor. This blog will discuss ethical methods to differentiate your practice and make it stand out from other practices.<br /><br />What does your practice provide that makes you unique and stands out from your competitors? You will have created your UVP if you answer this question clearly and precisely. A UVP is the force that drives your practice and your success. It is similar to the mission statement. However, the UVP has greater width and breadth. It is to be shared with others, including existing patients, potential new patients, referring doctors, and the public.<br /><br />What problems can you solve for the target market you would like to reach? What services do you provide that add value to your patients that your competitors don't? With a UVP, you are addressing a medical problem and providing a solution to why they should become patients in your practice. Remember, people don't buy things; they buy a solution, result, or benefit. You need to identify the one thing that you want your target market to think of and remember about you and your practice. That one thing needs to matter to those you are trying to attract in deciding whether to choose you or a competitor. Your UVP must be relevant to those you want to attract.<br /><br />Before creating your own UVP:Research how your competitors market and promote their practices.<br />Analyze what your competitors do and say in their marketing materials.<br />Analyze their websites and marketing messages to see what they do and how you can better solve their medical issues.<br /><br /><br /><div><h2 style="text-align: left;">Identifying your uniqueness</h2><br />Don't be afraid to be different – the key is to stand out from your competitors. The UVPs that stick out the most are short and memorable and have created a differentiation from competitors. Develop a UVP that creates a sense of desire and urgency for potential patients to become patients in your practice.<br /><br />Key areas that will help create your UVP. Answer why patients should become patients in your practice over a competitor<br /><ol style="text-align: left;"><li>Research what messages your competitors are offering compared to what value their services offer</li><li>Identify your target audience</li><li>Know what drives your target audience and what questions or concerns they may have about your services.</li><li>Differentiate yourself from your competitors by being unique</li></ol><br />There are two methods to differentiate your service:Delight your patients or make it easy for them to be your patients. Examples include online scheduling, payment online, contactless payment options, telemedicine, and early morning and late afternoon appointments. Practices that differentiate themselves on the ease of access by providing patients with access to care and a hassle-free experience will become attractive to patients.<br />Differentiating on the patient experience provides an experience that exceeds their expectations. These include personalization of care, exceeding expectations, and being proactive. It requires consistent efforts from both the doctor and their staff to make service differentiation work. Finding experienced and dedicated staff and updating their training needs can be challenging.<br /><br />There is no shortcut to maintaining and improving your quality standards. Few competitors focus on quality, so most cannot replicate your offering. Differentiating on quality usually comes with a higher price tag, which may exclude patients who make decisions based solely on price. Focusing on higher-quality care means fewer but more profitable patients, which gives you more time to concentrate on improving and growing your practice. Patients will be willing to pay the premium price only if you can explain the extra value they are getting by choosing your services. However, it is essential to remember that selling quality is not restricted to just the quality of your services. Most of the successful practices do not merely promote services. They offer how their services make their patients feel about themselves. Price Differentiation in a crowded healthcare market space will not be a sustainable UVP. Remember that plenty of patients will pay a premium for outstanding care, especially if they are convinced they will receive more incredible value. So, do not always rush to lower your prices. You can stand out from your competitors by raising your prices or, in subtle words, refusing to play the price war game. You can make your medical practice unique by pricing your services in contrast to your competition. This pricing proposition does not mean you should strive to be the cheapest, although that can be temporarily profitable. However, raising your prices will never work if your patients cannot understand the difference between your competitor’s and your offer.<br /><br /><br /></div><div><h2 style="text-align: left;">Examples of UVP in healthcare</h2><br />There are multiple opportunities for a medical practice to identify and promote its UVP.<br /><br />For example, a practice can offer enhanced access to the practice. Improved access can be accomplished by early morning, late afternoon, and weekend hours. Currently, gaining access to a medical practice is becoming more difficult. Consequently, some retail clinics (Target, Walgreens, CVS) offer same-day appointments, including walk-in appointments, with minimal waiting to see a physician assistant, nurse practitioner, or physician.<br /><br />Another option is to develop a reputation as an on-time physician. The current attitude among patients is that they will have long waits not only to make an appointment but also once they are in the office. One of the most common complaints patients have is the waiting to see the doctor. Patients often wait an hour to see the doctor. When I started my practice, my community's largest urology practice instructed patients to come at 10:00 A.M. and 2:00 P.M. This approach stacked up patients who waited 1-2 hours to see the physician. I capitalized on this opportunity by scheduling appointments for patients at specific times. I even promoted being on time, stating there would be no charge if the patient wasn't seen within fifteen minutes of their appointment. I know the approach was effective when I introduced myself at a social event, and the patient said, "Dr. Baum, I've heard of you. You are the doctor who doesn't charge a patient who has to wait." On rare occasions, I had to write off an office visit, but that was worth the publicity of creating a reputation of offering to see patients promptly.<br /><br />Today, it might be in vogue to offer telemedicine to care for many non-emergency medical conditions. As a result of the pandemic, it was necessary to see patients out of the brick-and-mortar office. We learned that we could provide good medical care without having to be eyeball-to-eyeball with the patient.<br /><br />Offer healthcare services to diverse populations and offer language-specific services. This can serve as a unique value proposition in areas with a culturally diverse population.<br /><br />If you ask a physician about the cost of an office visit, a lab test, or an imaging study, they will appear like a deer peering into the headlights. Providing transparent pricing and cost estimates for medical procedures can differentiate a healthcare provider in an industry where pricing is often complex and opaque.<br /><br />Another USP is concierge medicine. These doctors are decreasing their patient population and offer longer appointments and availability 24\7 for an annual fee. This concept is attractive to patients who can pay the yearly fee and want more attention from their physicians.<br /><br />Finally, healthcare has begun to pivot from treating illness to offering wellness advice. This area of medicine is generating enthusiasm from millennials to baby boomers. Many patients want to stay well and out of the doctor's office. Emphasizing preventive healthcare measures and wellness programs can set a physician apart by promoting a proactive approach to health.<br /><br />Bottom Line: Identifying what sets your practice apart is crucial for growth, profitability, and long-term survival. To differentiate yourself and to become memorable, it is essential to leverage the qualities that make you unique and memorable than your competitors. The times are a-changing (thanks Bob Dylan), and your patients are more educated and demanding than ever, so innovation must be at the forefront of your healthcare branding efforts. 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The independent administrator handles business processes after a fee schedule is negotiated between an employer plan sponsor and a health system, or network of health care providers.<br /><br />Direct contracting may also exist in centers of excellence such as ambulatory surgery centers, or through direct primary care or concierge medicine. Some of these models are insurance-related models and some are cash pay models administered outside or carved out of traditional insurance.<br /><br />There has been plenty written on the potential benefits of the direct-to-employer model for patients and providers – but what about for primary care physicians in private practice in particular?<div><br /><h2 style="text-align: left;">Primary care at the center</h2><br />Direct-to-employer contracting in the broadest model may be aligned with <a href="https://www.physicianspractice.com/view/how-to-choose-an-aco-partner">accountable care organization</a> (ACO) functions. These models have the <a href="https://www.physicianspractice.com/view/another-nail-in-private-practice-s-coffin">primary care provider </a>(PCP) at the center of the model where providers participate as part of a health system or owned enterprise or as independents with a practice outside of the flagship system. The ownership structure generally doesn’t influence the role of the primary care provider. Either model, with owned practices or independents, generally establishes the PCP as the “quarterback” for the patient’s care plan.<br /><br />PCPs are not just at the center of this model but the center of health care in general, touching various other providers and medical services. This is the case regardless of urban or rural settings. PCPs in independent or private practices are most often the mortar between the bricks when it comes to rural medicine. Within urban areas, independent and private practice PCPs are critical to meeting the needs of the community and assisting with capacity constraints. In the most well-functioning models, PCP’s can handle a majority of the high-value care for patients and closely work within referral models that allow for continuity of care and network use that favors the plan for financial utilization and clinical integration of data.<br /><br />Most clinically integrated networks – arrangements in which like-minded hospitals and/or independent providers share performance improvement, quality, value, and efficiency goals that result in improved quality and coordinated care at a lower cost – have a mix of both types of PCPs, owned and independent. Additionally, most value-based or risk-based arrangements have the PCP as the lynchpin and as the primary clinician within the model that is accountable to outcomes and performance. These primary care clinicians typically receive an incentive when performance measures are met. Often, they can be arranged and aligned with employer needs and the population of patients served. Women’s health may be of particular interest in a teachers’ union plan, whereas musculoskeletal outcomes and optimized care taking into account a return to work may be more important to factory line workers.</div><div><br /><h2 style="text-align: left;">What are the benefits?</h2><br />So how would primary care physicians in private practice benefit from a direct-to-employer relationship?<br /><br />Within "low-friction" environments in particular – i.e., ones with fewer hand-offs between the people, processes and technology involved – PCPs can flourish within direct-to-employer arrangements.<br /><br />When we work in collaboration, we can help inform, communicate, and pay for various aspects of the care path. PCP’s are critically important to allow all resources within a network to practice at top of license. Primary care is also important to establish new relationships or to maintain and better manage a patient. It is to the benefit of private practices to be in a tighter relationship with their health plans or patients and have a coordinated workflow with much less administrative burden if everything is being done correctly and information is shared comprehensively.<br /><br />With a direct-to-employer relationship, PCPs are aligned with a tightly maintained referral network, standing to gain the most from value-based-care performance, where they generally contribute minimally to overall costs. Their appropriate referral to in-network, high-value specialists is critical to maintain cost savings in performance and appropriate utilization.<br /><br />Shared resources might be offered either through an administrator within a direct-to-employer arrangement or from a system partner. These resources may include medical management, case management, care advisers, transition advisers, utilization management, prior authorization, care navigation, health care analytics, and more.<br /><br />So long as process and workflow are not completely disrupted, every decision made in this direct model with PCPs and patients at the center, stands to create benefits for patients and health plans.</div><div><br /><h2 style="text-align: left;">Patient views</h2><br />Providers often wonder how the patient views whatever alternative payment methods or contracts are hanging behind-the-scenes. But the truth is that patients are steadfast in what they have always wanted: value, convenience, and low friction.<br /><br />An employer with high turnover (such as a chain restaurant or retailer) might know that customer satisfaction and quality are important, but not as vital as convenience. Short-term costs are front and center and may cycle every year because turnover is simply too high. This sort of population still needs management, but in risk-based arrangements, the employer may not see the benefit of better, high-value care delivery from a robust PCP arrangement.<br /><br />Health plans for a school district, municipality, union, or a destination employer, should be doing more than just checking the box for an adequate, low-cost health plan. Progressive and strategic human resource leaders want employees to feel like they're getting something special. If they have to leave work, a more intimate relationship with their PCP allows them to better accommodate their schedule and to be more well informed of appropriate use of emergency departments, urgent care, and telehealth options. This way, patients can receive outstanding service, and the experience is not disruptive to patient satisfaction or employer/employee productivity. This is a marked example of how important a high-value PCP might be in a well-managed health plan.</div><div><br /><br />Patients and consumers of health care often want simplicity. If the model is improved in most or all of the "key" areas patients use to measure their providers, such as value, convenience, and low friction, it could make the interface and experience better.<br /><br />Ultimately, when there are too many stop-gate mechanisms or middlemen in between patient and clinician, it dilutes the value of that one-to-one relationship. Whereas a closer and more streamlined relationship with providers and provider systems creates an enhanced relationship for patients and better continuity. Needs are easier to meet, friction is reduced, and a more complete picture emerges driving cost out.</div><div><br /><h2 style="text-align: left;">Potential hurdles</h2><br />Of course, any private practice PCPs involved in a direct-to-employer relationship will have some potential hurdles and ripple effects to consider.<br /><br />For example, independent practices can find critical mass when aligning with larger entities, but can also be overwhelmed by requirements for clinical integration given the amount of stakeholders being served in this equation. Being a part of a direct-to-employer system doesn’t always help with capacity constraints. Additionally, the overhead required to be compliant, interoperable, and efficient within risk-based clinically integrated networks can be a detractor.<br /><br />Governance is a double-edged sword. You do have to align incentives and, as part of the clinical integration, data-sharing is expected. Some PCPs have traditionally balked at having to share data with larger hospitals or health systems, despite it ultimately being of benefit to their patients and helping to form a more complete picture for a care plan.<br /><br />Benefits administrators can help providers through this process by forging collaboration, aiding with outreach, providing analytics and metrics, and offering transparency, while designing a plan around key anticipated outcomes, and reporting on it.</div><div><br /><h2 style="text-align: left;">A way to flourish</h2><br />In principle, the health care industry seems to agree that this is fundamentally the right direction it needs to shift in, despite any lingering logistical concerns or red tape that may be holding many back from taking the leap.<br /><br />While primary care providers who are considering participating in such a model will need to weigh the risk to benefits, primary care can truly flourish within direct-to-employer arrangements that revolve around working with partners on designing care that is beneficial to everyone, sets expectations in advance, tracks accountability and continues to reduce friction in the process.<br /><br /><br /><h2 style="text-align: center;">15% Off Medical Practice Supplies</h2><div style="text-align: center;"><br /></div><h3 style="text-align: center;"><a href="https://www.zazzle.com/artnip/gifts?cg=196189491912815167&pg=1&sd=desc&st=date_created"><b><span style="color: yellow;">VIEW ALL</span></b></a></h3><div style="text-align: center;"><b><br /></b></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><b><div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTMU2JxK1cgazEmR1BW0RqhEYsFCQw35vGYzW3Jwg-WlwQ3WMMv68AfaR2lWfdfzvLWYkkUaAIJ7HzyNLUOw0Ql_jmw8NAnU9S3rvwn6dAvTq6o385S-539rRH-WMnTQ0YxD9pCgGrdA0/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="216" data-original-width="216" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTMU2JxK1cgazEmR1BW0RqhEYsFCQw35vGYzW3Jwg-WlwQ3WMMv68AfaR2lWfdfzvLWYkkUaAIJ7HzyNLUOw0Ql_jmw8NAnU9S3rvwn6dAvTq6o385S-539rRH-WMnTQ0YxD9pCgGrdA0/" width="240" /></a></div><a href="https://www.zazzle.com/manual_prescription_pad_large_light_grey-133957177087146087" target="_blank"><span style="color: #fcff01;">Manual Prescription Pad (Large - 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I never thought a small tree could provide lessons about healthcare and managing a medical practice. Yet, on further reflection, I believe several comparisons that apply to physicians and medical practices are worthy of mention.<br /><br />It is not easy to raise and care for <a href="https://www.youtube.com/watch?v=5KDtZfgvimE&pp=ygUNaGVyb25zIGJvbnNhaQ%3D%3D">a bonsai plant</a>, just as starting, growing, and maintaining a medical practice takes work. If we can successfully nurture a bonsai plant, then we can also manage to care for and nurture our patients and our medical practice. This blog compares nurturing bonsai plants with the care and feeding of medical practice.<br /><br />Bonsai plants often have problems that emerge when the routine is changed. Bonsai plants don't take kindly to changes in their water or exposure to light routines. The same holds true in your practice. The practice only runs smoothly when you deviate from the routine or the schedule. Suppose the doctors are to arrive at 8:45 and start seeing patients at 9:15. In that case, the staff is prepared, the patients are in the rooms, the phone is taken off the answering service, and everyone seems to be on the same page. If the doctor decides to arrive at 9:30, check e-mails, return a few phone calls, and begin seeing patients at 9:45 or 10:00, there will be mayhem in the office. Patients become surly, the staff are agitated, and no amount of hurrying can get the practice back on schedule.<br /><br />The same applies to hospital operating rooms (ORs). If the OR expects the doctor at 7:30 and they show up at 8:00, the entire OR schedule is delayed, and other doctors, patients, and OR staff will be upset. This will have a trickle-down effect on everyone involved.<br /><br />Let the bonsai plant provide you with the first lesson, i.e., having a routine—rarely, if ever, should you deviate from the routine you and your staff have agreed upon.<br /><br />Pruning is the art of retarding the growth of the tree to keep its miniature status and size. To have a fuller, miniature plant, it is necessary to trim back the branches.<br /><br />How often do you review your practice's balance sheet, looking at your assets and liabilities? How often do you look at your EOBs or denials of claims submitted to the insurance companies or the CMS? A successful practice does not run on autopilot. You must review the key performance indicators* (KPIs). These important metrics indicate the growth or the decline of your practice. When you identify problems, that is the time to <a href="https://www.physicianspractice.com/view/8-steps-to-follow-when-firing-practice-employees">consider pruning</a> what isn't working, such as dropping low-paying payers and looking for new sources of revenue, such as offering early morning hours, evening hours, same-day appointments, or Saturday morning appointments. Pruning is a necessity for a healthy bonsai plant and a necessity for a healthy practice.<br /><br />Caring for a bonsai plant takes a mister, measuring cups, and small pruning shears. But if you want to provide outstanding care for your bonsai plant, the experts recommend a soil moisture tester. You must have the right tools to provide optimum care for your plant.<br /><br />You can enhance your practice's efficiency and productivity if you ensure the staff has the right tools, including the <a href="https://www.physicianspractice.com/view/looking-at-the-costs-vs-benefits-of-new-technology-in-healthcare">right technology</a>. For example, is your website allowing your patients to make an appointment online? Does the website offer the demographic forms and the health questionnaire for patients to complete before they come to the office for their first appointment? This single feature can make the practice more efficient. Your patients will appreciate being seen on time instead of spending 20 to 30 minutes completing forms in the reception area before being seen by the staff and the doctor.<br /><br />As with bonsai plants, resources and tools can make all the difference in the world! Make every effort to give your employees the skills and technology to let them do great work and be their most productive.<br /><br />Pay attention to careful potting of the plant to ensure that the soil drains quickly, and keeping a moisture tray underneath it will allow the plant to believe that it is growing in the exact same conditions as its natural habitat.<br /><br />I have observed that happy doctors and happy office managers create a milieu that makes for happy staff, who, in turn, give patients a positive experience. Sometimes, obtaining this atmosphere is as simple as changing the verbiage or the language used. For example, suppose you call the area that patients enter when they open the door to the practice the waiting room. In that case, you are almost creating a self-fulfilling prophecy that the patients will wait before they are seen. However, if you change the term to the reception area, you create the aura where patients will be received and will be seen and processed very quickly. Changing this one term makes patients feel appreciated and that they are doing the doctor a favor by being part of the practice rather than the other way around—that is, the patient is the one who is making the effort rather than the doctor doing the patient a favor by providing healthcare.<br /><br />Unless you are a bonsai "maven,"** you must periodically ask for advice on managing your beloved plants. You may not know it all, and you will likely have to consult with a bonsai doctor when your plant fails to thrive. Likewise, your practice will occasionally need to consult with an expert to solve employment problems, establish a sexual harassment policy, or advise on taxes and investments. As with the bonsai plant, asking for help is not a sin. It may save your bonsai and your practice.<br /><br />Too much or too little water will cause your plant to wither on the vine. The same applies to a doctor's reputation. Physicians spend their entire lives building and protecting their reputations. Most patients have a favorable impression of the doctor and the practice. An angry patient with a bad experience can wreak havoc on a medical practice. Today, a patient who posts negative comments about the doctor and the practice can see their invective seen by thousands of viewers with just a mouse click. Therefore, physicians must take an active role in protecting their reputations. The best way to do this is to capture compliments from happy patients when they utter their accolades. This can be done by asking patients to share their experiences with one of the online review sites. I suggest to the patient in the exam room that they rate their experience with the practice at the POS or point of service.<br /><br /><b>Bottom Line:</b> Lessons for practice management are available in books and MBA schools and in the flora and fauna of our surroundings….or desktop...if that's where you keep your treasured bonsai plant.<br /><br />*Examples of KPIs are monthly charges\receipts, accounts receivables, RVUs, denials, number of new patients<br /><br />**Yiddish word for “expert”<br /><br />______________________________<br /><br /><a href="https://www.physicianspractice.com/authors/neil-baum-md">Neil Baum, MD</a>, a Professor of Clinical Urology at Tulane University in New Orleans, LA. 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Yes, the volume is higher – often much higher – than “normal” AR, and, as the name implies, the dollar value for each account is low. Cumulatively though, there is tremendous value in effectively managing and resolving these balances. Our data shows that up to 80% of open hospital insurance accounts fall under the low-dollar designation and account for as much as 15% percent of outstanding revenue. When it comes to physician groups, all AR is inherently low dollar, so developing an effective work strategy is vital to financial success. This is especially true for independent physicians in private practice that don’t have access to the same resources as large physician groups.<br /><br />In general, the approach to low-dollar AR at health care organizations is poor as internal teams often ignore these accounts for larger balances that have a better return on the time spent to collect. While this may make sense from a resourcing perspective, there are a variety of ways to close the gap to collect these high-value balances rather than leaving money on the table.<br /><br />Instead of dismissing that critical 15% of revenue, there is a three-tiered strategic approach to profitably managing and effectively resolving low-dollar AR.<br /><br />It's time to embrace low-dollar AR. Why pass on collectible revenue? There is high value in creating a plan to collect low-dollar balances now. 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This has real consequences for how they perceive the care they’re receiving and how well they follow instructions after discharge. A study by <a href="https://cdn.ymaws.com/www.theberylinstitute.org/resource/resmgr/pxpulse/TBI_PXPulse_Q3_Nov2022.pdf">The Beryl Institute</a> found that 76% of Americans surveyed said they had not had a positive patient experience during the prior three months, and 60% had an outright negative health care experience during that period of time.<br /><br />A lot goes into those numbers, though I want to focus here on overall <a href="https://www.physicianspractice.com/view/fulfilling-the-growing-need-for-primary-care">patient engagement</a> – the sum of the quality and amount of information, interaction, and mutual understanding between patients and caregivers through the entire patient experience. From the patient’s perspective, that experience begins before treatment or admission and continues through any transition of care (ToC). Those care transitions take many forms and might include a facility transfer or a discharge where managing follow-up appointments, drug regimens, and behavior changes largely falls on the patient.<br /><br />The stakes around quality communication through these care transitions can be high for the patient, of course. It also matters for hospitals. Last year, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9113654/#:~:text=The%20average%20readmission%20rates%20for,%2C%20and%20pneumonia%3A%2016.74%25.">readmission rates</a> for hospitals reached nearly 16%. That directly impacts the financial health of the institution when readmission is linked to reimbursements.<br /><br />Poor patient engagement isn’t the only communication issue in the hospital.<div><br /></div><div><br /><h2 style="text-align: left;">The problem of fragmented communication</h2><br />The challenge of patient engagement is an important aspect of the larger issue of fragmented communication within the health care system. I talk to doctors, nurses, and administrators across the nation, and the patterns are very predictable. Workflow efficiency is compromised by poor communications, such as phone tag, too many disparate systems, and the lack of contextual information exchange. If doctors and nurses have trouble engaging each other, it’s no wonder the patients aren’t better integrated into the information flow.<br /><br />Unifying everyone’s experience – staff and patients – should be the goal when considering patient engagement strategies. Managing the transition of care offers a good case study on the value of unified experiences. Especially tricky during transitions of care, patient outcomes and overall satisfaction can be closely tied to how well they understand their care when leaving the hospital. One of the most significant challenges in ToC lies in ensuring patient adherence to the provider’s recommendations post-discharge. It is here that technology can play a transformative role.<br />Understanding patient engagement tools<br /><br />Patient engagement tools can transform how patients and health care providers interact, fostering a more active and empowered role for patients to play in their care. These tools leverage digital platforms, mobile devices, and interactive communication channels to enable patients to access their health information, communicate with care teams, and make decisions about their treatment plans.<br /><br />In addition, they drive post-hospital care plan adherence with appointment reminders, follow-ups, education materials, and more through video, voice, or SMS text messaging. These tools keep everyone connected and relieve some of the health-management burden patients carry when they leave the hospital.<div><br /></div><div><br /><h2 style="text-align: left;">Enhancing the patient experience during ToC</h2><br />By leveraging agile patient engagement solutions, health care facilities and patients can experience a wide range of benefits, including:</div><div><ul style="text-align: left;"><li>Seamless information exchange: One of the primary challenges during health care transitions is the transfer of patient information across various care settings. Patient engagement tools streamline this process by securely and efficiently sharing EHRs between providers. As a result, patients experience reduced wait times, minimized duplications of tests, and a more cohesive care plan.</li><li>Empowered decision-making: By providing access to personalized health information, treatment options, and educational resources, patients are better equipped to make informed choices aligned with their preferences and values. This heightened sense of involvement increases patient satisfaction and confidence in their health care journey.</li><li>Real-time communication: During ToC, timely and effective communication is crucial to address patient concerns and coordinate care effectively. Patient engagement tools facilitate real-time messaging between patients and health care providers, enabling swift responses to questions, concerns, or patient condition changes. This ensures a smoother transition and reduces the likelihood of adverse events.</li><li>Reduced readmissions: Avoidable hospital readmissions, usually within 30 days of the initial admission, constitute a critical component of ToC management. <a href="https://www.mckinsey.com/industries/healthcare/our-insights/how-payers-could-unlock-value-by-improving-transitions-of-care#/">McKinsey & Company</a> employed a machine learning model and determined that, without primary care follow-up, patients face a 23% chance of readmission. Empowering patients through education, self-assessment tools, and post-discharge follow-up enhances their ability to recognize warning signs and seek timely care, preventing readmissions caused by avoidable complications.</li><li>Chronic disease management: Care continuity is a must for patients with chronic conditions. Patient engagement tools facilitate care coordination among different specialists and provide patients with personalized care plans, lifestyle guidance, and self-management tools to effectively manage their conditions beyond hospital walls.</li><li>Health literacy and empowerment: Patient engagement tools are pivotal in enhancing health literacy by providing accessible and understandable health information. When patients are more informed and confident in managing their health, they are more likely to engage in preventive behaviors and early interventions, leading to better health outcomes.</li></ul><br />Patient satisfaction is closely intertwined with the comprehension of their care after leaving the hospital. By fostering active patient participation, seamless information exchange, and improved communication between patients and health care providers, patient engagement tools enhance the patient experience and improve health outcomes. As the health care industry embraces digital transformation, these tools will remain central to achieving patient-centered care and optimizing the overall quality of health care services. Adopting these technologies is not just a step forward for health care providers but a leap toward empowering patients in their health journey.<br />We can improve the health care system. 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We shifted from zip code 33157 to 33183, and as I’ve recently <a href="https://www.rwjf.org/en/insights/our-research/interactives/whereyouliveaffectshowlongyoulive.html">learned</a>, this increased our life expectancy from ~79 years to ~86 years. My parents didn’t have a college education or any access to this type of data, but instinctively they moved toward what we all want and should have — safer neighborhoods, good schools, grocery stores with fresh foods, and job opportunities.<br /><br />Zip code determines up to <a href="https://www.forbes.com/sites/forbestechcouncil/2022/06/13/genetic-code-vs-zip-code-the-social-determinants-of-health/?sh=249d3fb581c1">60%</a> of health, and life expectancy can vary up to 30 years within a 10-mile span. Yet over <a href="https://theconversation.com/when-it-comes-to-your-health-where-you-live-matters-89352">50 million</a> Americans live in economically distressed zip codes, and we’re a far cry from all Americans having “the fair and just opportunity for every person to attain their highest level of health,” per the <a href="https://www.cdc.gov/nchhstp/healthequity/index.html">CDC</a>.<br /><br />We’ve made little progress on health equity because we haven’t been able to frame the issue around business cases that employers and payers can fully embrace. Capitation and advanced payment frameworks, particularly in Medicare, have enabled care models where community healthcare providers take care of transportation, food, air conditioners, pest control, and other socioeconomic needs that stand in the way of health. However, <a href="https://hcp-lan.org/apm-measurement-effort/2022-apm/2022-infographic/">80%</a> of the aggregated US healthcare spend is still essentially fee-for-service, and health equity can’t wait for value-based payments to become the norm. This means that employers and payers, who still directly own the substantial financial risk, need to pave the way through population health initiatives in the fee-for-service population.<br /><br />We’re at a breaking point as alarming research suggests that health inequity is both a humanitarian and an economic crisis that we need to fix unless we want to accept declining life expectancy and 7-10 year lifespan gaps relative to comparable countries. At a macro level, health inequity costs us <a href="https://www2.deloitte.com/us/en/insights/industry/health-care/economic-cost-of-health-disparities.html">$320 billion</a> today and if we do nothing, it will cost us $1 trillion by 2040, and we’ll all feel the financial impact of increased premiums.<br /><br />If we want a demonstrably more equitable healthcare system in the next 5-10 years, we need to 1) dismantle the attitudes and unspoken objections that linger in today’s healthcare business environment and 2) reshape healthcare business cases to embrace disparities head-on.<br />Dismantling the legacy attitudes toward health disparities<br /><br />While the recent advances in scientific research and public policy are encouraging, the business environment can still be pretty dismissive of health disparities, whether consciously or not. We need to address the doubts of business leaders and evolve their mindset:<br /><br />Is it relevant to my organization? When making decisions about population health initiatives, business leaders look for solutions that will have a meaningful, positive impact on as many people as possible. It may be easy to assume that those with a regular paycheck don’t struggle with social barriers to care like housing, food, transportation, health literacy, access to healthcare, and social support, but that’s not always true. Health equity should not just be the government’s focus in Medicare and Medicaid.<br /><br />More than <a href="https://www.mckinsey.com/industries/healthcare/our-insights/patients-struggle-with-unmet-basic-needs-medical-providers-can-help">45%</a> of consumers across all coverage types have some unmet basic need. These unmet basic needs typically mean lower productivity with an average of <a href="https://www.mckinsey.com/industries/healthcare/our-insights/income-alone-may-be-insufficient-how-employers-can-help-advance-health-equity-in-the-workplace">39 days</a> of lost productivity per year, not to mention higher health care costs and poorer outcomes. These unmet needs are more <a href="https://www.mckinsey.com/industries/healthcare/our-insights/income-alone-may-be-insufficient-how-employers-can-help-advance-health-equity-in-the-workplace">likely</a> in Black, Hispanic, and LGBTQ workers. Working populations in marginalized communities face many chronic conditions that have a higher prevalence and poorer outcomes — obesity, hypertension, diabetes, depression/anxiety, cancer, and maternal health, to name a few.<br /><br />The current economic environment has made the situation worse as inflation has hit low-income workers hard, with so many struggling to make ends meet. Even with health insurance coverage in place for their employees, employers face a myriad of socioeconomic circumstances from housing, transportation, safety, food insecurity, and lack of childcare that ultimately show up in medical cost trends. No doubt, having an income through a stable job is correlated with wellbeing but it doesn’t get us completely out of the woods on disparities. We’re way past the point where health equity is the government’s problem — it’s critical to the commercial population.<br /><br />It sounds complex, expensive, and hard to impact. Well-intentioned healthcare business professionals often feel helpless when facing the complex factors that drive health inequity. I hear sentiments like “I can’t fix poverty” or “I can’t just raise salaries across the board.” Yet in some ways, the answers lie in front of us, and it’s possible to have an impact, especially through the expansion of population health initiatives already underway.<br /><br />Community healthcare models, like those we’ve seen with <a href="https://www.chilmarkresearch.com/hotspotting-revisited/">Camden Coalition</a>, have shown us what breakthrough change can look like. Employers and payers can adopt the learnings from these models and apply them at a much broader scale. Deeply personalized, in-person, team-based care in local communities worked because they were intentional and because they unlocked the power of human connection and trust in healthcare.<br /><br />Human connection, trust, and empathy can exist across modalities — in person, asynchronous, and virtual. If we tap data, analytics, and virtual care more effectively, we can provide access to empathetic, team-based, culturally sensitive human providers at a much broader scale. Culturally sensitive texting has already proven to successfully engage low-income, hard-to-reach members. Culturally adapted nutrition advice helps people achieve weight loss and diabetes outcomes. AI-driven shared decision-making can help eliminate racial bias. What’s more, if we put our minds to it, AI and virtual data capture can provide visibility into socioeconomic data drivers at a much earlier stage than what we are able to capture in a purely brick-and-mortar world.<br /><br />Today's healthcare innovation environment has no shortage of solutions, and innovators will bend to employer and payer requirements. If employers and payers intentionally seek health equity impact from all healthcare investments, we’ll achieve a new normal.<br />Is there a real return on investment? I often hear doubts and fears among healthcare leaders about the business case behind socioeconomic-focused initiatives that sounds something like this: “Health equity is important but we have to prioritize ROI, cost trends, and profits.” The cynicism on ROI comes from a fear (and many failed initiatives) of spending more dollars on seemingly healthy populations without a return within the member’s lifecycle with a payer or employer.<br /><br />A general example like obesity also illustrates this point. Medical spending for a person with obesity is <a href="https://www.cdc.gov/pcd/issues/2019/18_0579.htm">$1,429</a> higher than a person of normal weight, and obesity prevalence varies drastically, with the most significant disparities showing up in the Black American population (e.g., Non Hispanic Black American adult women are one of the highest risk groups with obesity prevalence of over <a href="https://link.springer.com/article/10.1007/s40615-022-01269-8">55%</a>).<br /><br />Worse yet, behavior change interventions have <a href="https://link.springer.com/article/10.1007/s40615-022-01269-8">insufficiently</a> focused on this population, with many interventions demonstrating worse-than-average outcomes among Black Americans. Yet when it works, it saves money, reduces disparity, and saves lives, as in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359160/">this</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359160/">Colorado example</a> that saved <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5918290/">$16.7</a> for every dollar invested in a weight loss intervention that disproportionately targeted and enrolled Black Americans and Hispanics.<br /><br />Chronic disease is essentially a health equity problem, and population health interventions need to pinpoint and overcome drivers of inequitable outcomes in order to hit target returns on investment.<br /><br /><div><br /></div><div><h2 style="text-align: left;">Building the business model in three steps</h2><div><br /><br />Whether contemplating a new chronic disease initiative or designing equitable benefits for employees, we can build business models that incorporate health equity using three steps:<br /><br />While there are many publicly available resources that codify factors associated with disparities in health access and outcomes such as food retail environments and poverty rates, these datasets tend to be vast and multi-dimensional. With significant advances in artificial intelligence and the development of computational tools, we now have the ability to work with these data rich resources to better drive insights and reveal previously underappreciated and unrecognized needs within diverse cohorts.<br /><br />Understand, stratify, and engage populations - The first step is to understand our populations deeply, using all the data available to us. Publicly available data such as the area deprivation index points to important factors including income, education, and housing quality, based solely on addresses and zip codes. Claims data helps us understand the diagnoses and the associated medical costs of these populations and how this cost compares to the average.<br /><br />What percent of our population lives in areas with high social deprivation? Across our most common chronic conditions, what are the likely socioeconomic barriers? Food insecurity? Social isolation? Health literacy? What are the language and cultural needs of the population? This information serves as a foundation for the start of any intervention and may help target outreach to ensure equitable access in the engaged populations.<br /><br />Once engaged, standardized assessments and screeners help to capture individual data on socioeconomic barriers. While subpopulations with cultural and socioeconomic barriers often represent 20-30% of the problem we’re trying to solve, they often represent 70-80% of the cost.<br /><br />Tailor interventions for barriers to care - Equipped with a deep understanding of the populations we serve, we can tailor interventions to the needs of individuals. Too often, population health initiatives contend with “hard-to-reach” populations and mysteries as to why they won’t engage. The answers lie in unpacking the cultural and socioeconomic barriers and intentionally recruiting marginalized populations.<br /><br />Culturally diverse populations, including Asian, Hispanic, Black American, and other ethnicities, often seek doctors who speak their language, look like them, and understand their culture and experiences. Providers and healthcare workers, trained for awareness, cultural sensitivities, and ways to overcome barriers can have meaningful impact.<br /><br />We can deliver cultural adaptations to our interventions that deliver measurable outcomes in subpopulations. For example, design depression education into a <a href="https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-019-1031-7">fotonovela</a> for a Hispanic population to reduce stigma and improve PHQ scores. Adapt lo-carb recommendations in traditional South Asian recipes to address diabetes. Offer <a href="https://www.fiercehealthcare.com/payers/north-carolina-blues-plan-says-food-medicine-program-resulted-better-outcomes-diabetes#:~:text=North%20Carolina%20Blues%20plan%20says,better%20outcomes%20for%20diabetes%20patients&text=A%20health%20insurer%20launched%20a,those%20who%20spearheaded%20the%20effort.">food as medicine programs</a> with food delivery to food-insecure patients with diabetes. Tailored interventions are critical to the business case for any population health intervention — without them, we’re left with a black box on many members who don’t engage in healthcare solutions until the time comes for the emergency room visit.<br /><br />Measure the impact on subpopulations - Too often in healthcare business contexts, we make perfection the enemy of the good. We miss important insights from subpopulations because the numbers are too small and the chance of error or statistical insignificance is too high. As predictive models become more sophisticated, we’ve come to expect explainability from them. That is, the end point of the model is not risk stratification, but an explanation of why and the scope and size of opportunity. We now have the ability to iterate and measure rapidly to understand what avenues of outreach and intervention are effective in reaching historically underserved populations and how we might be more effective in our approach.<br /><br />However small the Ns, this basic information sliced across multiple factors including race, gender, cultural preferences, and socioeconomic status, are critical to measuring impact and making our interventions better. Of those who are food insecure, how much did blood sugar control improve as a result of the diabetes intervention we just launched? Did people of various incomes, ethnicities, and geographies utilize the new benefits at the same rates or did we predominantly serve the less disadvantaged? How is this trend improving over time?<br /><br />We’re at an inflection point, and my hope is that 5 to 10 years from now, zip code will drive much less than 60% of health. 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Perhaps you are thinking, “I need to hire a marketing or public relations firm.” You may feel comfortable managing your own public relations, there are reasons to consider hiring someone else to do the legwork. That way you can focus on your patients and clients which is the best use of your time.<br /><br />This article will review reasons to consider hiring a marketing firm and suggestions for vetting a potential firm for your practice.<br /><br />To find a marketing consultant for a healthcare practice, you can follow these steps:<br /><br /><b><u>Define your needs:</u></b> Before you start searching for a marketing consultant, identify your specific marketing needs and goals. Determine what areas of marketing you need help with, such as digital marketing, social media, branding, content creation, or patient outreach.<br /><br /><b><strike>Ask for referrals:</strike></b> Reach out to colleagues or other healthcare professionals who have used marketing consultants in the past. <a href="https://www.physicianspractice.com/view/giving-your-practice-a-checkup-obtaining-and-maintaining-referrals">Referrals</a> from trusted sources can help you find reliable and effective consultants.<br /><br /><b><u>Use online platforms:</u></b> <a href="https://www.physicianspractice.com/view/giving-your-practice-a-checkup-generating-new-patients-using-social-media">Utilize online platforms</a> that connect businesses with freelancers or consultants. Websites like Upwork, Freelancer, or Fiverr are good places to start. You can search for marketing consultants with experience in the healthcare industry.<br /><br /><b><u>Check industry associations: </u></b>Look for marketing consultants who are members of healthcare marketing associations or organizations. These professionals are likely to have specialized knowledge and experience in healthcare marketing.<br /><br /><b><u>Browse marketing agencies</u></b>: Research marketing agencies that have expertise in the healthcare sector. Agencies often have a team of professionals with diverse skills and experience.<br /><br /><b><u>Review portfolios and testimonials</u></b>: When you find potential consultants or agencies, review their portfolios and client testimonials to assess their track record and the quality of their work.<br /><br /><b><u>Schedule interviews</u></b>: Narrow down your list of potential consultants and schedule interviews with them. During the interviews, discuss your needs and objectives and ask about their experience and strategies for healthcare marketing.<br /><br /><b><u>Check references</u></b>: Don't hesitate to ask for references from past clients. Contact these references to learn about their experiences working with the consultant and the results they achieved.<br /><br /><b><u>Consider budget</u></b>: Consider your budget for marketing consulting services and ensure it aligns with the consultant's fees or agency's costs.<br /><br /><b><u>Sign a contract</u></b>: Once you've selected a marketing consultant or agency, sign a contract that outlines the scope of work, deliverables, timelines, and payment terms.<br /><br />Remember that marketing is crucial for the success of any healthcare practice, so invest time in finding the right consultant or agency that understands the unique challenges and regulations of the healthcare industry.<br /><br />Finding the right healthcare marketing agency can significantly impact your practice's success. Here's some advice to help you find the most suitable agency:<br /><br /><b><u>Experience in healthcare</u></b>: Look for agencies that have specific experience in the healthcare industry. Healthcare marketing comes with its unique challenges, compliance regulations, and target audience considerations. A specialized agency will better understand these aspects.<br /><br /><b><u>Portfolio and case studies</u></b>: Review the agency's portfolio and case studies. This will give you insights into their past work, the types of healthcare clients they have served, and the results they achieved.<br /><br /><b><u>Client references:</u></b> Ask the agency for client references or testimonials. Speaking directly with their previous or existing healthcare clients can provide valuable insights into the agency's capabilities, professionalism, and client satisfaction.<br /><br /><b><u>Compliance and ethics</u></b>: Ensure the agency is well-versed in healthcare compliance and ethical marketing practices. Healthcare marketing must adhere to strict guidelines to protect patient privacy and maintain ethical standards.<br /><br /><b><u>Digital marketing expertise:</u></b> In today's digital age, having strong online presence and digital marketing strategies are crucial. Look for agencies that have expertise in online marketing, SEO, content marketing, social media, and other digital channels.<br /><br /><b><u>Content creation</u></b>: Content marketing plays a vital role in healthcare marketing. Check if the agency can create informative and engaging content for your website, blog, and social media platforms.<br /><br /><b><u>Understanding of your target audience:</u></b> A good healthcare marketing agency should have a deep understanding of your target audience, whether it's patients, healthcare professionals, or referring physicians.<br /><br /><b><u>Strategic approach</u></b>: Seek an agency that takes a strategic approach to marketing. They should be able to create a comprehensive marketing plan tailored to your practice's goals and needs.<br /><br /><b><u>Measurable results:</u></b> Inquire about their approach to tracking and measuring the success of marketing campaigns. Metrics and analytics are crucial for evaluating the effectiveness of marketing efforts.<br /><br /><b><u>Communication and collaboration</u></b>: Choose an agency that values clear communication and collaboration. Regular updates, progress reports, and open communication channels are essential for a successful working relationship.<br /><br /><b><u>Budget considerations</u></b>: Discuss the agency's pricing structure and make sure it aligns with your budget. While cost is important, prioritize value and results over the cheapest option.<br /><br /><b><u>Contracts and terms</u></b>: Review the agency's contract thoroughly before signing. 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They also have fewer transportation options, making it more difficult to access care when needed.<br /><br />A lack of care providers poses another profound obstacle. Nearly <a href="https://protect-us.mimecast.com/s/vp1YCDkA2ASnoW30S5XV94?domain=streaklinks.com">20% of the US population</a> resides in rural areas, but only around 12% of doctors practice in these communities. The shortage of specialists is particularly dire: Rural areas have approximately <a href="https://protect-us.mimecast.com/s/ZgTgCERB2BHglzpMUpCWQA?domain=streaklinks.com">one-third of the number of specialists</a> per capita compared to urban areas. America’s ongoing <a href="https://protect-us.mimecast.com/s/RpwhCG6E2Ei0BPAGHQb5oH?domain=streaklinks.com">physician shortage</a> will likely increase the severity of this problem in the coming decades, leading to a further decline in the number of on-site physicians available in rural communities.<br /><br />The COVID-19 pandemic exacerbated many of the problems with delivering high-quality rural health care; however, the widespread expansion and embrace of telehealth proved to be a silver lining. According to a <a href="https://protect-us.mimecast.com/s/VaGbCJ6R2Ri1B2K5SvIazM?domain=streaklinks.com">McKinsey & Company study</a>, physicians now see between 50 and 175 times more patients via telehealth than before the pandemic.<br /><br />In and of itself, telehealth is not a magic bullet, however. The Pew Research Center notes that, as of 2019, 27% of US adults aged 65+ <a href="https://protect-us.mimecast.com/s/RqM0CKrR2RiBDY4mtGMced?domain=streaklinks.com">did not use the</a> Internet, and that percentage has not grown significantly since. Even access to the internet in rural communities is a significant problem. Furthermore, <a href="https://protect-us.mimecast.com/s/vjXFCM8626UR2LzWTPmdKr?domain=streaklinks.com">a study</a> from the Bipartisan Policy Center and the Center for Outcomes Research and Education found that many rural patients were reluctant to use telemedicine, even when it was readily available. Their primary worry was the quality of the care they would receive.<br /><br />A hybrid model for telehealth, such as that employed by <a href="https://protect-us.mimecast.com/s/mz16CNkR2RSEZQjXHy5wuh?domain=streaklinks.com">Troy Medical</a>, is the most promising solution for these dilemmas. This model calls for coordination of three key elements: a small medical clinic in the local community with a dedicated medical assistant physically present to help patients; an administrative staff to manage the logistics of the healthcare system; and a team of specialists delivering expert medical care via telehealth.<br /><br />This hybrid model successfully addresses the primary obstacles to high-quality care that rural patients and their doctors face and offers three additional benefits beyond those offered by non-hybrid telehealth approach:<br /><br /><br /><div><h2 style="text-align: left;">1). Better patient engagement.</h2><br />Medicine is so much more than a doctor telling a patient what's wrong and what to do. Effective medicine, whether in-person, or via telehealth, is rooted in strong physician-patient relationships which, in turn, engender better patient engagement. The trust that grows when a patient feels their doctor is providing personalized care is vital for good outcomes, particularly in complex cases.<br /><br />A hybrid model encourages robust relational ties between doctors and patients by helping patients feel simultaneously empowered and supported in their health care journeys. Because they can occur more regularly than in-person visits, virtual visits help patients forge better connections with their physicians. This sense of connection means rural patients will be more likely to listen when their doctors offer guidance on lifestyle modifications, self-care practices and other steps which allow them to take a more proactive role in their health and make informed decisions.<br /><br />Meanwhile, in-person clinic staff can help patients get comfortable using the digital tools available in conjunction with their telehealth care – such as remote monitoring and access to medical records – which can, likewise, prompt those patients to take a more active role in their health care.<br /><br /><br /></div><div><h2 style="text-align: left;">2). The right delivery model creates a win-win-win. .</h2><br />The key difference in the hybrid-model of rural healthcare is maximizing the use of local medical care and harnessing technology to deliver high-quality specialty care that is otherwise not available. Because there is a local clinic with a medical assistant, the hurdles of internet connectivity and navigating the electronic health record are completely solved. Furthermore, the medical assistant can be hands on the ground with the patient when an exam is needed as well as a trusted guide to navigate the complex medical system.<br /><br />This model makes telehealth feel like a regular clinic visit and the quality of healthcare delivery remains at the highest levels. The doctors are able to practice medicine on a long-term basis, giving continuity of care, because they have a team on the ground to help the patient implement their medical plan. And all of the medical billing goes through the patient’s medical insurance, just like any normal medical visit. But, most importantly, doctors are able to practice exceptional medicine and deliver care to patients who desperately need their help and are so grateful for the elevated level of care. This is why we all became doctors.<br /><br />But let’s not forget that the local community hospital is also a winner with the hybrid-telehealth model. Because the higher-reimbursement outpaint minor procedures, infusions, radiology, and laboratory studies are kept at the local hospital, the struggling rural hospitals benefit tremendously from this delivery system. With the epidemic of rural hospital closures, this novel approach can help maintain our medical infrastructure in rural America.<br /><br /><br /></div><div><h2 style="text-align: left;">3). More efficient care.</h2><br />Because medical facilities and MDs are more scarce in rural locations, patients often must wait many months and travel great distances for an in-person appointment. Physicians working virtually can typically see patients sooner, leading to earlier diagnoses, fewer risks of complications and better continuity of care. Once diagnosed, patients operating within a hybrid care model can then reach out to local clinic staff for help in scheduling necessary tests or interventions.<br /><br />Even when in-person doctor appointments are available, rural residents tend to have to travel long distances to reach healthcare facilities. Those with limited mobility, chronic conditions or tight budgets may find regular in-person physician visits especially difficult. By offering a telehealth option for routine check-ups, medication management, and certain follow-up visits and consultations, physicians and clinics can reduce their overhead while helping patients avoid the financial and time costs associated with frequent and lengthy travel.<br /><br />When a patient’s condition requires input from multiple providers, the hybrid model lets physicians easily consult with other specialists, share medical records, and collaborate with remote and in-person providers to formulate treatment plans. 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However, several common mistakes must be understood so that practice administrators can guard against them. Pointing out these mistakes is not a criticism of the process but acknowledgement of improper implementation. Medical practice leaders must recognize both the benefits and the potential pitfalls of <a href="https://www.physicianspractice.com/view/planning-your-practice-s-2024-strategy">strategic planning</a>, because it is their responsibility to ensure that strategic planning is conducted properly to achieve the desired goals. Here are four of the most-common planning mistakes we find:<br /><br /><br /><div><h2 style="text-align: left;">1. Attempting to forecast and dictate events too far into the future</h2><br />In part, this may result from the natural desire to believe we can control the future. It is a natural tendency to plan on the assumption that the future will merely be a linear continuation of present conditions, and we often underestimate the scope of changes in direction that may occur. Because we cannot anticipate the unexpected, we tend to believe it will not occur. In fact, most strategic plans are overcome by events much sooner than anticipated by practice leaders.<br /><br /><br /></div><div><h2 style="text-align: left;">2. Trying to plan in too much detail</h2><br />This is not a criticism of detailed strategic planning but of planning in more detail than the conditions warrant. This pitfall often stems from the natural desire to leave as little as possible to chance. In general, the less certain the situation, the less detail in which we can plan. However, the natural response to the anxiety of uncertainty is to plan in greater detail, to try to cover every possibility. This effort to plan in greater detail under conditions of uncertainty can generate even more detail. The result can be an extremely detailed strategic plan that does not survive the friction of the situation and that constricts effective action.<br /><br /><br /></div><div><h2 style="text-align: left;">3. Tendency to use planning as a scripting process that tries to prescribe actions with precision</h2><br />When practice leaders fail to recognize the limits of foresight and control, the strategic plan can become a coercive and overly regulatory mechanism that restricts initiative and flexibility. The focus for staff members becomes meeting the requirements of the strategic plan rather than deciding and acting effectively.<br /><br /><br /></div><div><h2 style="text-align: left;">4. Tendency for rigid planning methods to lead to inflexible thinking</h2><br />While strategic planning provides a disciplined framework for approaching problems, the danger is in taking that discipline to the extreme. It is natural to develop planning routines to streamline the strategic planning effort. In situations where planning activities must be performed repeatedly with little variation, it helps to have a well-rehearsed procedure already in place. However, there are two dangers. The first is in trying to reduce those aspects of strategic planning that require intuition and creativity to simple processes and procedures. Not only can these skills not be captured in procedures, but attempts to do so will necessarily restrict intuition and creativity. The second danger is that even where procedures are appropriate, they naturally tend to become rigid over time. This directly undermines the objective of strategic planning — enabling the organization to become more adaptable. This tendency toward rigidity is one of the gravest negative characteristics of strategic planning and of strategic plans.<br /><br />Indeed, strategic planning is an essential part of practice management, helping practice leaders to decide and act more effectively. As such, strategic planning is one of the principal tools used to exercise operational control. Remember though, that strategic planning involves elements of both art and science, combining analysis and calculation with intuition, inspiration, and creativity. To plan well is to demonstrate imagination and not merely to apply mechanical procedures. Done well, strategic planning is an extremely valuable activity that greatly improves practice performance and is an effective use of time. Done poorly, it can be worse than irrelevant and a waste of valuable time. 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The convergence of recent technology breakthroughs, demand from patients for a better experience combined with a holistic approach (clinical, social, behavioral) to patient well-being will require the need for modernizing care delivery systems. The critical need to reduce <a href="https://www.physicianspractice.com/view/practice-tip-of-the-week-reducing-stress">staff burnout</a> is further reshaping how healthcare organizations operate and engage with patients.<br /><br />Here are some of the areas where we expect to see these changes take place:<br /><br /><br /><div><h2 style="text-align: left;">Creating hyper-personalized consumer experience</h2><br />Watch for <a href="https://www.physicianspractice.com/view/adopt-a-true-patient-centric-approach-with-a-single-point-of-operational-control">hyper-personalization</a> to dictate the patient experience in 2024. Healthcare providers are harnessing technology to deliver highly personalized care. This extends beyond treatment plans; it encompasses understanding patient communication preferences, lifestyle choices, and individual needs. Through personalized approaches, practitioners will forge deeper connections with patients, leading to improved treatment adherence and outcomes while lowering the cost of care.<br /><br /><br /></div><div><h2 style="text-align: left;">Generative AI for predictive healthcare outcomes</h2><br />Artificial Intelligence (AI) augments traditional diagnosis to become a powerful predictor of healthcare outcomes. Generative AI algorithms are revolutionizing patient care by enabling providers to anticipate outcomes with greater accuracy. By leveraging extensive datasets and advanced algorithms, healthcare professionals can foresee potential health trajectories, allowing for proactive interventions and personalized treatment plans. This predictive capability will facilitate quick and accurate decision-making, ultimately improving patient care and prognosis.<br /><br /><br /></div><div><h2 style="text-align: left;">Holistic care: Embracing comprehensive well-being</h2><br />A paradigm shift toward holistic care is reshaping the traditional healthcare model. Recognizing that health is not solely defined by medical conditions, practitioners are adopting a more comprehensive approach. Beyond treating symptoms, healthcare providers now consider the interconnected aspects of patients' lives—including social, behavioral, nutritional, and physical factors. This holistic approach fosters a deeper embrace of patients' overall well-being, emphasizing preventive care and improving long-term health outcomes.<br /><br /><br /></div><div><h2 style="text-align: left;">Integrated healthcare management platforms: Simplifying operations</h2><br />The need for streamlined administrative processes has become a prominent challenge, especially for multi-location medical practices. The disparity in patient experiences across various locations has spotlighted the urgency for the standardization of the highest benchmarks. Integrated Healthcare Management Platforms are emerging as a solution, consolidating a hodgepodge of disparate software programs for billing, scheduling, and patient records into a amalgamated platform. When unified, these platforms streamline administrative tasks and safeguard standardized procedures across locations, and significantly alleviate the burden on already overworked office staff.<br /><br /><br /></div><div><h2 style="text-align: left;">Addressing Mental Health through Streamlined Screening</h2><br />The escalating mental health crisis in the US has accentuated the importance of early detection. Healthcare organizations are prioritizing and incorporating mental health screenings to flag patients at risk and alert staff.Integrating mental health screening tools that remove the barriers that traditionally prevent accurate completion and pushing the results into electronic health records modernizes this process, ensuring efficient data capture while reducing stress on administrative teams. Research has found that patients are more likely to be candid about mental health issues on private and or remote screening methods – even more so than when they are speaking with their primary care physician.<br /><br /><br /></div><div><h2 style="text-align: left;">Conclusion:</h2><br />As we enter into 2024, healthcare practices will deliver a profound evolution in patient care and experience. The convergence of patient-centric approaches, predictive technologies, holistic care models, and modernized administrative processes will help redefine the healthcare landscape and improve the patient experience. 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Last year’s figure was the most since 2019, when there were 51 cases filed.<br /><br />Health care bankruptcy filings rose across six consecutive quarters through the third quarter of 2023. But it was unclear if a decrease in the fourth quarter last year indicates an emerging trend, the report said.<br /><br />“We saw a dramatic increase in healthcare bankruptcy filings in 2023, continuing the trend which began in mid-2022” Gibbins Advisors Principal Clare Moylan said in a <a href="https://gibbinsadvisors.com/record-bankruptcy-filings-in-the-healthcare-sector-in-2023/">news release</a>. “Key observations from 2023 are the return of large bankruptcy cases with over $100 million in liabilities, and a spike in hospital filings, both of which appear to primarily be a result COVID-19 pandemic-related protections ending.”<div><br /><h2 style="text-align: left;">Five drivers</h2><br />Gibbins Advisors listed five factors contributing to the financial distress of health care organizations:</div><div><ul style="text-align: left;"><li>Capital market constraints. Interest rates may go down in 2024, but refinancings, access to capital, valuations and transactions still are affected by relatively high interest rates.</li><li><a href="https://www.medicaleconomics.com/view/top-10-benefits-hospitals-are-offering-to-keep-employees">Labor and supply cost pressures.</a> Agency labor is settling down in some markets, but there were large cost increases over the last two years and minimum staffing rations would be a challenge.</li><li>Revenue pressure. Payment rate increases are not keeping up with inflation and the end of Medicaid continuous enrollment may increase the number of uninsured patients.</li><li>Possible optimism. Rates and volumes could increase this year, but costs likely will remain a challenge, particularly for smaller organizations with revenues less than $500 million.</li><li>A shift to out-of-hospital care delivery. There will be challenges and opportunities as care moves out of hospitals and skilled nursing facilities to outpatient, community and home-based settings.</li></ul><br />“As we anticipated, restructuring activity in the hospital sector increased markedly in 2023 and we expect to see a continuation of that level of distress this year as hospitals, particularly rural and standalone hospitals, work through challenging profitability, liquidity and leverage dynamics,” said Moylan.</div><div><br /><h2 style="text-align: left;">By the numbers</h2></div><div><ul style="text-align: left;"><li>Last year there were 12 hospital bankruptcies, up from 11 in 2020, 2021 and 2022 combined.</li><li>Organizations with liabilities from $10 million to $50 million accounted for the most filings, totaling 39 last year.</li><li>There were 20 bankruptcy cases filed by pharmaceutical companies, the most of any subcategory.</li><li>There were six clinics and physician practices that filed for Chapter 11 bankruptcy protection in 2023.</li></ul><br />While there has been much analysis of <a href="https://www.medicaleconomics.com/view/positive-financial-finish-for-hospitals-and-health-systems-in-2023-though-challenges-loom">hospitals’ financial condition</a>, the Gibbins Advisors report noted not all failing hospitals file for bankruptcy, for two key reasons.<br /><br />The hospital may be owned by a larger health system that can close it and settle obligations without needing to go to court. Or, bankruptcy may not be an effective tool if a troubled hospital has no buyer or financial backers and already has closed, according to Gibbins Advisors.<br /><br />From 2018 to 2023, there were 117 total acute care hospital closures and 69 hospitals opened, resulting in net closure of 48 hospitals, according to Gibbins Advisors, which cited data from the Medicare Payment Advisory Commission. 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When the patient seeks a second opinion, the opinion of the second <a href="https://www.physicianspractice.com/view/5-tips-to-retain-great-physicians">doctor</a> may be different than yours. As a result, the patient may become confused, wants a third opinion, or accepts the advice of the second opinion. This article discusses a practical approach when a patient requests a second opinion.<br /><br />Why do patients request a second opinion?<div><ul style="text-align: left;"><li>They have a rare condition and seek a physician who might have more experience or training</li><li>There is confusion about the doctor's diagnosis or the treatment options, and the patient wants more information</li><li>The patient's symptoms have not improved after a recommended treatment</li><li>The patient wants assurance that all treatment options have been presented</li><li>The patient believes that the diagnosis is incorrect</li></ul><br />Let me share a second opinion story that happened early in my career. I diagnosed a young man with a solid mass in his testis, confirmed with ultrasound and elevated tumor markers. I suggested an abdominal CT scan, a chest X-ray, followed by an orchiectomy. The patient wanted to obtain a second opinion. The other urologist recommended a course of antibiotics, and that the patient should return in two weeks for a follow up examination. I thought this was incredulous. I suggested that the patient obtain a third opinion. I directed the patient to the medical school. The third urologist agreed with my recommendation. That experience taught me a lesson that I would like to describe.<br /><br />First, when a patient requests a second opinion. Take the high ground. Agree with the patient's request. Think of the Golden Rule: Wouldn't you obtain a second opinion if you were to have a major elective procedure? I know I would.<br /><br />Next, provide the patient with recommendations from like-minded, ethical physicians. This places the patient in the hands of someone who will provide the patient with an honest second opinion.<br /><br />Once the patient has selected the doctor for the second opinion, reach out and contact the second opinion doctor and describe the clinical situation. Ask the second opinion urologist for a follow-up call or note regarding their opinion.<br /><br />Finally, make copies of the patient's <a href="https://www.physicianspractice.com/view/practice-tip-of-the-week-improving-clinical-documentation">medical records</a>, give them to the patient, and send a copy to the doctor chosen by the patient. This avoids the situation of the second opinion requesting the records after seeing the patient or the second opinion repeating tests which also delays the patient's treatment. This last step indicates to the patient that you are making every effort to be helpful and a caring and cooperative physician. Also, this avoids the situation of the records being misplaced in the second opinion’s office since they do not have any information of the patient in their medical records. Also, if the patient wants a third or fourth opinion, they have copies of the records to show additional doctors.<br /><br />Bottom Line: You can expect that patients will occasionally request a second opinion. Following these steps ensures that there is continuity of care. 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The program can have a big impact on Medicare Part B reimbursements, using the MIPS composite performance score to determine if providers will receive a payment bonus, a payment penalty, or no payment adjustment at all. Adjustments are based on performance in four categories: quality, cost, promoting interoperability, and improvement activities.<br /><br />The biggest challenge for providers is to report data for at least six quality measures for a minimum number of cases for each calendar year. This poses an additional challenge for specialty providers as most of the measures were designed around the most common point-of-service where Medicare participants receive treatment – primary care. Specialty providers often find themselves force-fitting measures to fit the specialized care they provide. In addition, the benchmarks used to score performance keep raising the bar each year, making it increasingly difficult to earn a high score.<br /><br />MIPS is one of many government programs focused on <a href="https://www.cms.gov/blog/cms-national-quality-strategy-person-centered-approach-improving-quality">improving quality</a> with a focus on value-based care. Programs like MIPS seek to change provider behavior to ultimately improve patient outcomes with the most affordable costs – using penalties to drive that change. To reduce the burden of MIPS, it’s best to make the shift in behavior to support providers in delivering the best patient care – and making compliance with these programs a natural outcome of doing that well.<br /><br />Specialty providers can take three steps now to succeed with <a href="https://www.physicianspractice.com/view/5-ways-create-and-implement-better-mips-quality-improvement-strategies">MIPS</a> while prioritizing caring for their patients.<br /><br /><br /><div><h2 style="text-align: left;">Be proactive about MIPS</h2><br />To comply, CMS requires a full year of data for a minimum number of patients. If you have not considered your plan for 2024, don’t delay. Your plan for 2024 should recognize that it will be the strictest in the history of the program, including changes to 60 quality measures. It’s imperative to become familiar now with the <a href="https://www.federalregister.gov/documents/2023/11/16/2023-24184/medicare-and-medicaid-programs-cy-2024-payment-policies-under-the-physician-fee-schedule-and-other">CMS MIPS final rule</a> released in November. With a requirement to report on at least six clinical quality measures, start by understanding the measures and associated benchmarks that best fit your patient mix.<br /><br />Note that some clinical quality measures are specialty specific, while other measures need to be selected based on the appropriateness for the care they deliver. Many specialty practices need to incorporate primary care measures into their standard practice to have enough measures. For example, an ophthalmologist who treats patients with complications of diabetes can incorporate the HbA1c lab results into their documentation and get credit for an outcomes-based quality measure. With these considerations in mind, identify at least six measures to target in 2024 that will benefit your patients, and optimize your MIPS score.<br /><br /><br /></div><div><h2 style="text-align: left;">Make MIPS part of everyday practice</h2><br />Each year, the <a href="https://www.physicianspractice.com/view/without-benchmarking-data-practices-likely-to-miscalculate">benchmarks</a> have grown tighter, so it is reasonable to expect that will continue. Moreover, the outcomes for providers have shifted from gaining incentives to avoiding penalties – now a minus 9% for Medicare Part B reimbursements. Therefore, it’s imperative that providers make MIPS compliance a team effort by integrating the measures and associated documentation within everyday patient care workflows right from the start of the year. <br /><br />After identifying at least six quality measures, consider with all staff, from the front desk to the care team to billing and reimbursement, how best to incorporate each one into day-to-day care delivery and administrative processes. For example, when a patient checks in for care, establish a standard protocol for the front desk staff and medical assistants to update the medication list and document weight and blood pressure. You can leverage the required MIPS functionalities in your 2015 Edition Certified EHR to make sure that your clinical documentation will satisfy your MIPS efforts.<br /><br />In addition, consider how to make ongoing patient engagement part of your standard practice. For example, invite patients to connect via the patient portal, provide patient educational materials, offer virtual visits as appropriate, and increase proactive outreach for follow-up and preventive care. All these actions improve care and patient engagement while improving scores on MIPS measures at the same time.<br /><br /><br /></div><div><h2 style="text-align: left;">Keep an eye on what’s expected in 2024</h2><br />Even as CMS tightens the MIPS program, they are also actively working to reduce the burden on providers. One avenue is the creation of <a href="https://qpp.cms.gov/mips/mvps/learn-about-mvp-reporting-option">MIPS Value Pathways (MVPs)</a>. These pathways are designed to make it easier for certain specialties, such as orthopedics and neurology, to manage their participation in MIPS. However, not all specialties have an MVP available yet. Providers in those specialties can work with their professional associations to lobby CMS to expand MVPs.<br /><br />With all the changes and the potential impact on revenue, it’s important that providers stay informed. Many seek guidance from their EHR vendor and organizations that provide <a href="https://www.mymipsscore.com/">consulting expertise and technology tools</a> to streamline compliance. In addition, providers should actively use the CMS’s Quality Payment Program website to stay up to date on MIPS.<br /><br /><br /></div><div><h2 style="text-align: left;">Conclusion</h2><br />For specialty providers, there is a balance to strike with the MIPS program. With upfront planning, providers can implement processes that improve patient care and quality outcomes – and successfully address MIPS performance measures. The data collected by CMS is intended to inform patient-centered best practices that will continually improve clinical and financial outcomes. 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Physicians are turning to <a href="https://www.medicaleconomics.com/view/reform-group-pushes-to-curb-private-equity-control-of-health-care">equity funds as buyers</a> because equity funds typically pay more for a practice than any other form of buyer. Physicians need to understand <a href="https://www.medicaleconomics.com/view/health-care-private-equity-had-second-best-year-on-record-in-2022">why equity funds can pay more for a practice</a> than can be paid by a hospital, and the steps necessary to maximize the purchase price paid by the equity fund.<br /><br /><br /></p><h2 style="text-align: left;">Hospitals as buyers</h2><br /><br />Hospitals and equity funds are continually looking to acquire medical practices. From a practical perspective, hospitals typically cannot pay as much for a medical practice as the practice can receive from an equity fund. This is because the federal government carefully monitors whether payments by a hospital to a physician or physician group are excessive and will constitute a direct or indirect inducement for patient referrals in violation of the <a href="https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/">federal Anti-Kickback Statute</a>.<br /><br />Hospitals are allowed to pay a "fair market value and commercially reasonable" purchase price for a practice or as compensation to a physician without violating the Anti-Kickback Statute. A fair market value and commercially reasonable purchase price essentially equates to what a willing buyer would pay to a willing seller for the hard assets of the practice. This definition creates a great amount of controversy in many hospital/physician transactions and is dramatically lower than the price typically offered by the equity fund.<p></p><p><br /></p><p></p><h2 style="text-align: left;">No referrals necessary</h2><br />Conversely, given a physician cannot make patient referrals to an equity fund and the equity fund cannot make referrals to the physician, the Anti-Kickback Statute is usually not implicated in an equity fund/physician practice deal. Therefore, physician practices are often sold at a six- to 12-times multiple of the practice’s earnings before interest, taxes, depreciation and amortization. Known as EBITDA, that essentially is cash available after payment of all expenses including an agreed amount for physician compensation. The ultimate goal of the equity fund is to purchase multiple medical practices and, thereafter, combine whatever EBITDA can be removed from the medical practices and sell the aggregated EBITDA to yet a larger equity fund for a 10- to 16-times multiple. The spread between what the equity fund pays for the medical practices and the price it can receive when selling the aggregated practices to the larger fund, is what is driving this surge in acquisitions of medical practices by equity funds.<p></p><p><br /></p><h2 style="text-align: left;">Primary care practices and assets</h2><br />When representing primary care medical practices, we work with the medical practices to enhance their attractiveness to both hospitals and equity funds. To attract hospitals, the primary care practice needs to be responsible for directing the medical services for as many covered lives as possible or provide some type of service that is unique in the marketplace. The U.S. Supreme Court clearly states that if even one purpose of the payment by a hospital to a medical group is to induce patient referrals, the payment is illegal. Therefore, it must be made clear that the acquisition of the primary care practice is to assure appropriate coverage for people in the hospital's service area needing primary care services and not for the purchase of referrals and that the payment constitutes fair market value consideration for what is being purchased.<br /><br />Additionally, hospitals may want to acquire office buildings, land, equipment or other assets under the control of the primary care group. Each of those items can be acquired at a price equal to what an independent third party considers fair market value. Thus, the more tangible assets owned by a medical practice or by the physicians who own the medical practice, the greater the aggregate sum the hospital can pay to the physicians. The strategy is to allocate as much of the purchase price to the fair market value of these hard assets as possible to mitigate a claim that the hospital is paying for referrals by paying more for the medical practice itself than would be considered fair market value.<p></p><p><br /></p><h2 style="text-align: left;">Physician salaries</h2><br />Hospitals also try to attract physicians and their practices by offering higher salaries than the physicians historically earned in private practice. The concept is to compete with the equity funds purchasing power by paying higher salaries than are offered by the funds. However, the salaries a hospital can pay the physicians are also limited by the Anti-Kickback Statute. Consequently, the hospitals seek compensation guidelines from valuation companies and national physician compensation surveys to justify the offered salaries. Despite arguments by some commentators that the compensation surveys report artificially high salary ranges (the idea is that salaries reported by physicians to surveyors are overstated because the physicians believe the higher survey numbers will result in the hospitals’ ability to pay higher wages), hospitals have been successful in paying higher salaries than what physicians are usually paid in private practices (excluding physician’s income from ancillary services).<br /><br />Physician practices that desire to stay private and avoid hospital control, hospitals in rural communities who are losing physicians to bigger cities, and equity funds often claim that larger urban hospitals use revenue from facility fees to inappropriately subsidize the higher physician salaries. The theory is that in return for higher salaries, the physicians are induced to maximize referrals to their employer hospital, which some commentators suggest is a disguised violation of the Anti-Kickback Statute. Hospitals cannot use facility fees to pay excessive physician salaries.<br /><br />Hospitals have been able to acquire primary care physicians at a faster rate than acquiring specialists’ practices because, typically, primary care physicians do not have the same access to ancillary income opportunities available to specialists. Thus, the salaries of private practice primary care physicians are typically lower than the income of many specialists, enabling the hospital to employ primary care physicians at lower cost to the hospital and at an increased rate of pay for the physicians.<p></p><p><br /></p><h2 style="text-align: left;">Maximize EBITDA for private equity investment</h2><br />Although hospitals may claim that the acquisition of physicians and physician practices is intended to enhance patient care in the community (they deny a focus on obtaining additional facility fees), the equity fund is typically openly motivated by creating a financial return for itself and the physicians. A business strategy for every physician group seeking a sale to an equity fund is to find a way to maximize its available EBITDA because the available EBITDA is often sold to the equity fund at a six- to 10-times multiple. Thus, the higher the EBITDA, the higher the purchase price.<br /><br />Maximizing EBITDA requires the use of qualified advisers who have experience with these types of transactions. Maximizing EBITDA focuses on the practice's income statement to determine how to reduce expenses and increase revenue so that the profit available to the equity fund is maximized. Does the practice have excess staff or use outside services that are in excess of what is needed to appropriately run the practice? Mathematically, decreasing office expenses directly increases EBITDA. If the physicians own the medical office building to which the practice is paying rent, a reduction in office rent will increase the EBITDA. For every dollar increase in EBITDA, there is a corresponding increase in the purchase price by multiplying the increase in EBITDA by the multiple offered by the equity fund. The strategy is to find every expense incurred by the practice that can be reduced or eliminated, without affecting the delivery of patient services, that can result in an increas<span face="ui-sans-serif, system-ui, -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", Arial, "Noto Sans", sans-serif, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"" style="font-size: 1.1rem;">e to practice EBITDA</span><div><span style="font-size: 17.6px;"><br /></span><div class="py-2" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 #0000; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(229, 231, 235); box-sizing: border-box; padding-bottom: 0.5rem; padding-top: 0.5rem;"><div class="blockText_blockContent__TbCXh" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 #0000; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(229, 231, 235); box-sizing: border-box;"><p class="pb-2" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 #0000; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(229, 231, 235); box-sizing: border-box; line-height: 1.7; margin: 0px 0px 0.75rem; padding-bottom: 0.5rem;">The foregoing example illustrates the financial power of a proposed equity fund transaction. In addition, the equity fund will often pay the $1.8 million described above partly in cash and partly in stock of an entity affiliated with the equity fund. The strategy is to accumulate multiple practices to sell to a larger equity fund. By offering part of the purchase price in stock in contemplation of a future sale, the physicians stay employed by the fund in anticipation of a second enhanced payday. Thus, the equity fund argues that the physician is not only earning the nine-times multiple on the initial sale, but to the extent the physicians also receive stock and it sells in the future at a much higher multiple, the physicians receive an even greater return.<br /><br />Once the maximum EBITDA is determined and the resulting maximum purchase price is achieved, the task is to assure as much of the purchase price as possible is taxed at long-term capital gains rates. Long-term capital gains rates are achieved through sales of stock of a practice (however, equity deals are usually “asset sales” due to corporate practice of medicine restrictions and buyer adversity to acquiring unknown liabilities) or asset sales that appropriately maximize the allocation of the purchase price to payments for “goodwill.” It is also critical to assure that any purchase price paid, in part, in the form of equity fund stock is received by the physicians in a tax-free exchange. A knowledgeable tax adviser is critical for this purpose.</p><h2 style="text-align: left;">Strategies for small groups</h2><br />Understanding the foregoing is the basis for planning the future business sale of a medical practice. Assuming physicians do not have office or rent expenses they can reduce or eliminate to create EBITDA, and assuming they do not have large salaries they can reduce to create EBITDA, the strategy is to find EBITDA in other ways. A common strategy is for small groups to combine to become larger groups to create economies of scale and, thereby, reduce expenses and create EBITDA. Some practices form management companies to manage other practices and use the resulting income as EBITDA. Leveraging mid-levels and engaging in telemedicine has also become a source of revenue that can create EBITDA. Exploring these strategies will be addressed in a future article.<p></p><p class="pb-2" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 #0000; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; border: 0px solid rgb(229, 231, 235); box-sizing: border-box; line-height: 1.7; margin: 0px 0px 0.75rem; padding-bottom: 0.5rem;"><br /></p><h2 style="text-align: left;">Conclusion</h2><br />Given the change in the way financial markets reward innovation, which has caused equity players to enter into new types of businesses, health care has become an industry of choice due to the continued patient need for services and the resulting stable stream of income. Physicians and health care entities of all types need to carefully review this emerging market trend and plan for these new opportunities<span face="ui-sans-serif, system-ui, -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", Arial, "Noto Sans", sans-serif, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol", "Noto Color Emoji"" style="font-size: 1.1rem;">.</span></div></div><p><br /></p><h2 style="text-align: center;">15% Off Medical Practice Supplies</h2><div style="text-align: center;"><br /></div><h3 style="text-align: center;"><a href="https://www.zazzle.com/artnip/gifts?cg=196189491912815167&pg=1&sd=desc&st=date_created"><b><span style="color: yellow;">VIEW ALL</span></b></a></h3><div style="text-align: center;"><b><br /></b></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><b><div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTMU2JxK1cgazEmR1BW0RqhEYsFCQw35vGYzW3Jwg-WlwQ3WMMv68AfaR2lWfdfzvLWYkkUaAIJ7HzyNLUOw0Ql_jmw8NAnU9S3rvwn6dAvTq6o385S-539rRH-WMnTQ0YxD9pCgGrdA0/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="216" data-original-width="216" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTMU2JxK1cgazEmR1BW0RqhEYsFCQw35vGYzW3Jwg-WlwQ3WMMv68AfaR2lWfdfzvLWYkkUaAIJ7HzyNLUOw0Ql_jmw8NAnU9S3rvwn6dAvTq6o385S-539rRH-WMnTQ0YxD9pCgGrdA0/" width="240" /></a></div><a href="https://www.zazzle.com/manual_prescription_pad_large_light_grey-133957177087146087" target="_blank"><span style="color: #fcff01;">Manual Prescription Pad (Large - 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Families on this journey often encounter formidable challenges as <a href="https://www.medicaleconomics.com/topics/patient-relations">they seek the right resources</a> for accurate diagnosis and treatment for their children. They often question if their primary care physician or pediatrician is the most qualified to make recommendations and if they need a referral to a developmental-behavioral pediatrician. An overview of these disciplines demonstrates the overlap in their roles and capabilities for addressing ASD.<div><br /></div><div><br /><h2 style="text-align: left;">Understanding ASD</h2><br />The U.S. Centers for Disease Control & Prevention (CDC) <a href="https://www.cdc.gov/ncbddd/autism/signs.html#:~:text=Autism%20spectrum%20disorder%20(ASD)%20is,%2C%20moving%2C%20or%20paying%20attention">defines</a> ASD as a developmental disability caused by differences in the brain. Experts describe people with ASD as having problems with social communication and interaction, and restricted or repetitive behaviors or interests. They may also have different ways of learning, moving or paying attention.<br /><br /><br />The World Health Organization (WHO) reports that <a href="https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders">about one in 100 children</a> has autism, and while characteristics may be detected in early childhood, autism is often not diagnosed until much later.<br /><br />The American Academy of Family Physicians (AAFP) <a href="https://www.aafp.org/pubs/afp/issues/2010/0215/p453.html#:~:text=%2Fscreening%2F).-,Referral%20and%20Diagnosis,to%20excessive%20delays%20in%20diagnosis">advises</a> the earliest sign of autism in children is the delayed attainment of social skill milestones, including joint attention, social orienting and pretend play. They characterize language impairment as a common, but less specific, sign of autism, pointing to repetitive behaviors and restricted interests that may not be noted until after social skill and communication impairments are exhibited.</div><div><br /></div><div><br /><h2 style="text-align: left;">Diagnosis and referrals</h2><br />Referrals for diagnostic evaluations are crucial. Pediatricians should perform developmental surveillance, administer autism-specific screenings at 18- and 24-month visits and refer for comprehensive evaluations when concerns arise. Simultaneous referrals to relevant specialists prevent delays in diagnosis and treatment.</div><div><br /></div><div><br /><h2 style="text-align: left;">Overlap in pediatric and family physician roles</h2><br />Pediatricians, focused on infants, children and adolescents, often address ASD due to their emphasis on managing physical, behavioral and mental health. While pediatricians typically see patients under 18, <a href="https://www.aafp.org/about/dive-into-family-medicine/family-medicine-speciality.html">family physicians</a>, central to primary care, provide comprehensive health care for all ages. Both play vital roles in identifying and managing autism.Primary care's role</div><div><br /><ul style="text-align: left;"><li>Primary care providers <a href="https://pubmed.ncbi.nlm.nih.gov/31843864/">must understand</a> ASD diagnostic criteria, differential diagnoses and available supports and services. Familiarity with co-occurring medical conditions ensures a holistic approach to care. While medications can address certain aspects, there's no single medical therapy effective for all ASD symptoms.</li><li>Pediatricians' contribution</li><li>Pediatricians should <a href="https://www.aap.org/en/patient-care/autism/autism-diagnosis-in-primary-care/">perform</a> developmental surveillance, administer autism-specific screenings and provide referrals for diagnostic evaluations. The American Academy of Pediatrics (AAP) counsels physicians to perform developmental surveillance at all well-child visits, and also recommends administering an autism-specific screening tool at the 18- and 24-month. Understanding diagnostic criteria, differential diagnoses, available supports and managing co-occurring conditions are essential components of pediatric care.</li><li>Developmental-behavioral pediatricians</li><li>These specialists, with an additional three years of training in developmental and behavioral problems, <a href="https://www.tpathways.org/faqs/who-can-diagnose-autism/#:~:text=Developmental%20pediatricians%20are%20medical%20doctors,provide%20counsel%20and%20treatment%20accordingly">provide in-depth evaluations</a>, consider medical and psychosocial factors and offer counsel. They play a pivotal role in diagnosing autism and coordinating interventions, often collaborating with other specialists.</li></ul><div><br /></div><h2 style="text-align: left;">Early intervention matters</h2><br />Research underscores the significance of early diagnosis and intervention, especially before the <a href="https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatments/early-intervention">age of 2</a>. Early interventions enhance long-term positive outcomes, with some children progressing to a point where they no longer fall within the autism spectrum.<br /><br />Early interventions not only give children the best start possible, but also the best chance of developing to their full potential. The sooner a child gets help, the greater the chance for learning and progress. In fact, recent guidelines suggest starting an integrated developmental and behavioral intervention as soon as ASD is diagnosed or seriously suspected. Some children with autism make so much progress that they are no longer on the autism spectrum when they are older.<br /><br />In the intersection of pediatrics and primary care, collaboration and understanding across disciplines are crucial. By leveraging the strengths of pediatricians, family physicians and developmental-behavioral pediatricians, we can create a comprehensive support network for individuals and families affected by ASD. 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