Monday, May 31, 2021

Investing when markets are at all-time highs

The equity markets have again pushed against all-time highs. During these times, sentiment amongst investors is often split. Some believe the markets will continue to push higher and continue to buy into the euphoria of the markets rising. Others believe the markets are due for a correction and start pulling out of investments to preserve their profits. This is an action driven by fear. Whether putting more money into the markets with the belief they will continue rising in the short term or pulling money off the table in anticipation of an impending drop, both actions are emotional responses to feelings of euphoria and fear. Investing with emotion can lead to costly mistakes.


When markets are approaching and sometimes exceeding all-time highs, and there is uncertainty about whether they will head higher or lower, what are some non-emotional actions you can take?


Stick to your investment strategy


Having an investment strategy is critical. Staying disciplined during market uncertainty is key to long-term investment success, and your investment strategy is there to protect you from reacting emotionally and making mistakes. The strategy will tell you when to buy, what types of investments to buy, and the circumstances in which it is acceptable to sell. Having this investment strategy will allow you to focus on growing your wealth in a disciplined and planned out manner, while also ignoring the outside noise.


Rebalance


The markets are often cyclical, and while one asset class may be doing well, another may be struggling. This can lead to your asset classes straying from their target percentages. Some categories may become overweighted and others underweighted. One of the keys to long-term investing is keeping your asset allocation in line with its target percentages. If some categories are over or under weight, then your policy is taking on more risk than originally intended.

There are two preferred methods of rebalancing. Option one is to sell a portion of the category that is overweight and reallocate the proceeds to underweight categories. In tax-advantaged accounts like 401(k)s and IRAs, rebalancing is relatively easy to do because you can sell investments without having to worry about capital gains taxes; however, in taxable accounts like individual, joint, and trust accounts, the tax implications of selling must be factored into the rebalancing decision. You could end up owing a hefty capital gains tax if you rebalance by selling an investment with a significant gain. For taxable accounts, rebalancing strategy option two typically works best: add more money to the account and invest in the underweight categories.


Stockpile cash, invest at opportune times


Knowing when the markets will experience a pullback or correction is nearly impossible. However, when the markets head in a negative direction, excellent buying opportunities may arise and some investments may be trading at a discount. You can be prepared to take advantage of these moments by having cash on hand.

Start by determining the amount of cash you want or feel comfortable sitting in reserves. Use this stockpile to invest in categories trading at a discount during market pullbacks. Since it is impossible to know when the market has hit its bottom, use a dollar cost averaging strategy to invest incrementally over a set period. Buying incrementally removes the risk of putting all your chips on the table at one time and have the investments continue to drop. As markets and investment values continue to fall, you will incrementally purchase at more and more advantageous prices. It may not get you quite the return as if you had perfectly picked the bottom of the market pullback, but that is a difficult, if not impossible feat to get right consistently.

No one can really know whether markets will continue climbing or experience a pullback when pushing record highs. Having a plan in place will allow you to stay disciplined and invest without emotion. Remaining well-allocated and diversified across asset classes will reduce the risk in your overall portfolio. Finally, have a little cash available in case some investments are trading at a discount.


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Saturday, May 29, 2021

Myths of patient experience platforms

The pandemic has spurred many trends that had already been ongoing. Remote work, slow travel, and online eCommerce had already been on the rise when the pandemic became a global crisis and social distancing measures meant they became much more prevalent.


The adoption of digital healthcare systems, or patient experience platforms, is just one of those trends. Telehealth platforms became necessary as social distancing protocols meant that doctors and physicians needed a way to safely continue operating.

As with all new ways of doing things, the adoption of patient experience platforms requires an adjustment period. Patient experience and telehealth platforms are new. Not every practice in the healthcare sector has embraced it whole-heartedly. The terms ``patient experience platforms” and “telehealth” are often used interchangeably.


Many hospital managers, physicians, and private doctors are skeptical of telehealth. Many of the most-common concerns among medical professionals have been alleviated, whether by recent studies or the individual case-studies of private healthcare practices.

We’ll define what patient experience is and analyze some of the commonly held misconceptions regarding it.


What Is Patient Experience?


In the same way that marketing is the sum of a customer’s interactions with a brand, patient experience is the sum total of a patient’s interactions with a healthcare practice such as a hospital or a doctor’s office.

A patient experience platform helps to manage those interactions, in the same way that you would use an automation platform like HubSpot to manage your marketing workflows. Telehealth platforms are used for tasks like scheduling online appointments, facilitating virtual visits, maintaining client/doctor communication portals, and sending automated reminders for care procedures.
Difference Between Patient Experience and Patient Satisfaction

Patient experience and patient satisfaction are two terms that mean similar but subtly different things.

  • Patient experience is quantitative and measurable, and refers to factors like:
  • Patient appointment attendance
  • Communication between doctors and patients
  • Use of patient feedback surveys to improve care

Patient satisfaction, meanwhile, is qualitative and subjective. It refers to how much the patient experience meets the quality expectations and standards of the patient.

Patient satisfaction can depend on very subtle things, and many of them are related to patient experience. Even minor disruptions in the patient experience can negatively impact it.
A few ways to improve patient satisfaction include:
  • Offering personalized care
  • Investing time in educating your patients
  • Maintaining clean, sterile rooms
  • Leaving yourself open to patient questions and concerns

Patient experience is closely tied to the real-life processes and inner workings of your healthcare practice, namely the quality of care that your clinic provides as well as the level of your disease management and prevention.


Myth #1: Quality Care Needs to Happen Face to Face


Fact: Patient experience platforms improve the quality of in-person care

A healthcare practice or hospital is a business. It’s an idea to many people in the healthcare sector, but it’s true. Healthcare is expensive, time-consuming, and requires sophisticated equipment to be effective—that money has to come from somewhere.

A healthcare practice also requires hundreds of administrative, logistical, financial, and communication-based tasks to function—many of which are unrelated to your patient’s care.

Patients need to be reminded of their appointments, follow-up care has to be administered to make sure your patient is taking their medication and following your instructions, lab reports have to be organized and made accessible to both you and the patient in a way that’s HIPAA compliant.

Patient experience platforms automate a lot of these cumbersome busywork tasks so that you can focus on helping people by being a doctor.

The GetWell Loop self-report indicated that patient experience platforms reduced unnecessary office visits by 84% and $75 per visit. That adds up to a lot of extra funds in your bank account you can use on more staff and better equipment.


Myth #2: Only Younger Generations Use Telehealth


Fact: Older generations like baby boomers are just as likely to use telehealth as millennials or ‘Gen Z’ers’.

It’s commonly thought that only millennials and ‘Gen Z’ers’ embrace new technology like social media, smartphones, and digital healthcare. This isn’t true: older generations like baby boomers and the silent generation are just as likely to make use of digital healthcare.

Why? Because patient experience platforms make healthcare more accessible to elderly people who don’t have as much mobility or require more nuanced or intensive care.

When it comes to primary care, awareness of online services like booking appointments is most prevalent in adults ages 65-74.


Myth #3: Quality, Personalized Patient Care is Non-Scalable


Fact: Patient experience platforms not only delivery quality healthcare, they do so at-scale

Private practice physicians often argue that automation platforms take the human element out of a necessarily human profession, and that you can’t scale a practice that puts people at the center of it.

This isn’t so. Telehealth helps a practice to grow and reach more patients by delivering better quality healthcare.

We’ve already established how telehealth platforms free up more space for patient care by automating administrative tasks for you and your staff.

A typical office visit typically lasts 17 minutes. That’s not very much time to make potentially life-altering decisions regarding your patient’s long-term care. Especially if that time is spent answering unnecessary questions which can be easily answered with a Google search or by reading your FAQ page.


Myth #4: Patient Experience Platforms Treat Healthcare Like a Business and Patients Like Numbers Instead of people


Fact: Patient experience platforms enhance doctor-patient interactions, not replace them.

An essential characteristic of any good doctor is empathy for other people. It involves dealing with potentially life-threatening situations with calm, grace, and compassion at all times.

Many healthcare professionals are justifiably skeptical about using automation platforms to replace that human element at the heart of all good healthcare. How do you train an algorithm to have empathy for sick or injured people?

Turns out, patient experience platforms make doctors more accessible to their patients, not less.

They facilitate communication between doctors and patients through online portals and virtual visits where quick, one-off questions can be answered. They also streamline your clinic’s workflows and leave you more time with your patients during appointments.


Myth #5: Patient Engagement Platforms are Prohibitively Expensive to Roll-Out


Fact: Patient experience platforms save you money in the long run.

Patient experience platforms improve patient satisfaction. Patient satisfaction leads to long-term relationships. Long-term patient relationships mean repeat patients. Repeat patients are how your practice makes money, and more importantly earns a good reputation.

Many providers have an 80% retention rate for patients who register with their online within the first 30-days of their intake appointment.

It doesn’t stop there either. That improved patient loyalty leads to:
  • Improved appointment attendance: fewer cancellations or no-shows that drain your money and waste your time
  • More referrals: patients who have been with you for longer are more likely to recommend you to friends and family and write about you online
  • Better bill pay reminders: make sure that you get your money on time
  • Trackable ROI: you spend less money on traditional marketing methods like fliers and TV commercials where you don’t know how much of your investment yo’re getting back

Many of the negative perceptions regarding patient experience platforms and other telehealth technologies are countered by statistical research and the observable facts.

Telehealth platforms help you grow your practice while maintaining the quality of care by:
  • Facilitating communication between doctors and patients
  • Making quality care more accessible to elderly people
  • Enhancing doctor-patient interactions
  • Saving time and money by automating mundane, routine administrative tasks

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Friday, May 28, 2021

Confidentiality and consent considerations when treating minors

In the majority of treatment and disclosure of protected health information (PHI) scenarios, parents or legal guardians are entitled to provide informed consent for the treatment of the minor and may request the minor’s medical records. From both a legal and an ethical standpoint, informed consent is fundamental to medical treatment because of the value placed on a patient’s autonomy. As the American Medical Association’s Code of Medical Ethics Opinion 2.1.1, “[p]atients have the right to receive information and ask questions about recommended treatments so that they can make well-considered decisions about care. Successful communication in the patient-physician relationship fosters trust and supports shared decision making.” Typically, the older a child becomes, the more “weight” is given to their perspective – this is known as assent.


Like most situations, there are exceptions. 20 CFR § 401.55 addresses access to medical records, including those of minors. §401.55(c) states,
Medical records of minors –
Request by the minor. You may request access to your own medical records in accordance with paragraph (b) of this section.
Requests on a minor's behalf; notification of or access to medical records to an individual on a minor's behalf.


(i) To protect the privacy of a minor, we will not give to a parent or guardian direct notification of or access to a minor's record, even though the parent or guardian who requests such notification or access is authorized to act on a minor's behalf as provided in § 401.75 of this part.


(ii) A parent or guardian must make all requests for notification of or access to a minor's medical record in accordance with this paragraph and the procedures in §§ 401.45 through 401.50 of this part. A parent or guardian must at the time he or she makes a request designate a family physician or other health professional (other than a family member) to whom the record, if any, will be sent. If the parent or guardian will not designate a representative, we will decline to release the requested information.
(iii) Where a medical record on the minor exists, we will in all cases send it to the physician or health professional designated by the parent or guardian. The representative will review the record, discuss its contents with the parent or legal guardian, then release the entire record to the parent or legal guardian. The representative does not have the discretion to withhold any part of the minor's record. We will respond in the following similar manner to the parent or guardian making the request: “We have completed processing your request for notification of or access to _____'s (Name of minor) medical records. Please be informed that if any medical record was found pertaining to that individual, it has been sent to your designated physician or health professional.”


(iv) In each case where we send a minor's medical record to a physician or health professional, we will make reasonable efforts to inform the minor that we have given the record to the representative.

There are also situations where a minor may give informed consent for his/her care. As 42 CFR § 2.14(a) indicates,


(a) State law not requiring parental consent to treatment. If a minor patient acting alone has the legal capacity under the applicable state law to apply for and obtain substance use disorder treatment, any written consent for disclosure authorized under subpart C of this part may be given only by the minor patient. This restriction includes, but is not limited to, any disclosure of patient identifying information to the parent or guardian of a minor patient for the purpose of obtaining financial reimbursement. These regulations do not prohibit a part 2 program from refusing to provide treatment until the minor patient consents to the disclosure necessary to obtain reimbursement, but refusal to provide treatment may be prohibited under a state or local law requiring the program to furnish the service irrespective of ability to pay.

The main take-away from this CFR section is that the type of treatment being sought by a minor (i.e., substance use disorder, sexually transmitted diseases), as well as the law in the state in which the individual is seeking treatment is critical to determine what is permissible and what is not.

Overall, parents are entitled to provide informed consent for their child’s treatment, as well as receiving medical records. However, there are treatment exceptions where parents do not need to give consent, and this is based on state law.


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