Friday, October 29, 2021

Why you should stress empathy and gratitude in your medical practice

We’ve all heard about the importance of doctors and nurses having a positive “bedside manner.” We ask a lot of our healthcare practitioners to put aside the daily stress of their jobs and be fully attentive and genuinely caring to each patient.

But what’s being said among the staff—out of earshot of the patients—can negatively affect the bedside manner. Further, if dysfunctional behavior, inefficient processes, and bad relationships are allowed to fester, then a physician’s practice will continue to erode and its employees will want to leave.

Look at what’s going on in many companies across America. People are quitting their jobs in record numbers. Over four million Americans quit in August.

What’s driving this mass exodus? A lack of gratitude and empathy – whether it’s from management to staff or employee to employee. Most of the reasons people are quitting their jobs and looking elsewhere include work-life balance, compensation and benefits, company culture, career stagnancy. These are tied to not feeling properly appreciated or respected by the people they report to or work with.

Granted, the pandemic has considerably heightened the stress in doctors’ offices and healthcare facilities, showing cracks in company cultures. But although times of true crisis may challenge our ability to experience and express gratitude and empathy, such difficult times also demand that we work on enhancing our capacity for doing so. Because when we do, both the practice and the patients benefit.



Gratitude plus empathy equals brand ambassadors


Gratitude is seated at the heart of any truly great company culture, and it results in employees who live and breathe your brand. Employees who practice gratitude and its close relative empathy across personal and professional relationships will drive business growth while increasing their personal happiness. Patients know contented and engaged employees who genuinely like working together and who genuinely like helping the public when they see them. Gratitude is a currency in the sense that it accumulates when shared.

By expressing gratitude and showing empathy, leaders will show their employees respect and compassion, and in the process the workplace becomes a healthy place. Gratitude becomes the currency that helps build trust among team members.

As employers, it is our job to be transparent, share our vision and ask for input. In doing so, we build a positive and grateful culture supported by a team of internal brand ambassadors who fully acknowledge that we as an entire workforce are finding our way together. And when you have that positive force of internal brand ambassadors, then that kind of physician’s practice is one patients want patronize.

Here are three ways to make gratitude and empathy a major part of your practice’s culture:


Lose the scarcity mindset.


A crisis often encourages people to fall back on scarcity thinking, (e.g., what they don’t have), as pressures prompt some to react with fear and anxiety. What’s needed instead is an appreciation for each other that leads to people finding ways to help each other.

I cannot stress enough that a crisis is not the time to retreat to a scarcity mindset. Instead, it’s precisely the time to think of others, deepen our relationships and recognize the importance of support networks. It’s time to show renewed commitment to customers and communities as well as sensitivities to the challenges they are facing.


Think of all you can do, and for whom.


Learning to show gratitude on a wider scale starts with these questions:
  • Who has gone above and beyond to help me professionally, and why?
  • How will I show my gratitude to these people?
  • How can I give back to others?
  • How can I make a difference in the lives of those around me and in the lives of others in need?
  • Who have I taken for granted?

I believe in my heart that gratefulness is a social disposition or an attitude, and as such, it requires that we express it and exchange it with others. This is how we connect with one another in a way that lasts.


Embrace the strength of your team.


The resilience that’s honed by steady leaders and unified teams becomes stronger in times of trouble. People feeling isolated and vulnerable need to be thankful for good teammates, approach them for support and reciprocate. When times are tough, we can embrace and feel gratitude for what we still have, and we can use that strength of the team to fuel our individual and collective forward motion.

Identify the people who give you a sense of value and purpose and examine what you value most about your relationships. In times of struggle, it’s our relationships that pull us through.


15% Off Medical Practice Supplies


VIEW ALL



Manual Prescription Pad (Large - Yellow)


Manual Prescription Pad (Large - Pink)

Manual Prescription Pads (Bright Orange)

Manual Prescription Pads (Light Pink)

Manual Prescription Pads (Light Yellow)

Manual Prescription Pad (Large - Blue)

Manual Prescription Pad (Large - White)


VIEW ALL

Posted by at No comments:
Labels: , ,

Thursday, October 28, 2021

CMS increases payments for cognitive assessments and care plan services

According to the Alzheimer’s Association, “Alzheimer’s disease is the most common cause of dementia.” Most people appreciate that both Alzheimer’s disease and dementia have cognitive implications. What is the difference?


Dementia is an overall term for a particular group of symptoms, which include the following: difficulties with memory, language, problem-solving, and other thinking skills involved in a person’s everyday activities. Alzheimer’s disease is the most common cause of dementia due to the brain changes.



The presence of toxic beta-amyloid and tau proteins are believed to activate immune system cells in the brain called microglia. Microglia try to clear the toxic proteins as well as widespread debris from dead and dying cells. Chronic inflammation may set in when the microglia can't keep up with all that needs to be cleared. Atrophy occurs because of cell loss. Normal brain function is further compromised in Alzheimer’s disease by decreases in the brain's ability to metabolize glucose, its main fuel. These brain changes are considered biomarkers of Alzheimer's.

Given that an estimated 12.7 million people over 65 years of age are projected to have Alzheimer’s by 2050, it is not surprising that the Centers for Medicare & Medicaid Services (“CMS”) evaluated its reimbursement for cognitive assessments and care plan services. According to CMS,
Effective January 1, 2021, Medicare increased payment for these services to $282 (may be geographically adjusted) when provided in an office setting, added these services to the definition of primary care services in the Medicare Shared Savings Program, and permanently covered these services via telehealth. Use CPT code 99483 to bill for both in-person and telehealth services.

Why is this important for physicians and patients and what types of providers can conduct a cognitive assessment? First, cognitive impairment detection is a requirement of Medicare’s Annual Wellness Visit. Second, medical providers such as physicians, nurse practitioners, physician assistants, and clinical nurse specialists may offer a cognitive assessment in a variety of locations (e.g., office/outpatient setting, private residence, care facility, rest home, and/or telehealth).

Finally, the subsequent visits and care plans should utilize the following codes:

Service

Code

Things to Know

Initial AWV

G0438

You’re required to check for cognitive impairment as part of the AWV.

Subsequent AWVs

G0439

You’re required to check for cognitive impairment as part of subsequent AWVs.

Assessment of and care planning for patients with cognitive impairment like dementia, including Alzheimer’s disease, at any stage of impairment

CPT code 99483 (replaced the interim HCPCS code G0505)

If you detect a cognitive impairment during the AWV or other routine visit, you may perform a more detailed cognitive assessment and care plan.

Part B coinsurance and deductible apply.

You may bill this code separately from the AWV. If you choose to perform the AWV and the Cognitive Assessment & Care Plan Services in the same visit, add modifier 25 to the claim.

Includes Level 5 E/M service CPT code 99215 elements like:

  • comprehensive history
  • comprehensive exam,
  • high complexity medical decision-making

Providers can’t bill CPT code 99483 on the same day as these services:

  • 90785 (Psytx complex interactive),
  • 90791 (Psych diagnostic evaluation)
  • 90792 (Psych diag eval w/med srvcs)
  • 96103 (Psycho testing admin by comp)
  • 96120 (Neuropsych tst admin w/comp)
  • 96127 (Brief emotional/behav assmt)
  • 99201– 99215 (Office/outpatient visits)
  • 99324–99337 (Domicil/r-home visits new pat)
  • 99341–99350 (Home visits)
  • 99366–99368 (Team conf w/pat by hc prof)
  • 99497 (Advncd care plan 30 min)

99498 (Advncd care plan addl 30 min)



In sum, this is an important clinical area that medical providers should not overlook. It is equally important for medical providers to code accurately with the appropriate documentation to substantiate medical necessity.


15% Off Medical Practice Supplies


VIEW ALL



Manual Prescription Pad (Large - Yellow)


Manual Prescription Pad (Large - Pink)

Manual Prescription Pads (Bright Orange)

Manual Prescription Pads (Light Pink)

Manual Prescription Pads (Light Yellow)

Manual Prescription Pad (Large - Blue)

Manual Prescription Pad (Large - White)


VIEW ALL

Posted by at No comments:
Labels: , , , , ,

Wednesday, October 27, 2021

What physicians need to know about Management Services Organizations

While there are a couple of variations to Management Services Organizations (MSOs), this article will focus on the more common type which is a private equity-backed management company.

Essentially, this type of MSO is a limited liability corporation (LLC) operated by a team of management professionals and the corporation is owned by a private equity firm. The private equity firm owns this MSO as one of several companies in their investment portfolio; some of the companies are healthcare-related while others may be in a multitude of different industries (e.g. energy, transportation, etc.).

Within healthcare, one of the primary reasons a private equity firm utilizes an MSO is that it creates a corporate “vehicle” which allows them to operate throughout the United States regardless of the various corporate practice of medicine laws. These private equity-backed MSOs are specialty specific, meaning the MSO would only focus on one medical specialty, although a private equity firm may have a couple of different MSOs targeting different medical specialties.



The Process


Many times I hear physicians state that they “sold to private equity.” Well, in a sense that is correct, but in other ways it is not. Private equity individuals do not personally knock on the doors of medical practices to solicit a sale and I have never witnessed private equity investors involved in negotiations with physicians. These are the roles of management personnel that are employed by the MSO.

The MSO team members, often with a title of “business development”, are the people that exhibit at physician specialty conferences and call upon physician owners of medical practices. Once the MSO team can establish a dialogue with physician owners and explain the benefits of their particular structure, they will issue a non-disclosure agreement (NDA) for the physician practice to sign. Most of you reading this article have most likely signed NDAs before for some sort of discussion or potential transaction.


Letter of Intent


Upon executing the NDA, the management team will request some preliminary documentation. It is here where the MSOs can vary greatly as to the type and amount of documentation requested.

At a minimum, you can expect to release financials for three full years plus the current year-to-date. This gives them a good high-level picture of your practice and they will no doubt have a ton of questions for you as it pertains to the practice history, current operations, challenges, trends, plans, and more.

At the conclusion of this, they will issue a Letter of Intent (LOI). Again, each MSO is different and they may request a lot more information prior to producing an LOI. For example, they may ask for productivity reports from your EHR as well as charges by CPT code, physician compensation, etc. The LOI is a non-legally binding document which essentially outlines the key terms of the deal. It would include items such as the estimated value of the practice (and a related purchase price multiple), purchase price terms of the practice (and related procedures such as escrow), the relationship of the MSO and medical practice post-transaction, an estimated effective date for the transaction, a recasting of physician compensation (i.e., what physician compensation looks like now as compared to being a part of the MSO), percentage equity the company will buy vs percentage equity physicians will retain, and potentially several more items. The other important item (in case you are trying to consider several different purchasers) is what’s known as a no-shop clause. While you can be engaged in countless NDAs, there can be only one LOI that you execute at a time. This no-shop clause basically states that you agree to not entertain any offers from any other purchaser for a period of time (usually a minimum of 90 days) so that this first management company can complete its due diligence and deliver a firm offer.


Due Diligence


This is the first painful and time-consuming process. Depending on a great many factors, this could be six weeks or six months. Here are a few factors that can determine the length of the process:
  • Number of locations the practice has.
  • Number of providers the practice has.
  • How slow the practice is at responding to requests for documents (this can often include the time of year as your accountant could still be working on tax return filings)
  • What sort of issues they find that need further clarification (e.g. big decrease/increase in revenue, large capital purchase, recent changes in providers, lawsuits, etc.)

There are a whole host of items to be reviewed under the due diligence process but some of the key elements are:
  • Financial information. Income statements, balance sheets, tax returns, CPT charges, productivity reports, provider compensation, fee schedules, etc.
  • Legal. Vendor contracts, payor contracts, physician governance documents, litigation, or complaints (these could be medical malpractice, labor law violations, other liability issues, etc.)
  • Business sustainability. This is of course very important as of late with the pandemic. Expect a deep dive into patient volumes, procedures, billings, and collections, etc.
  • Assets. All clinical equipment, IT equipment, and office equipment will be reviewed. Expect someone to physically come on site for this process.
  • Human resources. Employee performance evaluations, bonus structures, and all of your benefits (paid time off, health insurance, dental insurance, 401(k), COBRA continuations, etc.).

There is nothing pleasant about the due diligence process and there are absolutely no shortcuts, so be prepared for an arduous task here. Remember though, that there is no way private equity will spend their investors’ money on your practice without performing a thorough due diligence. Thus, if you want to see this through, then you will have to go through the due diligence process.


Purchase Agreement


Once you have made it through the due diligence process, the management company will most likely provide you with an updated term sheet as some items (e.g., price) may need to be altered as a result of their findings. From there, they will produce a purchase agreement which is similar to buying a house. It states the terms of the sale, equity, payment(s), escrow, and a number of other legal provisions. If everything has been above board and communications have been free flowing thus far, there should not be any surprises and few major hurdles for negotiation at this point.
Management Services Agreement

With MSOs, there will also be a Management Services Agreement (MSA). The MSA is essentially a 30-60 page document that is akin to an operating agreement for how the relationship works post-transaction. Ideally, you would have seen this during the due diligence phase. This outlines in detail everything related to practice operations and how the MSO will deal with them (i.e., billing/collections, human resources, finances, accounting, taxes, information technology, purchasing, marketing, etc).



Final Thoughts


MSOs are not for every physician, but they are certainly here to stay for a long time to come. Some specialties have been working with MSOs for a long time (e.g., ophthalmology, dermatology, oncology) and some specialties are just starting to see or hear of MSOs. Private equity has great interest in medical practices and the MSOs allow them to operate legally and with mutual benefit to physicians. However, consideration of a MSO is certainly nothing that should be taken lightly. When you begin contemplating this initiative, it is highly advisable to contact a transactional consultant who has a lot of experience working with MSOs as that individual will be able to answer your questions as to the pros and cons and help you weigh whether this endeavor is a good fit for your practice.


15% Off Medical Practice Supplies


VIEW ALL



Manual Prescription Pad (Large - Yellow)


Manual Prescription Pad (Large - Pink)

Manual Prescription Pads (Bright Orange)

Manual Prescription Pads (Light Pink)

Manual Prescription Pads (Light Yellow)

Manual Prescription Pad (Large - Blue)

Manual Prescription Pad (Large - White)


VIEW ALL

Posted by at No comments:
Labels: , , ,
Subscribe to: Posts (Atom)