Showing posts with label health care law. Show all posts
Showing posts with label health care law. Show all posts

Thursday, January 5, 2023

Exit plans: Buy-sell agreement guide

A private practice physician’s career, as with many other professionals and entrepreneurs, is focused on growing their practice and serving their patients. Considering when and how they will inevitably exit their careers and, more importantly, create a “strategic exit plan” doesn’t tend to be the highest priority.

Certainly, focusing on serving patients is to their credit, but many doctors over time slip into a “die at the desk” mentality. Their practice is who they are, and their last day in the office has a greater chance of ending with their being carried out than exiting gracefully with a retirement party.

During their lifetime work, doctors do everything in their power to keep patients healthy, but they also know more than most that life is not always predictable; yet, successful practitioners often don’t make any preparation for ending their practice if their lives end earlier than expected.

If we have learned anything during the COVID-19 pandemic, stuff happens — many times outside of what we planned. Doctors and other medical professionals were frequently exposed to danger. What happens if we don’t make it to the office tomorrow? Our patients, staff and a lifetime of work dissipates into the air?

Having a contingency plan isn’t a planning option. It is a necessity.

Whether you are a solo practitioner or part of a large, complex medical group, a “buy-sell” arrangement is a must-have for private practices to protect their family, employees and patients. Your family deserves the economic value of your life’s work, your employees deserve the assurance they will remain employed and your patients need to know that their medical needs will be met.

We encourage our clients to have a buy-sell agreement that addresses the five Ds:


Death: Premature death is the most common item in a buy-sell, whether a solo practitioner or part of a group.

Disability: If you can no longer perform in your area of practice, disability insurance may cover a portion of your income and overhead, but what if you can never return to the practice of medicine? Make sure your agreement covers this possibility.

Divorce: In the event of a partner’s divorce, the shares of the practice cannot be left in jeopardy of going to the person who divorced a partner.

Disagreement: If partners can’t agree on major business decisions, a clause must be exercised to settle the agreement and potentially divide the practice.

Departure: If one doctor decides to retire while others want to continue, what is the valuation method and payout structure for the doctor who is retiring?

I have had the privilege in my 17-year career in financial services of working with many family medicine groups, dental practices and specialized doctors such as aestheticians. What I have found is that many are great businesspeople and certainly highly educated. But most don’t realize the inherent value of the practice they have created. It’s also important to recognize the value of the after-tax income the business produces — and that it may be your largest asset.

It’s critical to plan the eventual exit of your medical practice, just as you would a business. The appropriate time, attention and team are necessary to ensure maximum value.


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Wednesday, November 30, 2022

The 21st Century Cures Act: How patient engagement can help your practice remain compliant

In March of 2019, the Office of the National Coordinator for Health Information Technology (ONC) issued what is commonly referred to as the Information Blocking Rule to the 21st Century Cures Act. Information blocking was defined as any practice that is likely to unreasonably interfere with the access, exchange, or use of electronic health information.

As the American Medical Association points out, information blocking can occur in several ways and doesn’t necessarily have to be intentional on the part of providers. For example, patients might encounter information blocking if they are unable to access health records or transfer data to another physician. This could ultimately lead to patient complaints and potential penalties.

Although complaints have been filed against more the 170 health care providers in 2022 so far, there have been no investigations for information blocking by individual provider practices – yet. The Office of the Inspector General (OIG) has provided guidance on potential sanctions including up to a $50,000 fine for each incident, and one thing is clear: practices must act quickly or soon face regulatory compliance issues.

The best way to protect your practice is to ensure you are using patient engagement technology that complies with regulations, specifically a patient portal that makes access to health information easy and is positioned to adjust as patient and regulatory expectations around access to health information evolves.


Patient engagement, patient portals, and the Cures Act



Online patient portals are the critical patient engagement gateway to digital information access and Cures Act compliance. Through patient portals, patients are given 24/7 entry to secure personal health information from anywhere, anytime, and with no costs to download records.

Something to bear in mind is that patient portals are not created equal. Often, legacy portals utilize outdated integration methods and have interfaces that are neither modern in appearance nor intuitive to use, which can put healthcare organizations at risk. Patients that have trouble with portal technology may mistake a poor user experience as an intentional attempt at information blocking and lodge a complaint.

A portal that automatically delivers information to the patient, rather than relying on provider or staff action to trigger data moving from the patient record to the portal, is another critical functionality to recognize. Lab results, for example, are often anticipated by patients. Portals that automatically push results, within normal limits, to patients greatly reduce patient wait times, while also protecting providers from any accusations of information blocking.

For providers, patient portals and patient engagement tools can solve an array of other needs, such as:
  • Decreasing administrative burdens – Portals and digital patient engagement tools, such as patient intake and registration with online forms, can streamline front desk activities to reduce labor while decreasing time patients spend in the waiting room. Online patient self-scheduling greatly reduces phone calls to the office and allows patients to schedule appointments after working hours, a convenience many have come to expect in today’s consumer environment. Tools that notify patients of upcoming appointments and overdue balances decrease no-shows and accelerate cash flow.
  • Enhancing communication – Secure messaging has long been the backbone of patient communication within portals, reducing inbound phone calls and stimulating engagement. Modern solutions further augment messaging with workflows that allow patients to confirm or reschedule appointments, pay bills through text, and ask questions about their most recent results. As consumer demand for digital engagement increases, there will be continued growth in the adoption of not just these tools, but newer technologies like video telehealth as well. Remote visit options increase patient access to healthcare and their ability to stay on track with their care plans, while creating additional revenue streams for healthcare organizations.
  • Reducing legal risk – As of October 6, 2022, the ONC expanded its definition of information blocking. Today, data that must be accessible not only applies to the data elements contained to the United States Core Data for Interoperability, but also to electronic protected health information (ePHI). ePHI is the Designated Record Set (DRS) as defined in the Health Insurance Portability and Accountability Act (HIPAA). In other words, any data a patient has access to under HIPAA now applies to information blocking. An integrated portal solution can be mapped to confirm this data is included. Patient portals can also help providers manage proxy relationships for minors in states that limit access to health information by parents or caregivers.

Protect your practice with integrated patient engagement solutions


The volume of data healthcare organizations needs to manage increases daily and the regulations concerning the data will likely continue to evolve. Practices that provide modern patient portals and patient engagement solutions are best positioned to protect themselves from information blocking complaints and potential fines while enhancing the patient experience throughout the care journey.


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Thursday, November 3, 2022

Considerations for physician practice mergers

In recent years, there has been noticeable increase in practice mergers among physician groups. Undoubtedly with the ever-evolving reform of the U.S. healthcare industry, there is a lot of uncertainty for private practice physicians. Some practices are content with no organizational changes and some have decided to be acquired by hospitals. Others have gone the route (or are pondering) of merging with another private practice (either same specialty or different specialty). The decision to buy, sell, or merge a medical practice is more complicated than ever, and determining a medical practice's worth is just one element crucial to this process. For those that are considering merging with another private practice entity, there are many things to strategize about and that's assuming there will be a windfall of benefits by consummating a merger.

Physician owners must have a clear rationale for a transaction or truly understand a deal's impact on their practice's long-term financial future. Too often, however, there's a misguided sense of why the merger should take place at all, and there's far too little time spent defining how the merger enables them to beat competitors and increase organizational value. Those that fail to take this into account contribute to the failure rate of physician group mergers.

For many physician groups, the link between strategy and a transaction is broken during due diligence. By focusing strictly on financial, legal, tax, and operations issues, the typical due diligence around a proposed merger fails to test whether the strategic vision for the deal is valid. To do so, physician groups should bolster the usual financial due diligence with strategic due diligence. They should test conceptual rationale for a deal against more detailed information available to them after signing the letter of intent. They should also see if their vision of the future operating model is actually achievable.


A strategic diligence should explicitly confirm the assets, capabilities, and relationships that make a buyer the best owner of a specific target acquisition. It should bolster the physician owners' confidence that they are truly an "advantaged buyer" of an asset. Advantaged buyers are typically better than others at applying their established skills to a target's clinical and business operations. They also employ their privileged assets or management skillset to build on things like a target's practice reputation, patient experience, or relationships with referring physicians. Naturally, they also turn to their special or unique relationships with vendors and the community to improve performance, leading to advanced synergies that go beyond what's normal.

When change comes suddenly, it can turn strengths into weaknesses and sweep away dreams of success.The aim of a merger should be to achieve mutually reinforcing advantages.Michael Porter wrote that competitive advantages stem from how "activities fit and reinforce one another. . . . creating a chain that is as strong as its strongest link."By undertaking strategic diligence, physician owners will be able to not only define their main objectives, but also gain greater control over the desired direction of the new entity after the merger is consummated.
Some of the strategic diligence questions to ponder include:What are the strengths of each practice?
  • What could our practice be doing better?
  • What opportunities exist as a result of this merger?
  • What threats do we face by completing this merger?
  • What is the current culture of each practice?

It is critical for physician owners to be honest and thorough when assessing their advantages. Ideally, they develop a fact-based point of view on their beliefs — testing them with anyone responsible for delivering value from the deal, including physicians, physician extenders, clinical staff, and front and back office personnel.Above all, when it comes to the merger of two physician groups, culture is a key decision criteria.Culture should be evaluated and discussed prior to any financial considerations. In my experience this is of paramount importance for practice-to-practice mergers and is meticulously examined only through strategic diligence.


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