Complexifiers and simplifiers

There are two kinds of people: those who make things complex and those who simplify. In contemporary health care, patients are looking for simple solutions to complex problems. Also, medical practices are searching for simple solutions to solve the current complexity of managing a medical practice. This blog will focus on the complexifiers and the simplifiers in a medical practice and how to move from the complex to the simple solutions for many of our management issues.

Complexifiers are averse to reduction. Their instincts are to keep things complicated and to reject simple ideas. Often, they think that keeping things complicated maintains their job security. The complexifiers are stuck in the status quo and reject new ideas and new solutions for solving problems. The complexifiers take pride in consuming more bandwidth, more time, and patience than needed, and expect rewards for it.

Simplifiers thrive on conciseness and brevity. Simplifiers never let their ego get in the way of a better idea, improvement in efficiency, or suggestions to enhance productivity. When a simplifier is given a complicated task, they look for the simplest way to achieve what needs to be done. They find ways to communicate complex ideas in simple terms without losing the idea's essence or significance.

In modern health care, various factors contribute to the complexity or simplicity of managing a medical practice.

Examples of complexifiers and simplifiers in health care:

An issue that confounds doctors, office managers, staff, and even patients is the regulatory environment imposed by the government and insurance companies. Health care policies, regulations, and compliance requirements make it difficult to deliver health care services.

The health care industry is subject to numerous complex regulatory requirements, with rules and guidelines from various governing bodies to deliver high-quality, safe, and effective care. Yet it is these requirements that slow the delivery of health care. An example is the necessity for prior authorization (PA) for permission to see a patient, to prescribe medications, order an imaging study, or to proceed with an appropriate medical procedure. As a result, physicians must create prior authorization letters at the end of their day or generate these authorization letters in the evening, which is referred to as pajama time. The time requirement to create a PA is often several hours a week of uncompensated time.

Regulations such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States protect patient privacy and the security of personal health information. Health care providers must comply with these regulations to ensure sensitive data is appropriately handled and is encrypted to ensure that sensitive patient information remains private and secure.

Regulatory bodies set standards for the quality and safety of health care services, facilities, and medical devices. For example, the Joint Commission in the United States oversees health care organizations based on their compliance with established standards.

Regulatory agencies, such as the U.S. Food and Drug Administration (FDA), oversee the development, approval, and monitoring of pharmaceuticals and medical devices to ensure their safety and efficacy. The cost of studies to approve a new drug is more than $1B. This cost should decrease with the usage of AI.

Regulations govern how health care providers are reimbursed for the services they deliver. In the United States, the Centers for Medicare & Medicaid Services (CMS) play a significant role in determining reimbursement policies for these government-funded programs. Proper coding is necessary to receive the appropriate reimbursement for services provided. Many practices will down-code their services to avoid potential audits and penalties if their documentation does not meet the requirements for the billed codes.

These regulations pertain to the licensing, credentialing, and ongoing education requirements for health care professionals to ensure they possess the necessary qualifications and skills to deliver care. The credentialing process for a new physician can take four to six months, and as a result, the new physician cannot bill for their services.

With the growing adoption of telehealth and digital health technologies, regulatory frameworks are evolving to address privacy, security, and quality concerns specific to these platforms.

The take-home message is that the complex regulatory environment in health care creates both challenges and opportunities for providers. While compliance can be resource-intensive, time-consuming, and expensive, it is essential for promoting high-quality care and protecting the well-being of patients. It is a veritable nightmare for practices to stay informed about relevant regulations. This is an opportunity for simplifiers to find methods that protect the patient but not bury the practice in a mountain of complex regulatory requirements.

Let’s welcome the simplifiers

The holy grail of interoperability remains elusive. Other countries such as England, France, and Germany have solved the interoperability enigma. Why can't the U.S. health care system do the same? Seamless data exchange between health care systems and providers would streamline care coordination and improve decision-making. It is a difficult pill to swallow knowing that other developed countries achieve interoperability. Still, the U.S. health care system can't accomplish this.

Organizing care around patients' needs and preferences can enhance engagement, satisfaction, and outcomes while simplifying care delivery. For example, a frequent patient complaint is difficulty gaining access to the practice. This often necessitates patients going to urgent care centers for acute problems. This issue can be simplified using AI technology to effectively schedule patients 24/7 so that patients do not need to wait weeks or months to see a physician.

We need to simplify the measurement of outcomes and find methods to measure the quality of care. We need to transition from a system that focuses on volume of care to one that emphasizes quality of care. We need to encourage more efficient, effective, and coordinated care, with patients' interests taking priority over physicians' interests.

Since the pandemic of 2020-22, we have learned that we can offer patients good medical care in many instances without the necessity of having to touch the patient and see them in the office. Still, we can provide care using remote care delivery via telehealth platforms. As a result, we can make health care more convenient for patients by simplifying access to care.

Harken AI to simplify the delivery of medical care. AI-driven solutions and automated processes can help reduce administrative burden, analyze data, and optimize workflows, ultimately simplifying various aspects of health care delivery. The time has arrived to implement AI solutions. By leveraging AI as a strategic approach, rather than just reducing administrative burdens, we can deliver high-quality care more efficiently and provide decision support for treatment pathways based on robust data.

Bottom Line: Identifying and addressing complex problems and embracing simplifiers is crucial for optimizing health care systems and improving patient care.

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5 Ideas for Managing Physicians' Outside Activities

Almost every physician contract I review contains a provision limiting the physician’s ability to engage in “outside activities,” such as consulting, speaking, outside research, expert witness testimony, or even moonlighting.


However, physician practices rarely go far enough in monitoring their physicians’ outside activities and taking the steps necessary to protect the practice from possible liability, including conflicts of interest that may implicate federal law.

Recently, I worked with a client that permitted its physician-employees to engage in outside activities as long as they “disclosed” such activities to the employer. One physician, who rendered research activities through a separate entity he owned, ended up being subpoenaed in a government investigation. Unfortunately, the practice was also drawn into the investigation and the physician’s counsel was able to make a claim on the practice’s directors and officers liability insurance policy for such outside activities.

For many practices, the above scenario is a real possibility. Physician practices must take the time to evaluate their policies related to “outside activities."

The following are some ideas to consider:

1. Every employment agreement should restrict a physician from engaging in any outside activities without written approval by the employer. Although many physicians (and their counsel) find this unfair, there are many reasons why this is reasonable to require. Simple “notice” of the outside activity is insufficient to protect the practice in most cases and may be deemed to automatically suggest the activity was approved/consented to by the practice, thus implicating the practice’s insurance coverage.

2. The practice should have every physician complete a questionnaire concerning outside affiliations and organizations, at least annually. The practice should work with counsel, taking into account the practice’s specialty, to develop the appropriate questions to include. For example, the questionnaire should inquire whether each physician (or an immediate family member) owns, holds a position with, and receives any payments, royalties or other amounts from an outside healthcare entity unaffiliated with the practice. It is also important to know whether such entity does business directly or indirectly with the practice, particularly as it may relate to pharmaceutical, device and similar companies.

The physician should be required to advise the practice of any changes within 30 days and failure to comply, and/or falsification of responses, should be possible grounds for termination. The information collected from the questionnaire should be closely reviewed by the practice, with counsel as appropriate, to assure that there are no potential legal issues to be addressed (such as Stark self-referrals, Anti-Kickback, Sunshine Act, etc.).

3. Every practice should have a policy advising on the practice’s stance regarding outside activities. For example, the policy might set forth the following: the process for obtaining consent to outside activities; how payments are handled’ the amount/type of insurance required for the outside activity; events that require notice to the practice (i.e. investigation); clarification on intellectual property ownership; a requirement that the practice be indemnified in writing by the physician (and outside entity) related to such outside activity; and a requirement that the physician provide any written agreement with the outside entity for the practice to review.

4. In many cases, practices mandate, as a condition of approval, that the agreement for the outside services incorporate the practice’s own “Terms and Conditions,” as an exhibit. This exhibit then incorporates into the third-party agreement the practice’s desired terms related to indemnification language, intellectual property rights, insurance, control over the physician, etc. I have found this to be an effective approach to protect my clients, but it must be properly done to be sure the practice’s document controls.

5. Make sure the practice has adequate insurance coverage and determine what type of language might be required to minimize risk of a claim being successfully brought for a physician’s outside services. Determine whether each outside activity needs to be specifically excluded from the policy.

Because every practice is different, it is important to evaluate its specific needs and concerns when developing appropriate policies on outside activities. Any time and legal expense required to develop such practice documents are likely to be far less than the possible consequences of failing to so.

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Practice Metrics: Working Days vs Calendar Days

Often major decisions are made based upon knee-jerk reactions to data generated by well-meaning employees. But if you are only looking at data on a monthly basis, not a quarterly or annually, you could be hurting your business more than you think.


Each month has a different number of working days and this is something you need to take into consideration. For example for this year, here are the number of working days:

January: 22 working days
February: 20 working days
March: 22 working days
April: 21 working days
May: 22 working days
June: 21 working days
July: 21 working days
August: 23 working days
September: 19 working days
October: 23 working days
November: 19-20 working days (some companies shut down for both Thursday and Friday for Thanksgiving)
December: 20 working days

These can obviously change if your company shuts down for more than just the major holidays, or no holidays at all.

So looking at March, August and October your monthly data will look like you are performing much better than if you made decisions based upon data generated on September, February and December. This is particularly important for projecting your inflow, paying out bonuses and payroll, and making sure you have enough to make ends meet.

Of course review your monthly data, but keep in mind that some months will look bette. Looking at your information quarterly or even comparing to this time last year is your best bet. It also much easier to plan capital equipment, raises, or even hiring more employees based upon your ability to project out based upon working days.

I think this is an area that often get overlooked, as several practices often complain about how volatile the market is from month to month. Sure based upon your practice type, you could have seasonal business. If your are an orthopedic surgeon, summer and fall are most likely your busiest times of the year since people are more active and kids are back in school and playing more sports.

Depending upon location can also be a contributing factor. Perhaps you rely on tourism or the weather plays a factor. All of these areas are things to keep in mind, and know that you will have ebb and flow within your business. Just taking a step back and finding perspective when reviewing your information can provide you a less stressful review knowing that your business is not failing or employees are not performing.

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