Monday, May 12, 2025

Pros and cons of AI patient portal messages

Between increased administrative burdens and an influx of patient messages, many primary care physicians (PCPs) are turning to generative artificial intelligence (AI) tools to help draft patient portal messages. A new study suggests those tools can help — but they may also introduce dangerous errors that physicians fail to catch.

The study, published in Digital Medicine, found that most physicians missed critical mistakes in AI-generated message drafts in a simulated exercise. Some of the errors had serious safety implications.

“All but one physician ‘sent’ at least one fictitious response to a patient that contained an error,” the authors wrote.


A closer look


Researchers from MedStar Health, Georgetown University and the Naval Research Laboratory recruited 20 practicing PCPs in the Baltimore-Washington area. Participants were asked to review and edit 18 AI-generated responses to common patient portal inquiries. Four of the drafts contained significant errors.

These errors included:
  • A typo in a medication name.
  • Outdated COVID-19 vaccination guidance.
  • A failure to recognize urgent signs of a possible blood clot.
  • A missed case of diabetic ketoacidosis (DKA) in a child — mistakenly dismissed as a stomach bug.

At least 65% of participants missed each of the four errors, and between 35% and 45% submitted the problematic messages without any edits. Only one participating physician caught and corrected all four errors.


“Helpful” — But at what cost?


Despite these oversights, most PCPs responded positively to the AI assistance. According to post-task surveys:
  • 95% said the AI-generated drafts were helpful.
  • 90% said they trusted the AI’s performance.
  • 80% agreed the tool reduced their cognitive workload.
  • 75% believed the drafts were safe to use.

“I found the AI drafts to be helpful in responding to these [patient portal messages],” one survey statement read. Nineteen of the 20 participants marked it as true.

But the researchers argue that this trust — however well-intentioned — may lead to over-reliance.

“As the occurrence of automation complacency increases with reliability, the fact that most AI-generated drafts did not contain an error or patient safety risk may have resulted in vigilance decrement,” the authors noted.


The psychology behind the misses


The study points to several possible reasons why seasoned physicians may have missed obvious red flags:
  1. Automation bias: Relying too heavily on AI tools.
  2. Confirmation bias: Assuming the AI’s response aligns with their own.
  3. Functional fixedness: Failing to see alternative diagnoses when the AI’s answer seems plausible.
  4. Burnout and workload: Reducing diligence due to mental fatigue.

“These results highlight how physicians, as well as other stakeholders, understandably have a growing appetite for AI-driven technologies that can address workload burden,” the researchers wrote. “[They] may in fact be so overextended that any technology promising a reprieve is eagerly adopted despite the risks.”


Growing use, growing concerns


More than 100 health systems are already using generative AI to support clinician inboxes, including tools integrated into popular EHR platforms like Epic. The researchers behind this study argue that rollout may be outpacing safety testing.

While the AI drafts didn’t always include outright AI hallucinations, some gave incomplete or misleading advice. In the case of a child showing textbook signs of DKA, the Ai offered a generic response about stomach viruses — an omission flagged by only five of the 20 participating physicians.


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Friday, May 9, 2025

Unlocking the hidden potential in your medical office investment

For many physicians, the strategic importance of their medical office is often overlooked. More than just bricks and mortar, your medical office is the engine of your practice, driving both patient care and profit. A well-designed office space does more than function efficiently—it transforms how care is delivered, reduces staff turnover, and significantly boosts your bottom line. Recognizing and optimizing every aspect of your office, from its strategic location to the flow of patient traffic and the subtleties of its layout, is essential for turning this overlooked asset into a cornerstone of your financial success.


Incorporating Evidence-Based Design (EBD)


Evidence-Based Design (EBD) focuses on creating healthcare environments that are scientifically proven to improve patient outcomes, staff efficiency, and safety. By integrating EBD into the medical office design, physicians can directly impact their practice's effectiveness and patient satisfaction.
  1. Patient-centered layouts: Designing patient areas to minimize stress and promote healing can significantly enhance patient satisfaction—a key metric in value-based care models. Features like natural light, calming colors, and noise-reducing materials can contribute to faster recovery rates and reduced readmission rates.
  2. Efficient workspaces: Efficiently designed staff areas reduce fatigue and enhance productivity. Ergonomic workstations, logically placed equipment, and streamlined workflows reduce time wastage and improve the overall efficiency of care delivery.
  3. Safety, efficiency, and infection control through design consistency: Using Evidence-Based Design (EBD), we standardize exam room sizes and layouts to enhance operational efficiency and minimize medical errors. This uniformity not only simplifies workflows for caregivers but also improves patient safety by reducing the likelihood of falls or injuries. Additionally, consistent room designs support effective infection control practices, essential for maintaining a clean and safe environment. These strategic design elements substantially improve patient outcomes by optimizing both safety and efficiency.


Enhancing Value-Based Care through EBD


Value-based care models prioritize patient outcomes and satisfaction, which directly affect reimbursement rates under these models. By designing an office that enhances patient experiences and outcomes, physicians can improve their performance on value-based care metrics, such as patient satisfaction scores and outcome measures. This improvement translates into higher reimbursements and bonuses for quality care delivery.


External factors affecting medical office ROI


In addition to internal office design, several external factors critically influence the functionality and accessibility of a medical office, directly impacting patient satisfaction and practice profitability:
  • Accessibility and traffic flow: Easy access to the office from major roads and minimal traffic congestion can reduce patient stress and lateness, improving satisfaction and increasing the number of timely appointments.
  • Adequate signage: Visible and clear signage not only assists in easy navigation but also enhances the professional appearance of the practice, contributing to first impressions and patient confidence.
  • Sufficient parking: Ample and convenient parking is essential for patient accessibility, reducing late arrivals and no-shows due to parking difficulties.
  • Building condition and aesthetics: The external and internal condition of the building conveys a message about the quality of care. A well-maintained facility can enhance patient trust and comfort.
  • Local area and services: Proximity to pharmacies, hospitals, and other health services can increase convenience for patients and may lead to partnerships and referrals.


Considering a sew office space


If your current office does not support optimal practice operations or patient care, it may be time to consider a new space. Key indicators that a new office might be necessary include:
  • Lack of space for new services: If your current setup cannot accommodate emerging services such as telehealth or specialized treatment areas, it may limit practice growth.
  • Inadequate technology integration: An office that cannot support new medical technology may hinder your ability to provide state-of-the-art care.
  • Poor layout for efficient workflow: An inefficiently arranged office can lead to wasted time and increased staff frustration, impacting patient experience.
  • Inability to expand: If there is no room to grow or reconfigure your space to meet evolving healthcare demands, this can restrict your practice’s potential.


Conclusion


Your medical office is more than just a physical space; it is a strategic asset that can significantly enhance your financial portfolio through improved patient care and increased efficiency. Evidence-Based Design not only facilitates better patient outcomes but also optimizes operational efficiency, directly impacting the profitability of practices operating under value-based care models. By focusing on these principles, healthcare providers can ensure their office space is a powerful tool in achieving business success and exceptional patient care.

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Wednesday, May 7, 2025

Lead through crisis with confidence: A health care leader’s playbook for resilience and reputation

A crisis is no longer a rare disruption — it’s a defining feature of modern leadership. Today’s health care executives don’t face just one crisis at a time. You manage many layered and compounding crises: labor disruptions, patient safety incidents, cybersecurity breaches, public misinformation, AI-driven disinformation and shifting regulatory demands.

We are now operating in an era many call 'permacrisis' — a time defined by ongoing societal disruption, where the next challenge is never far behind. According to PwC, 96% of organizations have experienced disruption in the past two years, and 76% of leaders said it had a medium to high impact on business operations. Considering these high levels of disruption and impact, organizations without a well-integrated crisis response plan risk serious operational and reputational fallout.

For health care leaders, this means crisis is not a matter of if, but when, making readiness a strategic imperative. Whether they are leading a small practice or a large health system, health care leaders must be prepared to lead through volatility without sacrificing trust, care quality or organizational integrity. Crisis readiness is not a reactive task. It’s a well-planned strategic imperative. Crisis readiness can protect brand reputation, support continuity and strengthen stakeholder relationships when they matter most.

When health care organizations lead with values and communicate with transparency and urgency, they don’t just survive disruption, they grow trust, culture and credibility in the process.


Protect what you’ve built before crisis hits


The first step in your crisis readiness journey is protecting what you've already built: your organization's hard-earned reputation. This reputation is one of an organization’s most valuable and vulnerable assets.

Health care brands are built on credibility. A single crisis — whether a data breach, malpractice claim or public protest — can unravel a brand reputation if not handled with speed and purpose. In a digital-first world, where every mistake can quickly become a headline, how you respond matters as much as what happened. Silence often creates more harm than the incident itself. Leaders must act fast, speak clearly and connect every message to the organization's core values.

  • Start here:Identify your top five reputational risks
  • Align your leadership team on who leads response efforts
  • Pre-approve messaging templates that reflect your values, not just legal language

This isn’t about crafting the perfect message — it’s about communicating in a way that reflects who you are and what you stand for.


Earn trust before you need it


Trust requires continuous, proactive investment. It’s both your most powerful asset and your most fragile. Internally, employees look to leadership for clarity in a crisis. Externally, patients and community members watch what you do, not just what you say.

Data tells us trust in health care has declined measurably. During the COVID-19 pandemic, public trust in health agencies dropped sharply — and it still hasn’t fully recovered. That shift raises the stakes for health care leaders. Clear communication and visible leadership are no longer optional. They’re foundational.

But trust isn’t built through communication alone. It’s sustained through actions that align with your purpose. In a crisis, people pay close attention to whether you follow through on what you say. Do your decisions reflect your values even under pressure?

Your internal and external messages and actions must also align. What your staff hears should reflect what the public sees. Trust is earned through consistency and built with empathy. Speak early and be honest about what you know and what you don’t. Explain the actions you’re taking and how they reflect your values. When your words and actions align, trust follows and credibility grows.

Many organizations, however, overestimate the trust they’ve earned. PwC found that while 86% of executives believe employees highly trust their leadership, only 67% of employees agree. And 22% say they’ve left a company due to trust issues. In crisis, that disconnect becomes even more damaging. Trust isn’t just a message — it’s a measurable business risk.

  • Trust-building actions:Align decisions with stated values even under pressure
  • Create a unified messaging approach for employees and external audiences
  • Follow through visibly on commitments made during disruption


Don’t let an old plan create new problems


With trust as your foundation, your next priority is ensuring your response systems are current and ready to activate. Most health care organizations created or updated their crisis plans during the COVID-19 pandemic. But in the years since, the risk environment has changed dramatically.

AI can now generate fake videos, alter clinical messages or spread disinformation in minutes. Hackers target electronic health records. Labor actions escalate quickly in public view. Turnover at the executive level means fewer people know how to activate your plan — if a current plan exists at all.

A crisis plan must be more than a document. It should be dynamic, accessible and well-rehearsed. Every leader should know their role. Every employee should understand the basics. Your plan should flex to distinct potential incidents, with scalable tiers and clear operational actions communication pathways.

  • Refresh your plan with these steps:Incorporate AI risks, misinformation and digital threats into your scenarios
  • Review and update your crisis plan annually, and after leadership changes or major events
  • Run tabletop drills twice a year with executive leaders and designated crisis team members

The best time to revise your crisis plan was yesterday. The next best time is before a headline breaks.


Prioritize continuity because care can't wait


Your responsibility to provide care doesn’t pause in the midst of a crisis. Even when systems fail, patients still need access. Your organization’s ability to maintain continuity and a high level of patient care — without compromising safety, service or trust — is one of the clearest tests of crisis readiness, and a challenge unique to health care.

Continuity isn’t just about keeping the doors open to care for patients. It’s about sustaining clinical quality, protecting employee well-being and ensuring patients receive accurate, timely information. Whether leading an independent practice or a complex health system, you must prepare to operate through disruption — not around it.

That level of preparation starts with a strong infrastructure and practiced coordination. Cross-functional response teams. Localized decision-making authority. Communication plans that reach patients and staff across multiple channels.

Essential continuity actions:Map your critical systems and identify points of failure
Establish backup communication methods such as text, phone, signage, and digital tools
Train clinical and administrative leads to coordinate clearly and calmly in real time

Continuity is more than best practice in health care. It’s a commitment to those who depend on you most. While disruption is inevitable, disorganized response doesn’t have to be.


Create a culture that responds with resilience


Your ultimate defense against crisis is your organizational culture — the values and behaviors that guide your team when systems are stressed.

Every crisis is a cultural stress test. It reveals whether your values are just words on the wall or whether they are deeply embedded in how you operate. Health care teams that trust leadership and feel informed respond with stronger unity. Teams left in the dark often fracture under pressure.

Leaders have the opportunity to set the tone in every moment. Show up early and speak honestly. Acknowledge what you know (and what you don’t) without fueling fear. Offer clear actions and anchor every decision in your organization’s purpose.

Crisis-ready cultures do not emerge overnight. They are intentionally built through communication, leadership modeling, psychological safety and continuous learning. Invest in those traits now, and your organization can emerge from disruption stronger than it started.

To support culture during a crisis:
  • Define crisis response expectations in onboarding and role descriptions
  • Recognize calm, mission-aligned action after high-pressure events
  • Align internal messaging with your values and mission or purpose


Lead forward through uncertainty


Health care leaders cannot prevent crisis, but they can accept and prepare for the inevitability of a crisis and lead through one with confidence, clarity and care.

The health care practices that invest in crisis preparedness today will be the ones key stakeholders trust tomorrow. The clinics that communicate with transparency and humanity will retain staff during turbulence. The health care leaders who respond with values-driven purpose will find opportunity on the other side of disruption.

Your next crisis is coming. You decide today whether your organization will be ready to lead or forced to react. Resist the urge to feel overwhelmed. Start where you are by updating what’s outdated. Lead with purpose, and protect what matters most: your people, your reputation and the care your community counts on.

____________________________________________

Ayme Zemke, APR, is Chief Client Officer and certified crisis expert at Beehive Strategic Communication. She brings more than 25 years of experience guiding executives across health care, education, financial services and manufacturing through crisis and change. Ayme specializes in helping mission-driven organizations lead with purpose and communicate with confidence during high-stakes moments.


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Monday, May 5, 2025

Structures of medical practice transactions

Medical practice acquisitions represent a challenging and risky strategic decision. Here are three main legal structures for acquiring a medical practice: asset purchase, stock purchase, or a merger. All three of these structures are different types of acquisitions. A merger is a type of acquisition that has a particular legal meaning. The decision to buy, sell, or merge a medical practice is more complicated than ever, and Physician owners must have a clear understanding of the legal structure of the potential transaction.


Asset purchase


In an asset purchase, the buyer purchases specific assets of the target practice that are listed within the transaction documents. Buyers may prefer an asset purchase because they can avoid buying unneeded or unwanted assets and liabilities. Generally, no liabilities are assumed unless specifically transferred under the transaction documents. Because the liabilities remain within the selling practice, buyers can eliminate or reduce the risk of assuming unknown liabilities. Further, buyers typically receive better tax treatment when purchasing assets as opposed to stock. Buyers may also be able to reduce their taxable gain or increase their loss when they later sell or dispose of the assets.

The main risk to buyers in an asset purchase transaction is that a buyer may fail to purchase all of the assets it needs to effectively run the practice. There are also various aspects of an asset sale that can be time-consuming and drive up transaction costs, such as listing specific assets and determining their value. For some assets, third-party consent may be required before the assets can be transferred to the buyer. The manner in which title of an asset is passed to the buyer will vary depending on each kind of asset. Finally, there is always the risk that the seller could retain sufficient assets to continue as a competing going concern. This risk is usually mitigated by requiring that the seller enters into a covenant not to compete with the buyer.

Sellers generally disfavor asset transactions because the seller is left with potential liabilities without significant assets it could otherwise use to satisfy those liabilities. Also, the tax treatment of an asset sale is generally less favorable to sellers than a stock sale. The practice and its shareholders can each potentially incur taxable income, which could result in double-taxation of the sale proceeds. Entities that have pass-through taxation such as partnerships, LLCs and S corporations can avoid the problem of double taxation and thus may be more likely to accept an asset purchase structure.


Stock purchase


In a stock purchase, the buyer purchases the stock of the target practice directly from the target's shareholders. The practice remains an existing going concern after the purchase, and its business, assets, and liabilities are unaffected by the transaction. A stock purchase may be preferred if the buyer wishes to continue operating of the target practice after the purchase. Further, absent unusual circumstances, consent from third parties would not be needed to approve the transaction.

However, the buyer may be exposed to unknown risks by buying the entire practice, assets, and liabilities. Buyers can reduce its risk by holding back some of the purchase price in escrow to satisfy any liabilities that arise after closing.

Obtaining approval for a stock purchase can be problematic if the target has a large number of shareholders. Unless there are agreements in place before finalizing a deal, buyers cannot force shareholders to sell. Thus, a holdout shareholder could refuse to sell to the buyer. This result can be very undesirable for buyers and could ultimately cause the deal to fall apart.

Buyers may have less preferential tax treatment in a stock purchase. However, in certain circumstances, buyers can elect to treat the stock purchase as an asset purchase, thus securing a desirable tax treatment.


Merger


In a merger, two separate legal entities become one surviving entity. Under state law, the assets and liabilities of each are then owned by the new surviving legal entity. There are several structures that mergers can take.

The simplest is a forward merger, whereby the selling practice merges into the purchasing practice, and the purchasing practice survives the merger.

Sometimes, buyers will wish to keep the target practice as a separate legal entity for liability reasons, so the buyer will instead merge the target into a wholly-owned subsidiary corporation of the buyer, called a forward triangular merger. When complete, the subsidiary survives the merger, holding all of the assets and liabilities of the target practice.

Both a forward and a forward triangular merger generally require consent from third parties, as the target practice ceases to exist after the merger and all of its assets are owned by the surviving entity.

A reverse triangular merger is similar to a forward triangular merger, except that the target practice is the surviving entity, instead of the wholly-owned subsidiary of the buyer.

How a merger is taxed depends on its structure. Generally, forward and forward triangle mergers are taxed as asset purchases while reverse triangular mergers are taxed as stock purchases.

In terms of required corporate approvals, mergers generally require approval only of the seller's board of directors and a majority of its shareholders (absent other requirements in its charter documents). This lower threshold is particularly appealing when a target practice has multiple shareholders. However, shareholders who vote against the merger will generally have appraisal rights under state law. Appraisal rights, or Dissenters' Rights, enable dissenting shareholders to petition a court to obtain the fair market value of their shares. This can complicate transactions and increase the buyer's costs.

Clearly, medical practice transactions can be complicated.Consequently, it is imperative that physicians have an experienced and competent team consisting of a consultant, accountant, and attorney who help you review all of your options and choose the option that ensures your practice’s continued success.


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