Monday, November 22, 2021

Setting boundaries: How to say no — and when to say yes

As we approach the holidays, we often find ourselves feeling overwhelmed and overcommitted. ‘Tis the season to start setting boundaries, and it all starts with learning how to say ‘no.’


This is easier said than done, especially for physicians. We tend to be notorious people-pleasers who find ourselves saying ‘yes’ to things we don’t want to do because we hate to disappoint others or because we dread conflict. Other times we hesitate to say ‘no’ because we fear losing job or status, or out of fear missing out on opportunities. And of course, sometimes we agree to take on more than we should because of a superhuman view of ourselves that we are the ‘only one’ who can do the job, or that we should be able to handle more than anyone else.

According to psychologist Steven Cohen, PsyD, when we don’t know how to say no (or when we say yes for the wrong reasons), we end up resentful and angry, which takes a toll on our psyche. Cohen says that the first step to taking back control of your decisions is to stop saying ‘yes’ automatically. Instead, pause before answering to ask yourself one simple question: What are my motivations for agreeing to this request?

Consider your motivations


Start by assessing your rationale for agreeing to extra demands on your time and energy. One of the best questions to ask yourself is whether you are being offered an opportunity that will benefit you or add value to your life. Consider whether the task aligns with your future goals or is merely another responsibility added to your plate.

For example, imagine that your employer has asked you to sit on a newly formed work committee. If the committee involves issues that are important to you personally, or you think will lead to future desired opportunities in leadership, then it may be reasonable to agree to commit to the project. On the other hand, if you suspect that this committee is unlikely to accomplish any meaningful goals or benefit your life in any significant way, then respectfully declining is in your better interest.

One common reason that physicians bite off more than we can chew is an inflated sense of self-importance. The truth is that no one is indispensable, no matter how important or good at their job. It is a painful truth that when we are long gone, someone else will see our patients and chair our committees. Ask yourself if you are only agreeing because of ego or anxiety that you are the “only” person who can do the job (or do the job right). which compels us to take on every offer and opportunity that presents itself until we are so burned out that we can’t manage our regular responsibilities or take care of ourselves.


Overcoming fear


It’s also important to yourself whether you are saying ‘yes’ because of fear—are you afraid that if you say no, you will lose your job or the respect of others? Examine these anxieties and fears and determine if they are realistic or illogical.

For example, you may find yourself thinking, “If I don’t agree to serve on this committee, I’ll probably get fired.” According to Cohen, this is the type of automatic negative thought that is ripe for self-examination and cognitive reframing. Challenge your belief by asking yourself, “do I have any proof that I’ll get fired if I decline this opportunity? Is this a logical conclusion?” If the answer is no, practice reframing by thinking in a more positive way, like, “My practice is busy and successful, and I already participate in other committees. It’s likely that administration will understand that I can’t take on any additional workload.”

Another common fear is fear of missing out. We often agree to every offer because we are afraid that if we say no, we will stop being asked. Sometimes this is true—but it may not necessarily be a bad thing.We need to remind ourselves that it’s far better to seek out opportunities of interest, rather than getting sucked into more and more low value activities that come with saying ‘yes’ to every invitation.

How to say ‘no’


Before responding to opportunities, make sure to take the time to consider your decision—you don’t have to respond immediately. Avoid answering when you are too busy or distracted to make a good decision. Be aware of your surroundings and note that those around you may influence your decision.For example, if an administrator is asking you to do something in front of your peers, you may feel pressured to say yes. Instead of answering directly, ask for time to consider the request and answer after you have had time to determine whether it makes sense to agree. “It’s best to name a specific time when you will give a definite answer,” says Cohen, who advises not waiting too long to give your answer. “Once you have determined that this is not something that you want to do, say no as soon as possible.”

Cohen also cautions doctors to avoid over-explaining or rationalizing your answer. “When you try to justify your decision, this can create a sense that you can be talked into agreeing and may lead to more pressure to accept.” Cohen reminds us that “no is a complete sentence,” and to keep in mind that it’s perfectly ok to say no just because you want to – you don’t need a reason.

To make it easier to say no, practice the technique of positive visualization. Imagine yourself saying ‘no’ in a calm and confident way. Picture the person you are answering responding favorably.If you find yourself falling into negative thinking, deliberately choose to imagine a more positive scenario. “The good news is that the more you practice positive thinking, the easier it becomes,” says Cohen.


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Sunday, November 21, 2021

Study: Physicians usually wrong when estimating patients’ out-of-pocket drug costs

At a time when high drug prices are adding to patients’ high medical bills, few physicians are accurate when estimating of out-of-pocket costs.

According to a study appearing in JAMA, in a study of 371 primary care physicians, gastroenterologists, and rheumatologists found that only 21 percent of respondents could accurately estimate out-of-pocket drug costs when supplied with information on the drug’s price and the patients insurance plan’s cost-sharing mechanisms.



Specifically, the respondents were asked to estimate the out-of-pocket drug cost for a patient prescribed a new medication costing $1,000 a month without insurance. They were supplied with a summary of the patient’s insurance information including deductible, coinsurance rates, copays, and out-of-pocket maximum and were asked to estimate the cost at four points between January and December. They were asked to use the plans four types of cost sharing: deductibles, coinsurance, copays, and out-of-pocket maximums, the study says.

Overall, 52 percent of respondents were able to accurately estimate the drug cost before the deductible was met, 62 percent were able to accurately use coinsurance information, 61 percent accurately used copay information, and 57 percent accurately estimated the costs once the out-of-pocket maximum was met. Only 21 percent were able to answer all four correctly, according to the study.

The survey also looked at the respondents’ attitudes toward talking about costs with their patients. Most of the respondents (74 percent) agreed that they had an obligation to initiate cost conversations but had difficulty advising patients of out-of-pocket costs (77 percent). Main barriers to these conversations cited by the respondents were insufficient time (76 percent), insufficient knowledge (69 percent), and discomfort with the conversations (41 percent). A further 63 percent reported their patients expected them to solve their cost-related issues, the study says.

“Our study provides some hope that an EHR-based cost estimator could improve physician awareness of drug costs,” the study says. “Although we did not ask physicians to specify the details of their EHRs, those who reported having access to some information about out-of-pocket costs performed better than those who had no information.”


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Saturday, November 20, 2021

Third-party financing: a path for medical practices to thrive in an era of cost-shifting and declining revenues

A study released by the American Medical Association (AMA) in May 2021 showed that for the first time ever, a majority of physicians no longer work in private practice. The largest two-year increase of doctors jumping from small to large practices measured by the AMA survey since 2012 occurred between 2018 and 2020.

A separate survey from the Physicians Foundation conducted in July 2020 found that 8% of physicians had already closed their practices just five months into the Coronavirus pandemic, while 43% had reduced staff—with more than half of these practices experiencing losses of at least a quarter of their income.

Of the estimated 16,000 medical practices that shuttered in the early months of the pandemic, “the majority (76 percent) were private practice owners or partners” in small, independent practices, according to the survey. “The great majority of physicians will not leave medicine as a result of Coronavirus health risks,” the authors concluded, “but may be more likely to leave for economic reasons.”

In the Coronavirus era, some of the most endangered practices are specialties that don’t easily lend themselves to telehealth, or those that rely substantially on revenue generated from elective procedures, which are being curtailed because of avoidance of health care settings and staffing shortages, among other reasons.

Smaller practices may be less equipped to weather extreme economic pressures compared to hospital systems and large academic medical centers, because they usually have fewer revenue streams and may be more susceptible to cash flow disruptions. Layer on top of that insurance cost-shifting trends, and it adds up to additional burdens on small practices to get fully reimbursed for services they provide.

The proliferation of high-deductible insurance plans has made the patient the new payer. Out-of-pocket health expenses for Americans now surpass $400 billion annually, according to the Centers for Medicare and Medicaid Services. An AMA report from July found that collection agencies last year held a staggering $140 billion in unpaid medical bills. And this number is low, measuring only delinquencies already sold off. Medical debt is America’s leading cause of bankruptcy, according to the National Consumer Law Center.

To be sure, the financial pressures facing independent medical practices predated the pandemic. But the unique phenomenon of Coronavirus – filling urgent care centers while emptying elective surgery wards – has accelerated the consolidation trend.

According to AMA data, 72 percent of physicians owned their own practices in 1988. Now that number is down to 46 percent. In the face of so many challenges, what are those who value the independent practice of medicine to do?


THIRD-PARTY PATIENT FINANCING


To control their professional destiny, they must adapt and become as innovative with their financial instruments as they are with their medical instruments. Large health systems may be able to afford teams of financial professionals to focus on reimbursement and revenue, but in today’s lean environment, smaller practices are more likely to be focused on squeezing out enough revenue to meet a reduced payroll.



Some practices have adapted to cost-shifting trends by allowing patients to pay their bills in installments, but this type of direct patient financing can further stress revenue cycle management (RCM) as payments once rendered in days are now stretched over months. And if patients don’t pay, practices must either absorb the losses or make a significant human and revenue investment to collect these costs. This is not a sustainable solution.

Fortunately, small practices have new options to explore third-party patient financing to help patients plan for how they will pay their medical expenses – both expected and unexpected – while themselves receiving rapid payment and no-recourse financing from a financial partner.

There are many third parties entering the health care finance realm but having a firm understanding of the needs of providers and patients is crucial for success. Health care financing is not a simple plug-and-play solution in an electronic health record. Hospitals and health systems should consider the commitment to the space and knowledge of the intricacies of how health care organizations operate, from elective procedures to general health and wellness.

Health care organizations should also consider whether their partners will be able to anticipate and innovate new financing options that will integrate with existing infrastructure while also being able to adapt to the practice’s changing needs.

A BENEFIT TO PATIENTS AND PROVIDERS

For small practices, training medical support staff to have more granular conversations about payment and finance options at the time of service can be the difference between obtaining or foregoing care.Recognizing that every patient’s financial situation is as unique as their health care condition is important. Not everyone wants to or can pay for care the same way.

Health-only financing options are attractive to patients because they offer a chance to compartmentalize health and wellness expenses in one place. Third-party patient financing is equally attractive to small practices because it gets them out of the debt collection business and boosts their revenue cycle management through guaranteed payment in just a few days instead of up to a month with a traditional credit card—or potentially much longer (or not at all) with an in-house installment plan. And as consumers come to further understand the payment options available to them, a third-party financial partner can create additional consumer patient loyalty and, importantly, an improved patient experience.

Patients recognize that their responsibility for health care costs is growing. They already expect conversations and more transparency around their care costs and are seeking new ways to pay for the care they need, when they need it. In this new age of payment portals and online financial transaction platforms, third-party patient financing can now be offered by integrating a solution into the electronic health record and accessible through a patient’s online portal.

As Coronavirus, consolidation and cost-shifting challenge providers in new ways – as insurance companies pull back on specialty offerings and patients pull back on discretionary health spending – independent practices shouldn’t be overly burdened with calculating and collecting monthly payments, keeping delinquent accounts on the books, and eating the costs of their services if the patient doesn’t pay.

Independent-minded physicians got into private practice to focus on medical care, not bill collection. Third-party patient financing can help them meet the changing demands of their patients while improving their RCM and weather these stormy times.


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