First steps for opening up an independent practice

Are you considering an independent practice for yourself? Although it may seem an intimidating prospect, you will probably find that independent and solo practitioners are better able to provide quality care for their patients. In fact, Linda Girgis, MD, FAAFP , writing in Medical Practice Insider states that “patients receive the best care when their physicians maintain control of the way they practice.” What are some of the first and most important things you will need to do when planning your independent practice? The list may seem long and daunting, but there are a few items that are crucial and will help independent and solo practitioners move toward success. Hire quality staff. When you have skilled team members who are patient-focused, you can be more confident in your practice management. Your patients will be happier, knowing that everyone in your office truly cares about their well-being and that the practice is well run. Launch a marketing strategy. Create a professional website that provides your patients with information about your practice. List your location and contact information as well as an overview of your background and education. Make the website interactive, so patients can communicate with you and your staff, make appointments online, and pay their bills online. Set up an EHR system. Take advantage of technological advances by maintaining your patients’ health records electronically. With an EHR solution, you will spend less time on paperwork and more time being able to provide quality care to your new patients. Hire professionals. You will need to enlist help to stay on top of legal issues and accounting matters, particularly taxes. In addition, as an independent physician it will be your responsibility to credential with insurance companies, so you may need professional assistance to be sure that task is completed appropriately and in a timely manner. Communicate with the medical community. You know that communication is important once you are seeing patients as an independent physician, but it is just as important to reach out to specialty providers, labs, and healthcare facilities before you open your practice. Let them know what you have to offer, particularly when you have the ability to collaborate electronically. Independent and solo practitioners have an advantage in being able to focus more fully on patient care. Follow these guidelines to open and succeed in your independent practice!

Dante Capozzola

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Patient engagement at independent practices

Patient engagement is an important part of an independent physician's role in providing high-quality care to patients. Patient engagement means more than having a conversation during a visit. It means following up with that patient, communicating test results, and checking in on the progress of the patient’s medical plan. It also means the difference in having that patient return for follow-up visits and quite possibly even the difference in the future health and welfare of that patient. What are some patient engagement strategies for independent physicians? Key steps to take in engaging patients include: Continuing patient communication beyond the office visit Optimizing the features of a clinical EHR for independent primary care physicians Encouraging patient interactions at critical touch points. According to a playbook published by Health IT, “patient access to information and communication with providers can increase the quality of life,” particularly for those patients with chronic illnesses. A clinical EHR for independent primary care physicians offers you much more than the ability to maintain a patient’s health records electronically. You can also quickly identify patients who aren’t meeting goals based on custom care management protocols, reaching out to them to schedule follow-up appointments to address any potential gaps in care. Knowing that the patient’s time is as valuable as the independent physician’s time, patient engagement can be much more easily and efficiently accomplished through tools such as electronic messaging, to include appointment reminders and answering a patient’s follow-up questions. Quite often the patient - as well as the independent physician - thinks of information that needs to be shared long after the appointment is done. Communication with the patient enables everyone to share that information in a convenient manner, ensuring that follow-up care is appropriate and effective. Patient engagement helps both the patient and the independent primary care physician work toward happier, healthier patient results. Employing engagement tools at critical touch points, particularly as part of a follow-up plan, will improve your patient engagement success as an independent physician.

Tyler Comstock

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The importance of office staff at an independent practice

  As an independent physician, you have been trained and educated to treat patients. You probably did not prepare yourself to run an office. That’s why you hire office staff, to help you with the daily tasks that have to be done - and done well - to keep your practice running smoothly. The office staff at independent practices play a key role in ensuring that patients are happy and that you are able to give your attention to their medical care. Some of the tasks performed by office staff at independent practices include: Greeting and checking in patients Managing co-pays Accompanying patients to the exam room Answering phone calls Helping patients navigate their portal login Scheduling appointments Billing and other administrative tasks The role of the office staff is important for independent practices especially. With a capable team in your office, you can spend less time worrying about administrative details and more time focusing on patient care. When determining the number of office staff at independent practices, it is helpful to check industry benchmarks. It is also important to know how you work - and how you prefer to work. For example, if you are well organized, tend to stay on schedule, and are generally able to complete your paperwork in a timely fashion, you will need less help in the office. If your independent practice uses an EHR system that virtually eliminates the abundance of paperwork found in a typical medical office, you will also need fewer staff members in your office. Hiring staff members will add to your expenses, of course, but when you think of all the tasks they perform each day, allowing you to focus on what you do best, the expense is certainly justified. Gauge carefully the number of staff members you will need, be sure they know their specific responsibilities, and train them in medical office and customer service skills. Your patients will appreciate the treatment they receive from your dedicated staff, before and after they receive treatment from you as their primary care physician.

Roy Steiner

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What is an Independent Physician Association (IPA)?

Independent physicians who want to focus more on the care of their patients sometimes feel challenged with the need to keep up with compliance regulations, administrative contracts, and other overhead issues related to their practice management. An independent physician association (IPA) may be able to help by reducing or eliminating some of those headaches. Independent physician associations (IPAs) are on the rise. Essentially, an IPA is a business entity, owned by a network of independent physicians. IPAs vary in their purpose and activities, depending on the area of the country in which they are located. What do small and solo practice physicians need to know about them? Joining an IPA does not mean you are losing your independence. An IPA does, however, offer you the benefit of being part of a larger group, primarily for the purposes of contracting with third parties, for pursuing business ventures, and for reducing overhead costs. The American Academy of Family Physicians (AAFP), recognizing that there are benefits as well as risks involved with participating in an IPA, has established a list of Guiding Principles for IPAs. In part, the principles state that the IPA should “promote efficiency and effectiveness in the delivery of health care to patients that produces value.” This guideline aligns with your focus as an independent physician and with Elation’s philosophy to improve the quality of patient care while being more productive and more effective. An IPA can be a useful tool for practice management for an independent physician. As the AAFP warns, though, there are some risks involved. When you are considering an IPA, be sure to have your attorney review all documents related to the organization. AAFP advises, in particular, that risks might involve “conflicts of interest for the physician between financial gain and optimal care for the patient.” Another guiding principle for IPAs, according to the AAFP, is that “effective management of relationships between primary care physicians, limited specialists, and hospitals is critical to the optimal care of patients….” Elation is also focused on helping you, as an independent physician, to optimize those relationships with patients and with other physicians. Check out our solutions that can help you provide the highest quality care possible!

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Medicare's impact on independent practices

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its associated Merit-based Incentive Payment System (MIPS) have proved quite challenging to many independent practices. In addition, the Medicare-qualifying patient population is expected to increase from 55 million to 80 million by 2030. How does all of this impact independent practices? A recent BlackBook Research survey of 1300 very small independent practices found that “67% of such physician practices believe their independence will end with MACRA.” In addition, 89% of the solo practices that participated in the survey “plan to minimize Medicare volume to avoid filing quality and clinical practice improvement reports or cost performance reports to CMS.” There is much confusion among independent physician practices as well. Of the very small practices surveyed, “63% remain unsure which health information technology and products meet their needs for meaningful use, clinician usability, interoperability and coordinated claims and billing.” Fortunately for these independent practices, the Centers for Medicare & Medicaid Services (CMS) has released a new proposed rule for 2018 that would simplify requirements going forward. Recognizing that small practices may not have the resources needed to comply, CMS has increased the thresholds for required participation in MIPS in the proposed rule. The new proposal increases the threshold from $30,000 or less in Medicare Part B allowed charges or less than 100 Medicare patients to $90,000 in Part B allowed charges or less than 200 Medicare patients. Other proposed changes for 2018 include allowing the use of the 2014 Edition CEHRT (Certified Electronic Health Record Technology) and adding bonus points in the scoring methodology for caring for complex patients and for using 2015 Edition CEHRT exclusively. Moving from a fee-for-service structure to a value-based payment plan is an important strategy for independent physicians who are primarily focused on their patients’ healthcare outcomes. However, the future of these independent practices as it relates to their willingness and ability to continue in the Medicare program may depend on the outcome of the proposed 2018 rule.

Tyler Comstock

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Working in an independent practice vs a large clinic setting

Entrepreneurship is a life’s dream for many people. A person who is able to launch a business and report only to clients, rather than to a management structure or supervisor, may find happiness and fulfillment in his or her newfound independence. The same may be true for primary care providers who decide they want to practice independently rather than be employed by a larger health care facility. There are advantages and disadvantages both to remaining independent and to working in a large clinic setting. Challenges and benefits for the independent physician, according to Philip Masters, MD, FACP, writing for the American College of Physicians, include: -Practice management. An independent physician is ultimately responsible for all of the administrative tasks involved in operating and maintaining the practice. -Hiring staff. Such tasks cannot be handled alone, so the independent physician will have to recruit, hire, and retain quality staff members who can assist with patients and with administrative duties. -Billing, keeping up with regulations. The shift to value-based payments and the continuing debate over health care coverage will impact the independent physician’s practice in regard to billing and maintaining compliance. -Ensuring the integrity of protected data. HIPAA regulations apply to all protected health information, including electronically maintained data (ePHI). Independent physicians who take advantage of electronic health records (EHRs) must adhere to HIPAA regulations as well. -Developing closer relationships with patients. The independent physician has the opportunity to get to know patients more fully in a smaller practice. Likewise, there are challenges and benefits for the physician working in a larger clinic: -Reduced administrative burden. Most clinics are fully staffed with personnel assigned to patient services and administrative duties. -More resources for coverage. Clinics generally employ more than one primary care physician, so backup is available. -Lack of control. Dr. Masters points out that “scheduling and productivity expectations may be beyond your control, and policies and procedures may be developed by others without your input” in a clinic setting. -Other expectations, beyond providing for patient care. A clinic may expect its physicians to participate in committees or other activities within (and outside) the organization. -Business-like structure. Larger clinics are often focused on making money. The independent physician who is more focused on patient outcomes may find this a challenging adjustment.

Dante Capozzola

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Marketing trends for independent physicians

Marketing can be effective for independent physicians. As an independent primary care physician, you certainly want to focus on patient care without being concerned about promoting your practice. However, marketing done well can ensure that you actually have those patients in your practice that need your care! Marketing is not hard-pitch selling. Rather it is communicating and promoting the services you have to offer your patients. If you were a patient looking for a new independent physician, what would want to read or hear about that practice? A good marketing strategy to keep in mind, regardless of current trends, is to make sure your message is addressed to your specific clients’ needs. What are the trending marketing tactics that are most relevant to the independent primary care physician community? In 2017, healthcare marketing is all about the digital options. You should have a solid, useful website for your potential patients to learn more about your practice and for your current patients to use to communicate with you, set appointments, and pay bills. Optimize your web content and your social media posts to reach your specific target market. As an article in Healthcare Success, 10 Healthcare Marketing Trends to Watch in 2017, points out, the trend is to have “content that is authoritative, interesting and share-worthy.” You know that, of course, as an independent primary care physician, you may be competing with larger practices. Use that to your advantage in your marketing strategies. Believe it or not, patients consider their time to be just as valuable as you do yours. A very effective tactic for you is to emphasize that you are a small, independent practice so you also understand how important your patients’ time is to them. In addition, point out that by using your EHR solution for maintaining and viewing their patient information, you are able to provide the individual care they need at each visit, rather than being bogged down with their paperwork! Patients do tend to do their research before choosing an independent primary care physician. They want to see that you are able to provide coordinated care with specialty providers and labs. When you take advantage of digital marketing options, you can send that information and more, out to potential patients through your website and social media posts, straight to their mobile device. Promoting your practice does not have to be intimidating or time-consuming. Marketing can actually benefit both you and your patients!

Roy Steiner

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Reasons why independent physicians can stay independent

Even as the healthcare landscape changes, there are a number of solid reasons why independent physicians can and will stay independent. New healthcare regulations, insurance rules, and pressures to consolidate are challenges for independent physicians. However, most prefer to maintain their independence to better serve their patients with personalized care and advances in technology, including an EHR system for independent physicians. As healthcare payments shift to value-based care, independent physicians are actually better positioned to not only maintain their autonomy but to grow their practice. In fact, a 2015 Independent Physician Outlook Survey, as reported in Becker’s ASC Review, revealed that many independent physicians “envision a future where the employed physicians at larger healthcare institutions migrate back into a private practice or independent practice setting.” Almost half of the survey respondents agreed that innovation in business models, designed to focus on cost savings and efficiency, would help them maintain their autonomy. Incorporating an EHR system for independent physicians can be a crucial piece of such business model. Elation offers a provider-centric Clinical EHR that exists at the nexus of the clinical workflow, supports the physician-patient relationship, and drives outstanding patient outcomes, enabling independent physicians to provide the highest quality care and remain independent. Joining an Independent Physician Association (IPA) is another step toward maintaining independence. An IPA enables independent physicians with more leverage in certain types of contract and payment negotiations. About 49 percent of the survey respondents felt that an IPA would also help them by providing a forum for aligning with other, like-minded physicians. The survey report noted that “nearly half of independent specialists expect to sell their practices in the coming years, but not because they want to.” Independent physicians have a number of available reasons to stay independent. Employing the right tools for secure and effective patient communication as well as practice management is a key aspect of staying independent as a physician. Using advanced technology to more efficiently record and maintain patient health records enables the independent physician to focus on the core goal of the practice - quality patient care.

Tyler Comstock

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Independent physicians can stay independent during transition to value-based care

There is uncertainty surrounding how independent physicians will adapt to the transition from fee-for-service to value-based care. In reality, independent providers are already uniquely situated to succeed within this new landscape. Farzad Mostashari, MD, writing in the Annals of Family Medicine, cites research suggesting “that small, physician-owned practices …have lower average cost per patient, fewer preventable hospital admissions, and lower readmission rates than larger, independent- and hospital-owned practices.” Independent practices realize all of these benefits, while also providing personal attention and responsiveness to their patients. Since value-based care is focused on patients and the quality of care provided to those patients, independent physicians are poised to deliver on the type of care required to succeed in the value-based world.  Independent physicians have provided this kind of care for generations - but with the right technology, that advantage grows. Optimizing the value of care An effective EHR for independent primary care should be cloud-based and easy to use in the clinic, eliminating the need for redundancy and additional work. With the right technology tools, providers can focus more on the patient’s needs and less on the paperwork involved in a patient’s care.  Using a Clinical EHR helps to drive quality patient outcomes that are especially important in a value-based system. In addition, primary care physicians will take an increasingly important role as the quarterback in patient care within the value-based environment. Understanding a patient’s complete medical care profile, including having access to the network of providers a patient has seen for specialty medical services, will enable independent physicians to optimize the “value” in their transition to value-based care. Communications between providers can be a crucial element of making more efficient and more accurate medical decisions, which is the key to providing personalized high-quality care. To learn more about Elation Health’s cloud-based Clinical EHR solutions and how we can help you succeed in the new value-based care landscape, contact us today.

Roy Steiner

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How many office staff members do independent practices need?

The independent physician has to balance the need to keep overhead manageable with the need to adequately staff the practice. Too few staff members and patients are not well served. Too many staff members and the practice faces excess expenses. There is no magic formula for how many staff members an independent practice needs, but there are guidelines and suggestions that can help in the calculation. The first step, according to guidelines provided in an article published by the American Academy of Family Physicians (AAFP), is to compare their independent practice with industry benchmarks. Sources for available benchmarks include “the Medical Group Management Association (MGMA), Practice Support Resources (PSR), the American Medical Association (AMA) and the American Medical Group Association (AMGA), as well as local medical societies.” Benchmarks should address: The number of support staff per full-time-equivalent (FTE) physician The percentage of gross revenue spent on support staff salaries. Another consideration when determining how many staff members an independent practice needs is to review the overall practice management style and structure. If an independent physician is organized and completes paperwork efficiently - fewer staff members might be sufficient to maintain patient records and update charts. If the practice employs advanced technology tools, such as an EHR, enabling the independent physician to access and update patient information electronically, that should also be included in the considerations. Adequate staff members will be needed to support communication with patients, including checking in patients, answering patient questions on-site, and responding to patient telephone calls. If the independent practice collaborates with other providers or has satellite offices that require coordination of scheduling, additional staff members may be needed to ensure those services operate smoothly. Factors that may also affect the numbers include the qualifications and ability level of each staff member. For example, a staff person who checks in patients may have the capabilities to perform other duties in the office. If the patient level is high, however, individual staff members may need to perform separate tasks. There is no one answer to the question of how many staff members an independent practice may need. However, guidelines are available to ensure that staffing makes sense given the particular situation of each practice.

Dante Capozzola

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The importance of empathetic communication for independent physicians

Patients want to know their primary care physicians care about their well-being. Physicians want to be able to provide the highest quality care to their patients, especially with the current transition to value-based reimbursement. One method that has been proven effective in achieving all of these goals is empathetic communication. What is empathetic communication? As Kasley Killam explains in Greater Good Magazine, “empathy in a clinical context is the physician’s ability to understand patients’ emotions, which can facilitate more accurate diagnoses and more caring treatment.” Empathy builds trust, which further strengthens the patient-physician relationship that is so important to quality healthcare. When a physician takes the time to listen to the patient’s concerns, it can make a difference in the level of patient outcomes. An article in the Georgetown University Journal of Health Sciences notes interesting gender differences in physicians’ ability and practice when communicating empathetically. Published evidence shows that “female doctors are generally more empathic than male doctors when relating to their patients.” The journal article further explains that the “average duration of a female physician’s interview is ten minutes and forty-five seconds, compared to the seven minute and thirty-eight second average interview conducted by her male colleague.” Communication is extremely important for the patient and the physician both during the visit and after the visit. When the physician has to spend excessive time on paperwork, there is less time for face-to-face conversation during the patient’s office visit. A tool such as EHR can provide increased patient data access so the physician can spend more time focused on listening to the patient, displaying empathetic communication skills, and less time searching through files for information. After the visit, a patient may have questions or a physician may need to relay additional information to the patient. A communication tool that offers seamless, secure messaging for both patient and physician can also increase the empathy shown by the physician toward the patient’s concerns, thereby improving the quality of follow-up care.

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How independent practices can succeed with MACRA, MIPS and APMs in 2017

The Centers for Medicare & Medicaid Services (CMS) has deemed 2017 as the transitional year for independent physicians to comply with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). During 2017, there are a number of ways that independent practices can choose to participate in the program and remain compliant. Reporting for the MACRA was officially kickstarted in January. The results of the reporting that begins in 2017 will be reflected in the payments that are issued beginning in 2019. This allows for the tracking of a composite performance score under which all physicians will be graded under MACRA. The CMS Quality Payment Program, enacted by MACRA, enables independent providers to focus more on providing high quality care for their patients. The program offers two tracks for independent practices to choose from: Advanced Alternative Payment Models (APMs) or The Merit-based Incentive Payment System (MIPS) The MIPS track consolidates current fee-for-service Medicare programs (Meaningful Use, Physician Quality Reporting System, and Value-Based Payment Modifier) into a single program. When you choose the MIPS track, you also have the option to “Pick Your Pace” which, in the words of CMS, provides “an on-ramp to participating.” Participating in MACRA in 2017 What are the options for independent practices to be able to participate in MACRA in 2017? You can test the Quality Payment Program. As an independent provider, you simply have to submit some data from after January 1, 2017 to avoid the negative payment adjustment. This option exists to ease providers into greater participation in 2018 and 2019. You can participate for part of the calendar year, for a reduced number of days. You will still qualify for a small payment if you submit data on how your practice is using technology and what you are doing to improve your quality of care. As a Clinical EHR participant, you can demonstrate that you are taking steps to improve your patient care while streamlining and optimizing your clinical workflow. You can participate for the full calendar year. To take advantage of this option, you would have been ready to fully participate in the Quality Payment Program for a full calendar year as of January 1, 2017. You can participate in an Advanced Alternative Payment Model in 2017. With this option, you are excluded from the MIPS reporting required in the other options and you are given the opportunity to qualify for a 5 percent annual bonus. We want to help ensure that you are MACRA compliant in 2017. Contact us to learn more about your options!

Tyler Comstock

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New state policy aims to level the playing field for independent physicians

Independent physicians often receive lower reimbursements than their hospital-employed counterparts. The state of Vermont recognizes the situation and is working toward alleviating the issue with new legislation. The Vermont State Senate passed a bill in May 2017 that would level the playing field for independent physicians. The independent private practice physician has long received smaller reimbursements from insurance companies than the physician employed by a hospital. For the past four years, the Vermont legislature has been trying to rectify the situation. In fact, in 2015 they ordered two of the state’s insurers to restructure their billing method to be more equitable. However, that resulted in very little change, over a long period of time. The new bill, designed in part to keep independent private practice physicians from leaving the state, puts into place plans to “reduce pay disparities between independent physicians and academic medical center physicians by the ‘maximum achievable’ amount in the next three years.” The pay parity verbiage was added to the original bill, known as H.29, which was originally written to address Medicare supplemental insurance issues. Hospitals and insurance companies, along with two Senate committee chairs, opposed the bill. Why independent physicians should care At Elation, we work to help every independent private practice physician succeed, both in terms of quality patient care and practice management. Particularly, as the healthcare industry shifts the focus to value-based care, being able to provide quality, coordinated care for each patient and have it be efficient and cost effective will become more important. We realize that costs are high and inconsistent for an independent physician. We focus our efforts on small and solo practices, helping you optimize your practice through streamlined electronic records, interoperability, and collaborative health records. Explore a sample chart to see how Elation’s EHR solutions can benefit your independent private practice.

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