Is your independent practice calculating a DSO?

An independent practice is a business that needs to be managed in the most efficient manner to ensure its financial health, so the independent physician can continue caring for its patients’ health. Businesses must be able to budget appropriately, based on their projected income, and knowing when that income will hit the bank is one of the most important aspects of running a financially efficient independent practice. Calculating the Days Sales Outstanding (DSO) is a valuable way to understand the true financial picture of your practice.

Your DSO is “the time frame in the number of days it takes for you to see a patient and get the final payment posted into your billing system.” In other words, the DSO number indicates the amount of time you wait between the patient visit and the posted income from that visit. The lower the number, the healthier your financial situation.

P.J. Cloud-Moulds, writing in Physicians Practice, urges you to calculate the DSO number for your practice, even if you have an outside billing company doing the accounting work for you. The formula is relatively simple: Total A/R divided by Total Charges multiplied by the number of Days in the billing period. An example given by the author is $360,928.51 / $814,665.78 * 30 = 13.29 DSO.

Cloud-Moulds suggests that if the DSO is more than 60, meaning your average payment is posted 60 days or more after you’ve seen your patient, you should review your practice management and initiate some activities within your practice that will help you better track your revenue:

  • Bill out daily or at least weekly
  • Run your DSO on a monthly basis, consistently
  • Run your A/R reports at least every 20-30 days and clean up any outstanding claims
  • If you have a high lien A/R make a plan to follow up with attorneys on a quarterly basis
  • Have a dedicated person following up on unpaid claims
  • Do an annual A/R Review.

Nick Dealtry
March 20, 2018


History of cloud-based EHRs

Cloud computing is a relatively recent development. Although the concept of cloud computing, as a way to connect multiple users who could access the same programs, was introduced in the 1960s, true cloud computing began around the turn of the 21st century. Cloud-based, or web-based, electronic health records (EHRs) have likewise only been implemented for use by the independent physician within the past few years.

As recently as 2015, researchers who published their findings in the US National Library of Medicine National Institutes of Health stated that “Even though cloud computing in healthcare is of growing interest only few successful implementations yet exist” and that “many issues of data safety and security are still to be solved.” The researchers recognized that the use of the cloud in the medical field promises “advantages in dynamic resources like computing power or storage capacities, ubiquitous access to resources at anytime from any place, and high flexibility and scalability of resources.”

Today, those concerns of data safety and security in cloud-based EHRs have been addressed. HIPAA regulations have been adjusted to include in its privacy regulations the security of patients’ electronic protected health information (ePHI). Consequently, this type of data must be heavily safeguarded. Fortunately, cloud-based servers are initiating careful and tactical efforts (such as conducting risk analyses, encrypting data, etc.) in order to assure that a patient’s ePHI is kept safe and private.

In addition, because cloud-based systems are operated by external software-as-a-service (SAAS) providers, independent physicians utilizing these systems can be assured that they are always operating on up-to-date servers. This is because automatic updates exist within cloud-based EHR systems. Users then are likely to always be utilizing the most current version of the system allowing for the ease and capability of staying in compliance with federal security guidelines.

Current cloud-based EHRs, including solutions offered by Elation Health, provide savings on installation and maintenance both for the system and the IT department, automatic updates that allow for security compliance, seamless features that make it easy for practices to expand, and wide access for all users.

Roy Steiner
March 19, 2018


Reporting for MACRA in 2018

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law on April 16, 2015. According to the Centers for Medicare & Medicaid Services (CMS), MACRA “advances a forward-looking, coordinated framework for clinicians to successfully take part in the Quality Payment Program that rewards value and outcomes in one of two ways:”

  • Advanced Alternative Payment Models (Advanced APMs)
  • Merit-based Incentive Payment System (MIPS).

In November 2017, CMS submitted a final rule for the Quality Payment Program (QPP) created under MACRA. In the content of that document, CMS stated that the QPP program “emphasizes high-value care and patient outcomes while minimizing the burden on eligible clinicians. The Quality Payment Program is also designed to be flexible, transparent, and structured to improve over time with input from clinicians, patients, and other stakeholders.”

In 2018, according to CMS, there are approximately 622,000 eligible clinicians who will be required to report under MIPS. An additional 540,000 clinicians are “expected to fall below revised low-volume exemption thresholds set forth in the new rule, which exclude clinicians and groups receiving less than $90,000 in Medicare Part B reimbursement or treating fewer than 200 Part B beneficiaries.”

Independent physicians who have been challenged by reporting requirements or waiting for MACRA updates will now have to act quickly so they can be fully prepared to report for the full year in 2018. For those physicians who are uncertain of the scoring categories, Physicians Practice reports that Cost has now been added, although at a reduced percentage, for MIPS scoring in 2018. Those scoring categories include:

  • Quality (50 percent)
  • Advancing Care Information (25 percent)
  • Improvement Activities (15 percent)
  • Cost (10 percent)

Additional considerations for independent physicians reporting on MACRA in 2018 include bonus points for treating patients with complex conditions and for smaller practices that submit data on at least one performance category. Independent physicians are also eligible to join virtual groups to participate in MIPS in 2018.

Greg Miller
March 12, 2018


Value-based care and EHRs

The Office of the National Coordinator (ONC) for Health Information Technology (IT) has published a Health IT Playbook that includes pertinent information about value-based care. According to the publication, “Health care payments should encourage improved care delivery and ensure appropriate compensation for patient-centered care — including care coordination, integration, and prevention and wellness.”

The publication goes on to say that “All clinicians, payers, and other players in the health care system must make fundamental changes in their day-to-day operations to improve quality and reduce health care costs.” However, the progress away from fee-for-service and toward value-based care is slow and unsteady.

As of September 2017, a very small percentage of physicians were motivated by value-based care incentives. One of the challenges may be that value-based care is “paperwork heavy.” Independent physicians who use electronic health records (EHRs) in their practice have found a way to reduce their paperwork and streamline their practice’s operations.

EHRs enable an independent physician to provide that quality, value-based care that is so important to the patient as well as to potential financial incentives for the practice. Using the EHR solution to input a patient’s medical data and to coordinate with other physicians and healthcare facilities can help the independent physician spend more time speaking with and listening to the patient during the visit.

As the ONC Heath IT publication states, the value-based care concept means that “doctors and other clinicians can focus on coordinating care to ensure their patients, especially those with chronic conditions, get the right care at the right time — while avoiding medical errors and duplication.” EHRs enable all providers caring for a patient to provide input and to retrieve medical information about that patient, easily and securely, resulting in higher quality care for that patient.

At Elation Health, we are building a powerful technology-driven ecosystem that will become the homebase of every patient’s health, and eventually transform the delivery of healthcare itself. And that’s why our mission is a commitment to strengthen the relationship between patients and physicians, and to enable phenomenal, value-based care for everyone.

Tyler Comstock
February 9, 2018


EHRs and the opioid crisis

As the opioid crisis continues to grow in the US, healthcare professionals are exploring options for independent physicians to proactively work toward curtailing the use and abuse of the prescription drugs. Technology can play a significant role in helping to achieve the goal of reducing addiction numbers and stopping the opioid crisis in its tracks.

The use of Electronic Prescribing for Controlled Substances (EPCS), for example, has been introduced as a way to address these high rates of drug abuse across the country. By making prescriptions harder to forge or steal, it reduces the ease with which teens and other citizens can access prescription drugs.

Electronic health records (EHRs) are another promising technology tool that can be used to stem the growth of the opioid crisis in the US. A setting that can be included in the EHR default technology can restrict the amount of tablets an independent physician is able to prescribe at one time for an opioid prescription.

A study published by the Centers for Disease Control and Prevention (CDC) in March of 2017 was conducted of patients on opioid therapy to determine “data quantifying the transition from acute to chronic opioid use” that the researchers found lacking in current studies. The researchers found that “the rate of long-term use was relatively low (6.0% on opioids 1 year later) for persons with at least 1 day of opioid therapy, but increased to 13.5% for persons whose first episode of use was for ≥8 days and to 29.9% when the first episode of use was for ≥31 days.”

A separate study conducted by researchers at the University of Pennsylvania School of Medicine found that physicians in two Penn Medicine emergency departments prescribed fewer tablets initially when their EHR was set to default at 10 tablets per prescription. Initial prescriptions for the lower amount of tablets increased, while the “number of prescriptions written for 20 tablets decreased by almost 7 percent, and prescriptions for 11 to 19 tablets decreased by over 13 percent.”

The lower number of tablets in the initial prescription may help stem the frequency of long-term use and abuse, as found in the CDC study. Independent physicians can play a key role in contributing to a reduction in opioid addiction and abuse, at the prescribing level, with the help of EHRs.

Tyler Comstock
February 8, 2018


How to make your independent practice more patient-centered and patient-centric

As a general rule, most physicians launch an independent practice so they can help their patients. At some point, though, that focus can get lost amid the paperwork, rules and regulations, insurance requirements, and other non-patient related administrative burdens. As an independent physician, you can return your practice to the patient-centered and patient-centric organization you intended it to be.

Physicians Practice offers some helpful ideas:

During the visit, focus on the patient. Maintain eye contact. Using electronic health records (EHRs) will help you maintain accurate medical records and access them efficiently, but while the patient is in the room, keep your focus on the patient and have a meaningful discussion that keeps the patient at the center of your attention.

Stand up to insurance companies. Physicians Practice advises to “examine your practice and who is controlling it.” If insurance companies are making it more difficult for you to do what you know is in your patient’s best interest, drop those companies. In fact, many independent practices are forgoing insurance companies completely and forming Direct Primary Care (DPC) practices.

Take the time to communicate with your patients. Listen to their concerns and answer their questions. A patient-centric independent practice puts the patients first, even when you feel you are in crunch mode, time-wise.

Give your patients access to their records and to you. Quite often, patients think of questions after their visit. They may have forgotten instructions regarding medication or a follow-up care plan. They may also want to see their medical information online. EHRs give them that access, so your patients know they are at the center of your practice.

As an independent physician, do not lose sight of the fact that your patients should be the reason you practice. There are many tools to assist you with administrative tasks, but keep these points in mind as well throughout the day to make your practice more patient-centered and patient-centric.

Tyler Comstock
January 22, 2018


History of independent physicians

In the very early days of rural America, doctors often went to patients’ homes in a horse and buggy and took care of the entire family’s ailments and injuries. Doctors in the late 1700s and 1800s were generally not formally trained, but were expected to treat everything from a broken arm to contagious diseases. They probably learned their trade from the town doctor who was retiring and needed a replacement. Fees were direct pay and may have involved livestock or even baked goods.

These were the first independent physicians in the US. Many were dedicated and qualified, while some were considered “quacks.” By the mid-1800s, those physicians who were concerned with the path of their profession saw the need for formal training and regulation. In 1846, the American Medical Association (AMA) was formed and in 1900, the Journal of the American Medical Association (JAMA) was founded.

According to an American Academy of Family Physicians (AAFP) Foundation paper, by the turn of the 20th century, the AMA set objectives to:

  • Purify the profession from quackery
  • Establish an orthodox medical education based on natural science
  • Promote standards for public health (sanitation, food and drugs)
  • Standardize medical education

Subspecialties then began to be established, along with more formal education and tighter regulations. As providers began to align themselves with hospitals and other healthcare facilities, the number of truly independent physicians began to decline and is now less than half of all providers.

In 2016, an AMA study found that only 47.1% of physicians held ownership in their own medical practice. This number was down significantly from four years earlier, when 53.2% practiced independently. Many physicians cite burnout or financial considerations as their reasons for giving up their independent practice and seeking employment in a larger organization.

However, the independent physician is not close to being extinct. Autonomy and independence will continue to be important factors for this group of dedicated doctors and the independent physician is now and always will be a permanent fixture on the healthcare landscape.


Tyler Comstock
January 16, 2018


Tips for physicians considering entering into ACO agreement

The decision to join an Accountable Care Organization (ACO) can be challenging for independent physicians. Some providers might be skeptical as to whether joining such an organization might reap more rewards than restraints. For independent physicians, there are many considerations involved but there can also be many potential benefits.

Physicians who are considering entering into an ACO agreement might want to consider the following:

  • Independent physicians may qualify for the Medicare Shared Savings program as part of the ACO. Establishing strong partnerships with other physicians within the ACO and coordinating services can result in increased savings for all. A recent article in Referral MD advises, though, that “to reduce costs and increase savings, practices and physicians should carefully consider which healthcare providers they choose as partners.”
  • The independent physician’s “data will need to be more accessible, more accurate, and more appropriately used to align with the greater ACO value proposition.” The article, “Preparing for accountable care organizations: a physician primer,” points out that data will “become of paramount importance” for a physician joining an ACO.
  • Managing the necessary data is a more efficient process with an electronic health record (EHR) solution. Patient information is available with one click, during and after the patient visit. In addition, coordinating with other providers is less time consuming when collaborative takes place electronically rather than through faxes or a series of phone calls.
  • Independent physicians should “have a clear understanding of patient attribution, financial incentives, and quality metrics within any ACO agreement,” according to the Primer. Going into the agreement with a clear picture of responsibilities and ramifications will help ensure the ACO and the independent physician are successful.
  • Patient engagement and retention are enhanced in an ACO. According to Referral MD, providers “communicate more efficiently and tend to make better-informed decisions because of specific quality standards that determine the savings they receive,” resulting in higher quality care and patient satisfaction.

Nick Dealtry
January 9, 2018


How EPCS will grow in 2018

The US Department of Health and Human Services (HHS) reports that 116 people a day die from opioid-related drug overdoses. Prescription opioid painkillers account for at least half of these deaths. Technology can play a significant role in preventing such prescription abuse and, subsequently, in combatting the opioid epidemic that has become a national emergency.

Electronic Prescribing for Controlled Substances (EPCS) was introduced as a way to address the high rates of drug abuse across the country. By making prescriptions harder to forge or steal, EPCS reduces the ease with which teens and other citizens can access prescription drugs. The electronic prescriptions, referred to as eRx, allow physicians to create e-prescriptions that can be received and acted upon by pharmacies.

In 2017, six states – New York, Maine, Connecticut, Rhode Island, Virginia, and North Carolina –  mandated the use of EPCS. In 2018, that trend is expected to grow. Legislation has already been introduced in New Jersey, Massachusetts, Texas, Pennsylvania, and Illinois, with several additional states anticipated to follow suit.

Federal legislation was introduced in 2017, mandating the use of EPCS for Medicare Part D patients. More movement on the national level is also expected for 2018.

The use of EPCS in 2018 is expected to grow as an effective tool in the battle against opioid addiction. As HITConsultant points out, “technology now enables the delivery of prescriptions in a trusted, secure, compliant, and truly efficient manner.” Stemming the abuse of paper prescriptions is an important step toward combatting the opioid abuse epidemic.

Electronic health records (EHRs) that are certified for EPCS will also play a growing role in 2018. EHRs transmit information electronically, so that only a verified recipient, in this case the pharmacist, can access the information. EHRs certified for EPCS use a two-step authentication process to ensure that those using the system have the authority and the appropriate need to do so. Elation’s EHR solution provides EPCS capabilities for many of our independent physician customers.

Tyler Comstock
January 8, 2018


Why independent private practices will continue to be a permanent fixture

Contrary to popular belief, the private practice is not headed toward extinction. Though the numbers are down slightly, just under half of all physicians owned equity in their practice in 2016. Even with the added administrative burdens of regulations and reporting requirements, independent physicians are still focused on providing quality care and on developing productive relationships with their patients.

For many independent physicians, that autonomy is more important than the potentially higher income they might see as employees of larger healthcare facilities. Independent physicians are able to manage their practice to be sustainable while at the same time providing quality healthcare to their patients on a more personal level.

As recently reported in Medscape, the independent private practice is here to stay, as a permanent fixture on the healthcare landscape, mostly due to “emerging new business models, cost-saving technological advancements, and the tenacity of physicians determined to practice medicine on their own terms.”

Independent physicians are exploring a number of alternative practice models, including the direct primary care practice (DPC). Some smaller independent practices have also made the move, literally, to share office space and other resources in an effort to be more efficient with their financial investments.

Many independent physicians actually leave employment in a larger healthcare facility to launch their own practices. According to the Medscape article, “more than half (52%) of all self-employed doctors responding to Medscape’s 2014 Employed Doctors Report say they were previously employed.”

Technology tools such as electronic health records (EHRs) help independent physicians manage their patients’ medical information, their billing and scheduling records, and their communication with patients, adding to their opportunities for success.

Elation Health continues to support independent physicians with our EHR solution, fulfilling our mission to strengthen the relationship between patients and physicians, and enable phenomenal care for everyone.

Nick Dealtry
December 20, 2017