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Learn tips that help independent physicians grow successful practices.
The Centers for Medicare & Medicaid Services (CMS), in its zeal to reinforce the need for value-based care among all healthcare providers, may be slighting smaller independent practices, according to an article published in Health Affairs earlier this year. Performance data from CMS’s Merit-based Incentive Payment System (MIPS) shows that “small practices performed considerably worse in terms of Composite Performance Score (CPS) and financial penalties compared to their large practice counterparts.”
Health Affairs suggests a number of ways in which CMS can be more supportive of the many small practices participating in MIPS, so that all can be more profitable and more successful.
Medicare could implement additional incentives for quality reporting. Small, independent practices may not have the resources available to them for “information technology and other support systems to facilitate automatic reporting, perform manual reporting, or achieve the MIPS end-to-end quality reporting bonus.” As a result, they often are not able to adhere to CMS reporting requirements that are necessary to earn the bonus. Health Affairs suggests that possible solutions could include “scoring adjustments that apply only to small practices, such as a higher end-to-end reporting bonus amount (for small practices only) or increasing the bonus points per measure (i.e., earning more points for fewer measures reported for small practices only).”
CMS could modify MIPS rules to reduce quality reporting burden for small practices. Simplifying or reducing the 50 potential measures for independent physicians to report would significantly reduce the reporting burden on those smaller practices. In fact, “CMS has set a precedent in the Improvement Activities domain, where small practices receive double weighting for reporting relevant activities.”
CMS could also adapt approaches from other payment models to provide small practices with resources necessary to meet MIPS goals related to quality reporting or care redesign. Other models, including the Accountable Care Organization (ACO) Investment Model and the Comprehensive Primary Care Plus (CPC+) model offer alternatives for financial strategies and incentives.
Finally, the article suggests, “new fee-for-service billing codes implemented through the Physician Fee Schedule could be encouraged, or their use could even be incentivized as part of quality measures, among small practices in MIPS to offset costs from initial investments required to deliver care coordination services, improve quality, and/or contain costs.”
Greg Miller March 5, 2019Read
Convenience, reliability, and security are critical features of an electronic health record (EHR) system. For the independent physician, a cloud-based EHR can mean additional time spent with the patient and less time spent with maintenance and necessary updates to the system. Cloud-based EHRs are on the rise as more physicians find that these valuable features are important to their practice success and their ability to provide quality healthcare to their patients.
Globally, the healthcare cloud computing market is projected to reach $44.93 billion by 2023, from an estimated $19.46 billion in 2018. One of the major factors in this growth is the advantage of cloud usage. According to a report posted on PRNewswire, North America accounts for the largest share of this market, which can “primarily be attributed to the increasing adoption of EHRs among medical professionals.”
Independent physicians are recognizing the advantages of cloud-based EHRs in increasing numbers. With cloud-based EHRs, much of the administrative and maintenance burden is shifted to the Software as a Service (SAAS) provider, allowing physicians and their clinical staff to spend fewer resources on the installation and upkeep of the server and more time with the patient.
Cloud-based EHR systems actually solve many of the issues that practices may be worried about when choosing to adopt an EHR system. In server-based EHR systems, thousands of dollars can be spent in order to install and implement a server, hardware, and software. Additionally, regular maintenance and management from a local IT department is also needed.
Cloud-based EHR systems are already established by a SAAS provider, meaning the expense of money and time diminishes dramatically. Much of the configuring, security and software is handled by the SAAS provider, thus cancelling a significant bulk of the anticipated work. And because the server is created and managed by the provider, this means that the vendor is more likely to meet HIPAA patient information confidentiality standards. This makes future expansions of a practice an easy task rather than a complete overhaul of the system. The practice does not have to worry about the capacity of the servers or any additional licensing fees.
Technology tends to advance rapidly and incrementally. Regulatory requirements also require updates to EHR systems. Cloud-based EHRs are on the rise as more independent physicians recognize that they offer the convenience, reliability, and security they need for their practice to keep up with changes and to provide quality healthcare to their patients.
Tyler Comstock February 19, 2019Read
When deciding to purchase and implement a new electronic health record (EHR) solution for an independent practice, there are a number of considerations to review. A new EHR, as with any new technology, can be a significant change for the independent physician and clinical staff. With the right information at hand, however, choosing a new EHR for independent practices can be a smooth and beneficial process.
The first question to ask is where the practice needs a new EHR or a new EMR, or electronic medical record. Many healthcare professionals use the terms interchangeably, but they are actually slightly different. The office of Health Information Technology (IT) clarifies the differences between the terms:
Electronic medical records (EMRs) are digital versions of the paper charts in clinician offices, clinics, and hospitals. EMRs contain notes and information collected by and for the clinicians in that office, clinic, or hospital and are mostly used by providers for diagnosis and treatment.
Electronic health records (EHRs) are built to go beyond standard clinical data collected in a provider’s office and are inclusive of a broader view of a patient’s care. EHRs contain information from all the clinicians involved in a patient’s care and all authorized clinicians involved in a patient’s care can access the information to provide care to that patient.
Another question to ask when choosing a new EHR is whether the system enables independent physicians and their patients to communicate with each other using seamless, secure messaging. Elation’s EHR solution provides this capability and more, to support the physician-patient relationship.
A critical question for a new EHR for independent practices is whether the system will be cloud-based or server-based. The difference between the two is quite simple: with cloud-based EHR systems, data is stored on external servers and can be accessed with any device that has an internet connection, while server-based EHR systems store data within the practice on a personal server. With cloud-based EHRs, much of the implementation and maintenance burden is shifted to the Software as a Service (SAAS) provider, allowing the doctors and the practice to spend less resources on the installation and upkeep of the server and more time with the patient.
Finally, a new EHR for independent practices must come with vendor support and minimal training requirements. With Elation’s EHR solution, training takes less than one hour. Elation is simple and intuitive – proficiency comes quickly. In addition, Elation’s support of independent practices is available 24/7, so providers can focus on their patients without interruption.
Tyler Comstock February 6, 2019Read
The electronic health record (EHR) dates to the 1960s, when computer systems were first being developed and honed for practical use. Paper medical files continued to be used for some time (and are actually still being used in some medical practices today), but the computer revolution added significantly to the evolution of the medical record. So when was the EHR first implemented?
The earliest known predecessor to today’s EHR was the Problem-Oriented Medical Record (POMR) developed by Dr. Lawrence Weed “so that medical students and practitioners could function in a structured, rigorous way more like that of workers in the scientific community.”
As noted by the American Health Information Management Association (AHIMA), “From the moment technological advances moved data entry from punch cards to keyboards, and data display from printed results to video display terminals, innovative physician tinkerers around the country have seized on the opportunity to improve healthcare delivery.”
The AHIMA, in its HIM Body of Knowledge, identifies several of the earliest efforts to implement EHRs, known by various names in the 1960s and 1970s, including electronic medical records, computerized medical records, longitudinal patient records, and electronic charts. Those “more well-known efforts include:
Tyler Comstock January 28, 2019Read
The ideal electronic health records (EHRs) solution will enable physicians to operate more efficiently and effectively, providing higher quality care to their patients. Maintaining patient records on paper, kept in files on a shelf, was not only time-consuming but increased the possibility of errors when handwriting could not be deciphered or papers were lost. The EHR provides the opportunity to input patient data during the visit and to easily access it before and after the visit.
Physicians have been challenged by the transition to EHRs, in part because their system may not have been designed to truly make things easier for them. The ideal electronic health records (EHRs) solution, such as Elation’s Clinical First EHR, keeps in mind the specific needs of very busy doctors who want to spend more time caring for their patients than interacting with technology.
A white paper published recently by Stanford Medicine cites the results of an online survey conducted in March 2018, of 521 primary care physicians in the fields of Family Practice, General Practice, and Internal Medicine. Asked how EHRs affected them and their practice, almost three-fourths of the survey respondents said that “the first order of business should be improving the user interface of EHRs to enhance efficiency and reduce screen time.”
Suggestions ranged from shifting data entry to clinical support staff to including a “highly accurate voice recording technology that would act as a scribe during patient visits.” Additionally, almost half of the primary care physicians participating in the survey noted that ideal electronic health records will be “transformed into a powerful tool that helps with clinical care, predictive analysis to support disease diagnosis and prevention, and population health management.”
Interoperability was the top concern for the primary care physicians. The Stanford Medicine white paper cites “the need to make patient data available easily and readily to professionals from all parts of the health care system for the benefit of the patient.”
Elation Health understands that well-conceived EHRs will make things easier for doctors by enabling them to access patient data easily and securely, coordinating with other healthcare providers for the patient’s care. Elation’s EHR solution provides physicians the ability to spend less screen time and more face time with their patients, as they chart, e-prescribe, and order lab tests all from the same screen. The Cockpit View eliminates back-and-forth linear workflows, letting doctors click less and do more for their patients.
Tyler Comstock January 22, 2019Read
Tax laws are changing over the next few years. Some of those more significant changes have to do with eligible deductions for medical expenses. Independent physicians should be aware of the 2019 tax benefits from medical expenses, for themselves and for their patients.
The tax changes include an increase in the standard deduction as well as a lower threshold for medical expenses for those who do itemize. In the 2018 tax year, medical expenses that exceed 7.5 percent of a person’s gross income can be written off. However, with the 2019 tax year that number reverts back to 10 percent of gross income.
AARP reports that eligible medical expenses include:
According to AARP, Medicare beneficiaries spend an average of $5,680 on medical expenses each year. The current threshold of 7.5 percent will help those patients as they tend to have lower incomes. In fact, AARP states that 49 percent of those taking advantage of the medical expense deductions have earnings of less than $50,000 per year.
In other tax-related news, the House Ways and Means Committee introduced a tax package on December 10, 2018, that “includes a five-year moratorium on the medical device tax; a two-year delay for the so-called Cadillac tax on high-cost employer plans, which won’t expire until the end of 2021; a two-year delay of the health insurance tax; and a full repeal of the tax on indoor tanning,” according to Modern Healthcare. However, that tax package is not expected to pass in the Senate.
Tyler Comstock January 9, 2019Read
Although the percentage of physicians in independent practices has fluctuated in recent years, at least one doctor has decided to return to her roots as an independent physician after practicing for 30 years. Erica Swegler, M.D., a member of the AAFP Board of Directors, explains in an article recently published by AAFP why she is returning to a solo practice, where she started her career as a physician just after her residency.
So why return to independent practice? It’s not all about the money, obviously. Dr. Swegler cites the lower rates of burnout among independent physicians as one positive aspect of working in an independent practice. In fact, a recent survey of 235 health care professionals in 174 small independent primary care practices in New York City found their burnout rate to be only 13.5 percent.
Dr. Swegler enjoys the autonomy in her practice, in particular the ability to focus on her patients’ needs and not the needs of the organization. As she says, “I have the satisfaction of taking care of my patients by placing their needs first…. I can practice to the highest level of my license and ensure that my patients have only the right, appropriate care they need.”
Tyler Comstock December 14, 2018Read
Independent physicians must run an efficient practice, to be financially solvent and to provide quality healthcare to their patients. The right electronic health record (EHR) system can help do just that, but some providers may find that their EHR system is challenging or actually requires more of their time than they are able to give it. The right technology solutions offer an EHR for solo primary care physician practices that benefit both provider and patient.
Salvatore S. Volpe, MD, a New York-based solo primary care physician, spoke with Health Leaders in 2016, to offer tips for using an EHR for solo primary care physician practices in an efficient, effective manner. At the time, Volpe had been using an EHR for his practice for eight years. He also belongs to the board of directors of the New York eHealth Collaborative and serves as chair of the health information technology committee for his state medical society.
Volpe’s tips on optimizing an EHR for solo primary care physician practices include:
Take a team approach. Independent physicians with a small staff should involve that staff in the EHR process. Training each team member on the features of the EHR system can help the provider significantly when it comes time to input or retrieve patient information. Medical assistants and other clinical staff can take the time to pull up relevant screens and even add certain patient notes, so the provider has more time to spend with that patient during the visit.
Invest in prep time. Volpe advises that reviewing patient data, including test results, prior to the patient visit can better prepare the provider for the visit as well as reduce the time needed to review that information while the patient is in the room.
Ask for help. Independent physicians can ask for help within their practices, from their team members, as well as from the EHR provider. At Elation Health, we understand there will be questions about the EHR system. With our extraordinary 24/7 support, providers and their staff get the help they need from our team of dedicated user success specialists within 30 minutes or less – 365 days a year.
Tyler Comstock December 10, 2018Read
Patient data must be protected by independent physicians, whether that information is contained in paper files or in electronic health records (EHRs). However, it can be confusing to both patient and provider as to exactly what constitutes protected patient data. HIPAA, the Health Insurance Portability and Accountability Act, is a federal law that governs health-related transactions and procedures to protect patient health information and patient privacy.
What information is protected and who is responsible for protecting it?
The HIPAA law refers to “covered entities” as those responsible for protecting patient data. Health and Human Services (HHS) states that “every health care provider, regardless of size, who electronically transmits health information in connection with certain transactions, is a covered entity.” Further, HHS defines “health care providers” as all “providers of services (e.g., institutional providers such as hospitals) and providers of medical or health services (e.g., non-institutional providers such as physicians, dentists and other practitioners) as defined by Medicare, and any other person or organization that furnishes, bills, or is paid for health care.”
Protected health information (PHI) is essentially identifiable patient information. Anything that can identify the specific patient on paper, in an EHR, or when discussed verbally, is illegal for the independent physician to disclose without the patient’s explicit permission. HIPAA’s Privacy Rule “protects all ‘individually identifiable health information’ held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral.”
Specifically, the individually identifiable health information that is considered PHI includes information that identifies:
• the individual’s past, present or future physical or mental health or condition,
• the provision of health care to the individual, or
• the past, present, or future payment for the provision of health care to the individual.
Individually identifiable health information also includes many common identifiers such as the patient’s name, address, birth date, and Social Security Number that are illegal for the independent physician to disclose.
Tyler Comstock December 3, 2018Read
The independent physician plays a key role in a patient’s health, but the independent practice often runs on a tight profit margin. Providing quality, value-based care while maintaining financial stability can be challenging for some smaller practices. The Centers for Medicare & Medicaid Services (CMS) encourages and rewards the move toward value-based care, but reimbursement can sometimes put a small, independent practice in a bind while waiting for that pay for performance.
CMS has recognized the value in the independent practice and wants to encourage smaller practice to remain independent. In fact, recent studies have shown that “small, physician-owned practices, while providing a greater level of personalization and responsiveness to patient needs, have lower average cost per patient, fewer preventable hospital admissions, and lower readmission rates than larger, independent- and hospital-owned practices.”
Independent physicians have several strategies available to them for providing value-based care and participating in pay for performance plans. Value-based care generally requires time beyond the office visit to manage chronic conditions or to follow up on care plans. Independent physicians may find that they are spending additional time communicating with patients or with other providers. This time is typically not covered by traditional billing codes.
However, CMS recently added ongoing care codes to reimburse independent physicians for that extra time. For example, code 99487 is assigned for treating medically complex patients with an increased reimbursement rate of $93.67. Population health management can add to the efficiency of treating patients with complex or chronic conditions.
Another strategy for the independent physician is to join an Accountable Care Organization (ACO). While the physician retains independence, joining the ACO enables the practice to take advantage of the power of the group. Independent physicians in ACOs may be able to participate in Medicare’s Shared Savings Programs, in addition to enjoying cost savings and collaboration with other members of the group.
CMS also recently launched the Small, Underserved, and Rural Support initiative to “provide free, customized technical assistance to clinicians in small practices.” The program offers program level support and practice level support for practices of 15 or fewer physicians, with priority given to those practices located in a rural area, in designated health professional shortage areas (HPSAs), or in designated medically underserved areas (MUAs).
Tyler Comstock November 14, 2018Read