Independent physicians guide to 2020

Many of the changes that independent physicians can anticipate in 2020 are continuations of policy, regulations, and other challenges faced by both doctors and their patients over the past several years. Healthcare costs will continue to be a concern as will reimbursement and billing policies. A few newer issues of concern in 2020 include the shortage of quality healthcare workers and the patient’s increasing desire to have healthcare provided more conveniently, through the use of technology when possible.

Healthcare costs

Healthcare costs are a concern for patients and physicians every year. In 2020, however, patients will increasingly expect price transparency and about three-fourths of them will look up procedure costs online so they can be better informed about what to expect. Legislation is also being considered that would eliminate “surprise” billing so patients are not alarmed when they receive a bill after treatment. Education is key to help patients better understand and prepare for the costs of their care.

Prescription drug prices are also a major topic for 2020. Several major drug makers increased their list prices on 50 prices at the beginning of 2020. While the Lower Drug Costs Now Act passed through the House of Representatives, its survival in the Senate is seen as doubtful. Independent physicians need to be aware that their patients will be increasingly concerned about drug prices in 2020 and may need assistance with managing their prescriptions.

Value-based payments

For independent physicians who see Medicare patients, there are some changes for 2020. The Medicare Physician Fee Schedule conversion factor increases slightly, from $36.04 to $36.09. This will probably be the last significant increase in the conversion factor as there will be no inflation update in the next six years.

Independent physicians participating in Merit-based Incentive Payment System (MIPS) will face escalating penalties, particularly those who do not report any quality measures in 2020. It will be very important for independent physicians to focus on that quality reporting in 2020 so they can avoid the negative payment adjustment in 2022.

The value-based care movement has impacted payments from many private payers as well, as they see the value in paying for the quality of healthcare outcomes rather than for the quantity of office visits. Experts predict this will be a growing trend in 2020 and beyond.

 Learn more about how physicians can use the data in their electronic health records (EHRs)
to maximize reimbursement and to help patients stay healthy.

 Staffing

One of the challenges that independent physicians may face in 2020 is a shortage of qualified clinical staff. Healthcare professionals, such as nurses, are growing older and retiring and there are fewer younger people filling their positions. One estimate is that the US will need approximately one million more nurses in 2020. According to The American Nurses Association (ANA), there will be more registered nurse jobs available through 2022 than any other profession in the United States.

Convenience of care

Patients are increasingly looking for ways to save money and to use technology for their own convenience. Their healthcare is no exception. Telehealth, connecting with the independent physician via telephone or video calls, is growing in popularity, which creates challenges for the provider who operates in a traditional practice to improve access for patients.

Telehealth has also been recognized by the Centers for Medicare & Medicaid Services (CMS) as a viable alternative for seeing patients, especially younger patients and those who live in rural areas. Telehealth services are included in the 2020 Physician Fee Schedule and CMS is allowing Medicare Advantage beneficiaries to access additional telehealth benefits, starting in plan year 2020.

Anthony Pappas
February 4, 2020

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The development of electronic health records

The question of who invented electronic health records (EHRs) actually has many answers, but the development of EHRs can be traced back to the early 1960s. Traditionally, patient medical records had been kept on paper, in files. Those files were marked with various identifying information, often including the patient’s last name and an ID number, which may have contained part or all of the patient’s Social Security number. Those files were kept in cabinets or on shelves designed especially for medical records.

In the 1960s, Larry Weed, an American physician, researcher, educator, and entrepreneur, developed the Problem Oriented Medical Record. With this, Weed introduced the idea of electronically recording and maintaining patient data. Weed may be identified as the person who invented electronic health records themselves. In 1972, however, the first electronic medical record (EMR) system was developed by the Regenstrief Institute, according to the University of Scranton. Regenstrief’s EMR system was expensive and so was not attractive to physicians for use with their patients. The system was used, though, “by government hospitals and visionary institutions.”

As the personal computer became more common and more affordable, and as the Internet developed, EHR innovations also developed. Web-based EHRs started to emerge. In 1991, the Institute of Medicine (IOM), a division of the National Academies of Sciences, Engineering, and Medicine, led the way toward computer-based patient records by sponsoring studies and reports on the relatively new concept.

Throughout their development, EHRs have been identified by many names, including electronic medical records, computerized medical records, longitudinal patient records, and electronic charts. A Pearson Higher Ed publication states that “in 2003, the IOM chose the name electronic health records, or EHR, because ‘health’ means ‘a state of well-being.’”

The IOM subsequently established eight core functions that should be performed by an EHR, including:

  • Health information and data
  • Result management
  • Order management
  • Decision support
  • Electronic communication and connectivity
  • Patient support
  • Administrative processes and reporting
  • Reporting and population health

According to Pearson, these “eight core functions … became determining factors in the evolution of EHR, and the ability to perform these functions is the criteria by which EHRs are judged.”

Anthony Pappas
January 28, 2020

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What independent physicians need to know about opting out of Medicare

Many independent physicians may consider opting out of Medicare for a variety of reasons. Some cite the burden of reporting requirements while others struggle with the low reimbursement rates. There are considerable regulations involved in Medicare and independent practices may feel overwhelmed with keeping up with the reporting, particularly those participating in the Merit-based Incentive Payment System (MIPS).

The idea of opting out of Medicare, however, causes independent physicians to pause and consider whether it will work for their practices. While they may want to continue caring for elderly patients, they also recognize that Medicare requirements may actually be detrimental to their practices. Centers for Medicare & Medicaid Services (CMS) data shows that the number of independent physicians who have opted out of Medicare has steadily increased since 2013, when 130 physicians opted out. In 2016, CMS states that 7400 physicians opted out of Medicare for their practices.

One option for physicians who choose not to participate in Medicare and independent practices that want to remove themselves from the insurance middleman completely is to shift their operating model. Independent physicians who convert their practices to a direct care model typically do not accept any form of insurance, including Medicare. Instead, they charge a monthly membership fee which is typically adjusted according to the patient’s age.

A major drawback to opting out of Medicare is losing the practice’s elderly patients. Unless those patients are able to pay out of pocket, for example in the direct care model, they will typically search for another provider who will accept Medicare for their care.  In addition, if the decision turns out to not be a good one for the independent physician, the process of re-entering the Medicare world in a financially positive way can be lengthy.

The independent physician who is considering a Medicare opt-out and who currently cares for Medicare patients should carefully calculate whether losing those patients will work well for the long-term success of the practice. Those patients must be informed in writing of the physician’s decision. Other paperwork must be completed, including signed agreements with Medicare patients who decide to stay with the practice. Most importantly, the practice’s billing system must be transformed to ensure that no accidental Medicare billing occurs after the physician has officially opted out.

Anthony Pappas
January 21, 2020

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EHRs and their potential for independent physicians

Electronic health records (EHRs) hold great potential for independent physicians and for their patients. However, many EHR solutions do not offer the capabilities needed for providers to be able to realize that potential. More than just a place to store patient data, an EHR should be the solution that independent physicians and their patients need to stay well informed and to ensure positive healthcare outcomes.

Practice efficiency is certainly one of the potential results of using the right EHR system. In an EHR, patient data is entered and maintained in a manner that reduces errors and duplications. No longer are independent providers or their clinical staff attempting to read someone’s handwriting or searching for a piece of paper in a file folder.

Enhanced collaboration with other providers is another very real potential for independent physicians using EHRs. Providers with patients who see specialty providers, who need lab tests, or who experience stays in a healthcare facility are able to see notes from the other providers in real time, without having to wait for faxes or for records to be sent through the mail. When an EHR enables care coordination through collaboration, the independent physician can see and input updates so that all providers caring for that patient can take action based on the most up-to-date clinical information.

Patient access to their own healthcare record is also a potential benefit for independent physicians. As Michael Dowling, President and Chief Executive Officer of Northwell Health, writes in a recent Forbes article, “When patients know the details of their health and the risks they face, there’s a better chance that they’ll make an effort to change their lifestyle and take corrective action.” Patients who have access to a portal where they can view their health records, test results, and medications, are better equipped to participate in their plan of care.

Though not all EHRs are alike, those that offer these benefits, such as the Elation Clinical First EHR, hold significant potential for independent physicians. As Dowling argues, the potential for independent physicians in an EHR is “a user-friendly tool that integrates artificial intelligence and other emerging technologies that capture and share data that patients and clinicians need and want.”

Chris Anderson
January 14, 2020

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Independent practices and cybersecurity considerations

Maintaining secure patient data is a critical consideration for an independent practice. Patients want the reassurance that their medical information will not be shared with anyone who should not have access. Independent physicians using electronic health records (EHRs) must ensure that those records are not susceptible to security breaches, to reassure their patients as well as for a number of other cybersecurity considerations.

Smaller independent practices are particularly vulnerable to security breaches. Rather than react to threats, however, the more effective approaches are proactive, according to John Nye, vice president of cybersecurity strategy at an IT consulting firm who spoke on cybersecurity during a session at the Healthcare Information and Management Systems Society (HIMSS) Annual Conference in Las Vegas in 2018.

Independent physicians should look for potential areas within their technology systems, to identify and correct vulnerabilities. This could entail contracting with an outside IT firm or even hiring a hacker to determine if there might be breaches in the system. Certified ethical hackers can look at the independent practices systems and try to “break in,” reporting to the physician their findings and recommendations. As cybersecurity expert Nye said, “We have to start looking, and finding, these issues before the bad guys do.”

In addition to patient concerns, the independent physician has the responsibility to protect electronically transmitted patient data under the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was enacted as part of the American Recovery and Reinvestment Act of 2009. Subtitle D of the Act addresses the privacy and security concerns associated with the electronic transmission of health information, including associated penalties for violating patient data security rules.

The Department of Health and Human Services (DHHS) has also published guidance on what to do in case of a cybersecurity attack. The Office of Civil Rights (OCR) lists, in its Quick-Response Checklist, states that a HIPAA-covered entity:

  • Must execute its response and mitigation procedures and contingency plan
  • Should report the crime to other law enforcement agency
  • Should report all cyber threat indicators to federal and information-sharing and analysis organizations (ISAOs)
  • Must report the breach to OCR as soon as possible, but no later than 60 days after the discovery of a breach affecting 500 or more individuals.

Anthony Pappas
January 10, 2020

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How independent physicians are at the crux of value-based care

As front-line providers, independent physicians are well positioned to offer patients value-based care that supports the three-part aim of the Centers for Medicare & Medicaid Services (CMS): better care for individuals, better health for populations, and lower cost. Equipped with the technology to track and maintain patient data, independent physicians are able to provide true holistic care on a more personalized basis.

Shawn Morris, CEO of Privia Health, posits in a recent issue of Modern Healthcare that “Independent physicians and physician groups—relieved of some of the administrative burdens they face in the corporate environment—are empowered to deliver more personalized care experiences for patients and are a linchpin in the search for the quadruple aim: improved population health, better patient experience, better provider experience and reduced costs.”

Technology solutions such as electronic health records (EHRs) enable the independent physician to track patient data in real time and spot trouble areas within the patient population and for each individual patient before those areas become major issues. Independent physicians provide preventative care, ensuring that patients are properly immunized and vaccinated, for example, that could mean the difference in whether a patient may be susceptible to a catastrophic illness.

In particular, independent physicians can use EHRs to holistically evaluate their patient population with a longitudinal record that trends vitals and lab values over time. Providers can quickly identify patients who aren’t meeting goals based on custom care management protocols, Meaningful Use objectives, or specific document tags, and easily schedule a follow-up appointment to address any potential gaps in care. Direct patient engagement is a critical piece of value-based care as well, a piece that independent physicians are able to provide more readily than their employed counterparts may be.

As Morris continues in his article, “independent doctors are happier practitioners than their employed colleagues and less likely to burn out. Studies also show that physician-owned practices have significantly lower preventable hospital admissions. The bottom line is independent physicians are crucial to an effective healthcare marketplace.”

Lynley Norberg
December 9, 2019

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Making money decisions as an independent physician

The independent physician is typically focused on providing value-based care for patients and on running a financially successful practice. Money decisions that an independent physician must make include personal financial considerations that often are neglected, in deference to the need to care for patients and run an efficient practice.

A recent article in Medical Economics suggest several areas for the independent physician to pay attention to when making money decisions:

Student debt. The Association of American Medical Colleges has found that 75% of medical students carry debt related to college and medical school. The median debt for independent physicians is $200,000. Refinancing that debt could help the independent physician save money, depending on the type of loan involved.

Retirement planning. Even the youngest independent physician who may have just launched a practice should start thinking about retirement funds. Putting money into a 401k or 403b can be a smart strategy for preparing for retirement.

Children’s college funds. Independent physicians still paying their own college debts may be challenged with envisioning the need to pay for their children’s education. However, just as with retirement planning, the earlier the parent gets started, the more the child will have available when the time comes to go to college. State-sponsored 529 plans can be a good option for investing for the independent physician’s children’s college funds.

Life and disability insurance. Physicians in independent practices are not able to rely on employers to provide benefits such as life and disability insurance. They should consider investing in insurance policies that will provide coverage if they are not able to work and generate income as well as appropriate life insurance to provide for their families.

Estate planning. Money decisions that affect the independent physician’s family should be made as early as possible. Estate planning includes designating a power of attorney, writing a will, and possibly even establishing a trust.

A professional financial planner or investment advisor can help guide the independent physician in the necessary and appropriate money decisions that will affect the physician’s practice and family, throughout every stage of the independent physician’s career.

Lynley Norberg
November 1, 2019

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The status of independent physicians by state

The story of whether independent physicians are declining or rising is different in each state. A Physicians Foundation survey conducted in 2014 found that the highest number of independent physicians were located in Louisiana. According to the survey, 52% of the physicians in that state were practicing as independents. The lowest number of independent physicians was in North Dakota, where only 7% of physicians were in independent practices.

After Louisiana, the next top nine states were: Texas (49%), New Jersey (45%), Illinois (44%), Arkansas (43%), Hawaii (42%), Idaho (42%), Arizona (39%), Utah (38%), and Tennessee (38%). Ranking just above North Dakota, in the bottom ten of the list were Vermont (24%), Minnesota (23%), Massachusetts (23%), Alaska (19%), Indiana (19%), New Mexico (18%), New Hampshire (18%), South Dakota (17%), and Wisconsin (12%).

In 2018, Medscape ranked the “best” and “worst” states in which to practice, based on factors such as “physician compensation, burnout, malpractice, healthcare quality, access to health and rate of uninsured patients, … personal well-being, cost of living, higher education levels, median earnings, tax burden and unemployment.” In their study, Medscape determined the top five states to be:

  1.       North Dakota
  2.       Hawaii
  3.       Nebraska
  4.       Vermont
  5.       Iowa

Medscape determined the bottom five states to be:

  1.       West Virginia
  2.       Louisiana
  3.       Mississippi
  4.       Kentucky
  5.       New Mexico

In contrast, a research study reported by US News & World Report and based on factors included in the categories of “opportunity and competition” and “medical environment” found the ten best states for physicians to be: South Dakota, Nebraska, Idaho, Iowa, Minnesota, Wisconsin, Kansas, Montana, North Dakota, and Wyoming.

Lynley Norberg
October 17, 2019

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How to Run an Independent Medical Practice

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Explore all the details of running a practice by downloading our eBook: The Business of Medicine
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The role of the doctor in healthcare is changing. To ensure success, independent physicians must do more than just provide phenomenal care ­- they need to understand the business side of medicine too. The competing aims of running an independent medical practice and providing patient-centered care can feel overwhelming. While there’s a lot to cover – here’s a quick overview of the essentials of running an independent medical practice.

Tips and Tricks to Running an Independent Medical Practice

There are several ways that independent physicians can sharpen their practice management skills while maintaining their focus on their patients. Here are some recommendations to balance running a business and keeping your patients happy – all at once.

Using Technology

Before the widespread adoption of Electronic Health Records (EHRs), independent physicians would need to complete a file full of paperwork on a patient, review the information before the patient visit, and potentially wait for faxes of additional paperwork from specialty providers after the visit. Time was wasted on excessive documentation and delays in receiving information from other providers, which further increased the potential for errors and duplication – then along came the EHR.

EHRs enable physicians to easily input patient data and to have immediate access to other providers’ data on that patient. In addition, the EHR, often referred to as an EMR or electronic medical record, improves “patient safety by requiring computer-based physician orders that eliminate illegible handwriting and misinterpreted verbal orders,” according to the Harvard Business Review (HBR).

Diagnoses are more accurate, particularly for patients with chronic or complex conditions who require coordinated treatment by multiple physicians. EHRs enable those physicians to collaborate to ensure that duplications or errors are reduced and even eliminated when prescribing medications, ordering lab tests, and developing a detailed healthcare plan.

EHRs help physicians provide more accurate diagnoses while providing more collaborative care.

Finding the Right Team

As an independent physician, you have been trained and educated to treat patients. Your staff is essential to keeping your practice running smoothly. As shifting payment and business models place more demands on care coordination and patient engagement, staff plays an increasingly patient-facing role. The office staff at independent practices play a key role in ensuring that patients are happy and that you can give your attention to their medical needs.

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
  • Performing clinical tasks to supplement the physician encounter
  • Answering phone calls
  • Helping patients navigate their health record and their care plans
  • Scheduling appointments
  • Checking insurance eligibility
  • Intaking new patients
  • Auditing charts and other billing-related functions

With a capable team in your office, you can spend less time worrying about administrative details and more time focusing on patient care.

independent medical practice - team

When determining the number of office staff needed for independent practices, it is helpful to check industry benchmarks. It is also important for you to have an understanding of 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.

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 physician.

Engaging Patients and Coordinating Care

Patient engagement is an important part of an independent physician’s role in providing high- quality care. Patient engagement means more than having a conversation during a visit. If you are a primary care physician, it means quarterbacking the patient’s care, following up to ensure the patient is completing their care plan, 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.

Key steps to improving patient engagement and care coordination:

  • Continuing patient communication beyond the office visit
  • Utilizing the features of an EHR
  • Encouraging patient interactions at critical touchpoints
  • Understanding interoperability

Understanding Interoperability

For independent providers, providing coordinated care can be a huge challenge. When your patients see specialty providers, have lab tests, or receive services at other healthcare facilities, the primary care provider can be left in the dark. For high-quality, coordinated care, this information is essential in making the right care decisions for patients, and it’s all about interoperability.

Interoperability has become a huge healthcare buzzword. How does it make a difference in patient care?

HIMSS defines interoperability as “the ability of different information systems, devices or applications to connect, in a coordinated manner, within and across organizational boundaries to access, exchange and cooperatively use data amongst stakeholders, with the goal of optimizing the health of individuals and populations.”

independent medical practice - tech

The most important outcome of interoperability is ensuring the physician can use the information that is being shared. As an independent physician, you need to be able to interpret data quickly and easily to provide your patients with quality coordinated care.

Faxes, emails, and even phone calls provide ways to share patient information. However, digital interoperability, where electronic systems are in sync, is more elusive.

Unfortunately, the lack of investment in integration tools and interoperability from large health systems means that often, EHR data is siloed in hospital EHRs and can’t be integrated to ambulatory EHRs or easily acted upon by physicians or patients.

APIs, HL7 technologies, and other integration protocols are growing, however, and more healthcare IT companies are taking an open approach to interoperability. Application program interfaces (APIs) can be a big driver for toward a more interoperable patient record. APIs essentially enable software systems to access each other’s information and can allow all of the members of a care team across applications to access patient information, including crucial data that has been inputted by other providers the patient has seen for care.

Ensure Practice Success

Running an independent medical practice takes a lot of work but is extremely rewarding. By taking the time to review the business aspects of medicine you are already on the path to success. Understanding how to handle back-office tasks effectively, optimize workflows with technology, and find a good team will provide the backbone you need to focus on patient care.

To effectively run an independent practice and get paid, you also must understand which health policies impact you and determine what type of practice model you want to implement.

For more information on these components of running an independent medical practice download our eBook: The Business of Medicine.
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Lynley Norberg
October 7, 2019

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The Business Side of Medicine: Everything You Need to Know

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The role of the physician within the business side of medicine is rapidly evolving. The complexity of treating patients and running a medical practice has increased. Keeping pace with technology adoption, policy changes, and emerging new payment models highlight the need to focus on effective operations in a medical practice. Balancing the art, science, and business side of medicine has become the new normal for any physician, whether you run your own practice or work for a hospital.

Many med school grads want to open their own practices – but don’t know where to begin. Here’s a quick overview of everything you need to know to get started.

Understanding Healthcare Today

Healthcare has changed significantly over the last few years and therefore, so has the business side of medicine. Previously, most doctors operated under a fee-for-service (FFS) model where they would perform services and then receive payment. Now, policymakers are shifting away from the FFS model towards a value-based care approach, where physicians are paid based on patient health outcomes.

Value-based care focuses on the quality of patient care rather than the number of patients seen. Its goal is to provide better care for individuals and to improve population health while lowering costs.

Value-Based Care is Backed by Healthcare Policies

The implementation of value-based care lies in a variety of health policies. It impacts how physicians work and get paid more than ever before. Below is a list of health policies that impact independent practices the most:

New Practice Models

As a result of these healthcare policies and shifts in medicine, new practices models are emerging:

  • Accountable Care Organizations (ACOs): These organizations split the cost of healthcare between doctors, hospitals, and other healthcare providers. These groups come together voluntarily to provide coordinated, high-quality care for Medicare patients.
  • Independent Physician Associations (IPAs): These associations allow providers to remain independent while enjoying the benefits of being part of a larger business entity. IPAs help independent physicians’ contract with third parties to pursue business ventures and reduce overhead costs.

Independent Practices

State of Independent Care

Despite what the media reports, not all private practices are becoming victim to healthcare consolidation. Just under half of all physicians owned their practices in 2016, which is only slightly lower than in previous years. These practices are focused on providing high-quality care and building strong relationships with their patients, even with new administrative burdens.

business side of medicine - care

Benefits

Healthcare is personal and intimate. Patients trust doctors to provide a very important service and staying independent allows physicians to spend more time with each patient. They also have additional freedoms like:

  • The ability to work within all types of health systems
  • The ability to offer a variety of treatment options
  • The ability to refer patients to any other specialist provider

The network that is created by independent physicians provides patients with a huge range of health professionals to select from for whatever they need – instead of being limited to a single corporation. This means that patients can always get the best care possible.

Recent studies reaffirm the idea that independent practices provide the most cost-effective and high-quality care.

Running an Independent Practice

There are a lot of components to consider when it comes to running an independent practice. Here are a few tips and tricks to help you keep things going smoothly:

  • Utilize technology: Finding the right tools to support your practice is critical to long-term success. Specifically, an electronic health record (EHR) system can streamline physician workflows and ultimately give doctors more face-to-face time with patients, instead of screen-time filling out notes and paperwork.
  • Find personable staff: The right team keeps things running smoothly and is the first impression of your practice. Make sure your team is trained in necessary medical office tasks and customer service to provide everything patients need before seeing the doctor.
  • Encourage patient engagement: Engaging with patients is an important component of providing high-quality care and is more than just conversions in the office. Engagement includes supporting the patient with their care plan outside of the office from following up on progress to communicating test results.

Run a Thriving Independent Practice

With the right tools and team plus an understanding of the business side of medicine, you are set on the right path towards a thriving career as an independent physician. Taking the time to review the administrative principles will allow you to focus on providing exceptional patient care in the future.

At Elation, we understand how running a successful practice while providing patient-centered care can feel overwhelming. We’re dedicated to developing resources and tools to make the long-term success of your practice feel manageable while providing phenomenal patient care.

For more details on how to run a successful independent practice download the complete eBook, The Business of Medicine.
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Lynley Norberg
September 30, 2019

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