Driven by value-based care, independent small and solo practices are on the rise

After several years of decline in the number of independent practices in the US, a recent study has shown a recent increase. The study, conducted by Black Book Research, found that “independent and physician-led group practices began to rally back up to 72.0% in 2017.” Previously, the trend had been toward independent physicians moving to hospital employment or employment in a practice with only some ownership.

Doug Brown, Founder of Black Book Research, states that the recent trend is probably a result of population health and value-based care models “driving more coordinated, integrated and consumer-centric physician organizations.” Brown adds that “Physicians not affiliated with hospitals are recognizing there are long-term savings if they assume risk and manage population health in the same way as a hospital in an ACO.”

To that end, however, many independent physicians are hiring consultants to help them determine the requirements and benefits of joining an Accountable Care Organization (ACO). When asked about the move to value-based care and how it would affect their practice, many stated they have “no strategic plan activated for transforming population health management or value-based care solutions end-to-end to confront known deadlines because there are no internal experts identified.”

Very few of those physicians surveyed have begun value-based care software vendor selection activities. Of the 900 physician organizations that participated in the survey, “95% of group practice and large clinic Chief Information Officers state they do not have the information technology or staff in-house needed to transform value-based care end-to-end as their physician and or executive team envisions.”

Overall, the research indicates that while more physicians are choosing to remain or to become independent because of value-based care initiatives, they continue to need expert help in understanding how to benefit from the population health and value-based models.

Roy Steiner
June 29, 2018


Independent physicians seek EHR systems that meet their unique needs

Independent physicians know what they want – and they want more – from their electronic health record (EHR) systems, but many are underutilizing their EHR’s current features. These are the findings of a recent study conducted by Black Book Research that included larger practices with a dozen physicians and more, as well as smaller and solo practices.

According to the study, “93 percent of practices use the three basic EHR functionalities most often: data repository, order entry and results review.” Among those larger practices, with 12 or more physicians, 30 percent expect to replace their current system within the next three years.

The Black Book study found that a significant majority of independent physicians “are looking for cloud-based and mobile tools that offer on-demand data and visibility into financial performance, compliance tracking and quality goals” as well as “speech recognition capabilities and support for telehealth and virtual care.”

Even though independent physicians indicated in the poll that they want more out of their EHR, most of the smaller and solo practices are “still under-utilizing advanced features such as electronic messaging, clinical decision support and patient engagement tools.” In addition, those providers still see interoperability as a “sticking point.”

Independent physicians may need to ramp up their use of advanced technology, including cloud-based EHRs, as younger patients see those aspects of a medical practice as a growing need. A similar study of consumers, also conducted by Black Book, found that “a commanding 91 percent of patients younger than 50 said they prefer tech-savvy practices with advanced capabilities and connectivity.”

Smaller, independent practices will have to make that investment in EHR capabilities that will benefit their patients as well as their practice to continue to be successful. Elation Health is focused on helping those independent physicians by building a powerful technology-driven ecosystem that will become the home base of every patient’s health, and eventually transform the delivery of healthcare itself.

Nick Dealtry
May 29, 2018


What is a web-based EHR?

The choice of an electronic health record (EHR) solution can make a significant difference to an independent physician’s practice. The EHR is designed to ensure the physician has access to patients’ medical information, can collaborate with other physicians, and has the communication tools necessary to follow up with patients after the visit. The choice also involves deciding whether the independent practice will use a web-based EHR.

The web-based EHR is cloud-based, meaning it does not use an internal server. 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.

Cloud-based EHR systems actually solve many of the issues that independent physicians may be concerned about when choosing to adopt an EHR system. In server-based EHR systems, thousands of dollars are often spent to install and implement a server, hardware, and software. Additionally, regular maintenance and management from a local IT department is also needed. In contrast, web-based EHR systems are already established by a software as a service (SAAS) provider, meaning the expense of money and time diminishes dramatically.

As a recent article in the AJMC points out, “With cloud-based systems, physicians don’t have to worry about system meltdowns, natural disasters or weather patterns that can literally crash systems in a horrifying blink of the eye. Backup requirements, protocols and capabilities with traditional EHR/EMR systems are not always as secure nor provide safeguards. Patient data stored on the cloud will always be there, accessible from anywhere and at any time.”

Security concerns, particularly about patient confidentiality, are addressed by the cloud-based server’s careful and tactical efforts (such as conducting risk analyses, encrypting data, etc.) in order to assure that a patient’s medical data is kept safe and private. The 1996 Health Insurance Portability and Accountability Act (HIPAA) helped to insure and protect the confidentiality and security of healthcare information. Included in this “healthcare information” are patients’ electronic protected health information (ePHI). Consequently, this type of data must be heavily safeguarded.

The convenience of a web-based system manifests itself in the independent physician’s ability to access patient data from virtually anywhere. Cloud-based EHRs offer a range of advantages for independent physicians who would rather focus on patient care instead of having to worry about hardware and software issues.

Roy Steiner
May 22, 2018


The impact EHRs have on patient engagement and satisfaction

Patients want the option of being able to communicate with their independent physicians electronically. In a recent Black Book industry survey, 84 percent of those responding “asserted they are seeking the most technologically advanced and electronically communicative medical organizations available for their healthcare alternatives.” Most of those surveyed who were in the under-40 age group also stated their dissatisfaction with the current level of technology capabilities among their healthcare providers.

Doug Brown, managing partner of Black Book Research, says that “Healthcare consumers more frequently interact through electronic media in 2018, and while they value contact with their providers, they don’t have the patience for lacks in hospital interoperability, incorrect billing and access to scheduling and results.”

Patients under 40 who participated in the survey indicated that they wanted more electronic options for accessing medical records and even for accessing their healthcare options, often preferring technology-based choices such as telehealth. Brown adds “Involvement with healthcare consumers through technologies is proving to be a significant element of patient satisfaction.”

Electronic health records (EHRs) are key to communicating with patients, providing patients with access to their own medical records, and engaging those patients so that they become more participatory in their own healthcare. Face-to-face time is still important and effective for the independent physician, but technology options that enable electronic engagement before and after the visit will prove invaluable in keeping those patients engaged.

Interoperability, the ability for EHR systems to “talk” to each other is also becoming increasingly important for the independent physician. Interoperability provides the physician the ability to electronically share patient information between different EHR systems and healthcare providers, improving the ease with which doctors can provide care to their patients and patients can move in and out of different care facilities.

As technology advances, patient engagement and satisfaction depend more and more on the independent physician’s ability to communicate electronically and to take advantage of the advanced features of a top quality EHR system.


Tyler Comstock
May 8, 2018


Tips for retaining patients at your independent practice

An independent physician’s practice is much like any other business, in that it must attract and retain customers – in this case, patients – to remain financially viable. While attracting new patients is largely a matter of marketing and ensuring that the community knows about you and your services, retaining patients at your independent practice involves a slightly different set of activities.

Communication is key. Before, during, and after the visit, you and your staff should communicate with the patient in a manner that is customer-focused and informative. Be available to answer questions and to ensure the patient understands follow-up instructions.

Schedule the follow-up appointment. As the patient is checking out and is still in the office, schedule an appointment for the next well-check or to follow up on the current visit. Be proactive rather than relying on the patient to call back and schedule an appointment.

Emphasize prevention, regular visits, and checkups. Helping patients understand that “prevention is better than cure” can not only help you retain those patients but can also benefit the patients themselves. As one expert put it, “youngsters and healthy adults often don’t value this message (and) are reluctant to go for regular visits to their doctor.”

Use the latest technology to maintain patient data. Electronic health records (EHRs) enable you to track your patient’s medical history and input visit notes easily and seamlessly. Less time searching through paperwork means more time to spend with the patient.

Ensure the patient’s total experience at your independent practice is positive. From the initial phone call to the time the patient leaves the appointment, everything affects how that patient views your practice. Front office staff should be customer-focused, meaning pleasant and courteous. Wait times should be at a reasonable minimum. The visit with the independent physician should be informative and productive. And the check-out process should be easy and likewise customer-focused.

Retaining patients is crucial to the success of an independent physician’s practice. Everyone on the team can participate in making it happen. A bonus for the practice with satisfied, returning patients is that they will quite often share their experiences with friends and family, who may become new patients!

Roy Steiner
May 1, 2018


Tax-filing tips for independent physicians and practices

The new tax plan, passed at the end of 2017, does not impact taxes that will be filed this year for 2017 income. Most of the significant changes in the tax plan will take effect with 2018 income. However, there are some timeless tips that independent physicians should note, when filing tax returns for themselves and for their independent practices. Of course, it is always best to consult a professional to ensure the tax filing is legitimate, accurate, and appropriate for each individual physician and practice.

  • Making the maximum contribution allowed to an IRA may help reduce the amount of taxable income for an independent physician. The amount of the contribution and qualifications for deducting the contribution vary.
  • An independent practice is a small business. There are a number of business deductions that can help offset income. Equipment, travel expense, professional development costs, and other business-related expenses may be deductible.
  • The practice, as an established business, may be a pass-through entity if it is a sole proprietorship, partnership, LLC, or S-corp. As a pass-through, the business income is essentially the independent physician’s income.
  • Charitable deductions for 2017 can still make a difference for the independent physician. One financial advisor suggests that “most physicians forget that they can also donate securities from their taxable accounts.” This type of donation also enables independent physicians to potentially avoid capital gains taxes.
  • Investing in a 529 fund, a college fund for an independent physician’s children, may qualify the physician for a state tax break, depending on the state and other factors.

In 2018, some of the allowable tax deductions will change and the standard deduction on a tax return will increase. Many independent physicians who receive a paycheck from their practice will see more money in that check and, in fact, probably already have early in the year because of tax plan changes.

Planning throughout the year for possible tax deductions and liabilities will help offset the time and stress involved in gathering all the information at the end of each year for the tax preparer. Strategies planned consistently throughout the year may also help the independent physician see a healthier financial picture for the practice.

Tyler Comstock
April 10, 2018


What are common EHR features?

An electronic health record (EHR) provides the independent physician with a patient’s medical data that had been previously recorded on paper and stored in file folders. Of course, EHRs do much more than just provide a patient’s medical record. There are many common EHR features that benefit both the independent physician and the patient.

The office of Health Information Technology (Health IT) defines an EHR system as one that is “built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care. EHRs can:

  • Contain a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results
  • Allow access to evidence-based tools that providers can use to make decisions about a patient’s care
  • Automate and streamline provider workflow.

Easy access to digital information is a prime feature of an EHR solution. Independent physicians have the ability to input and review a patient’s information during the patient visit. The physician can then collaborate seamlessly with other providers to provide coordinated care. EHRs eliminate the need to request records from specialty providers, laboratories, or healthcare facilities, and then wait for those records to be faxed.

Additionally, EHRs provide the opportunity for patients to access their own medical information. Patient portals encourage patients to be more actively involved in their own healthcare, by reviewing their data and asking questions or clarifying instructions with their independent physician. Communication is another common EHR feature that enables both patient and physician to send messages electronically and securely.

EHRs also enable the independent physician to document visit notes, order lab tests, e-prescribe, and write referrals in any order, all from the same screen. With easy access to a patient’s medical history, the independent physician can holistically evaluate the patient population with a longitudinal record that trends vitals and lab values over time.

Most importantly, EHRs feature the ability to 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.

Nick Dealtry
March 27, 2018


What are the advantages of cloud-based EHRs for independent practices?

Electronic health records (EHRs) can improve the efficiency of an independent practice, enabling physicians and patients to access relevant medical information seamlessly. The independent physician is able to use EHRs to coordinate care for the patient as well as provide a communication tool for secure messages between the patient and physician. EHRs can be cloud-based or server-based. What are the advantages of cloud-based EHRs?

Essentially, the advantages for independent practices are focused on cost and convenience. The “financial outlay” for cloud-based EHRs is “is less than those associated with traditional EHR systems and their servers,” according to an article in the American Journal of Managed Care (AJMC). The article explains that “Initial outlay and systems set-up costs for a traditional system installation and implementation can include a number of expenditures for maintenance, software, updates, and licensing fees.”

Additionally, regular maintenance and management from a local IT department is needed. In contrast, cloud-based EHR systems are already established by a software-as-a-service (SaaS) provider, meaning the expense of money and time diminishes dramatically.

Security issues around the patient data are also minimized with a cloud-based EHR solution. As 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 convenience of a cloud-based system manifests itself in the independent physician’s ability to access patient data from virtually anywhere. AJMC further explains that the physician has the “capability of logging on with any device and anywhere an Internet connection is provided.  Collaboration, interoperability, and data-sharing are made easier, ensuring greater continuity of care.”

Technology changes rapidly; however, since cloud-based systems are operated by external SaaS providers, practices utilizing these systems can be assured that they are always operating on up-to-date servers. There is no need for installing updates manually, as is the case with server-based systems.

Cloud-based EHRs offer a range of advantages for independent physicians who would rather focus on patient care instead of having to worry about hardware and software issues.

Nick Dealtry
March 26, 2018


Strategies for communicating costs to patients

Healthcare costs are rising. More people are opting for higher deductible health insurance plans because they are, at least in the short term, more affordable. At the physician’s office, however, those patients who are met with requests for payments when they have not met their deductibles may experience “sticker shock,” particularly at the beginning of the plan year.

Ensuring that the independent physician and the practice’s office staff are able to communicate these costs to patients appropriately may become critical to the practice’s success. In today’s online world especially, patients who become frustrated with having to pay too much for healthcare tend to post their thoughts on review sites like Yelp and HealthGrades.

Helping patients understand their costs will help the independent physician with administrative tasks as well. A recent study published in the Annals of Internal Medicine found that “during the office day, physicians spent 27.0% of their total time on direct clinical face time with patients” with the rest of the time being spent on administrative duties. Freeing up some of that administrative time will enable the independent physician to spend more quality time with patients.

Communicating costs to patients can involve not only explaining deductibles, co-payments, and visit fees but also practice-related policies such as appointment no-show fees. If these policies are new, communication needs to happen immediately and frequently. The independent physician should take advantage of social media, email newsletters, the practice website, and other opportunities to get the word to existing and potentially new patients about fee-related policies.

The practice might also consider payment options, given the profusion of higher deductible plans among patients. Again, those payment options and the obligations associated with them should be clearly communicated at the time of the visit as well as through other channels such as social media, flyers in the office, and on the website.

Clear communication with patients, particularly regarding costs, can help the independent physician’s practice maintain positive, rewarding relationships with those patients.

Greg Miller
March 22, 2018


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