How many office staff members do independent practices need?

The independent physician has to balance the need to keep overhead manageable with the need to adequately staff the practice. Too few staff members and patients are not well served. Too many staff members and the practice faces excess expenses. There is no magic formula for how many staff members an independent practice needs, but there are guidelines and suggestions that can help in the calculation.

The first step, according to guidelines provided in an article published by the American Academy of Family Physicians (AAFP), is to compare their independent practice with industry benchmarks. Sources for available benchmarks include “the Medical Group Management Association (MGMA), Practice Support Resources (PSR), the American Medical Association (AMA) and the American Medical Group Association (AMGA), as well as local medical societies.” Benchmarks should address:

  1. The number of support staff per full-time-equivalent (FTE) physician
  2. The percentage of gross revenue spent on support staff salaries.

Another consideration when determining how many staff members an independent practice needs is to review the overall practice management style and structure. If an independent physician is organized and completes paperwork efficiently – fewer staff members might be sufficient to maintain patient records and update charts. If the practice employs advanced technology tools, such as an EHR, enabling the independent physician to access and update patient information electronically, that should also be included in the considerations.

Adequate staff members will be needed to support communication with patients, including checking in patients, answering patient questions on-site, and responding to patient telephone calls. If the independent practice collaborates with other providers or has satellite offices that require coordination of scheduling, additional staff members may be needed to ensure those services operate smoothly.

Factors that may also affect the numbers include the qualifications and ability level of each staff member. For example, a staff person who checks in patients may have the capabilities to perform other duties in the office. If the patient level is high, however, individual staff members may need to perform separate tasks.

There is no one answer to the question of how many staff members an independent practice may need. However, guidelines are available to ensure that staffing makes sense given the particular situation of each practice.

Dante Capozzola
July 7, 2017

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The importance of empathetic communication for independent physicians

Patients want to know their primary care physicians care about their well-being. Physicians want to be able to provide the highest quality care to their patients, especially with the current transition to value-based reimbursement. One method that has been proven effective in achieving all of these goals is empathetic communication.

What is empathetic communication? As Kasley Killam explains in Greater Good Magazine, “empathy in a clinical context is the physician’s ability to understand patients’ emotions, which can facilitate more accurate diagnoses and more caring treatment.” Empathy builds trust, which further strengthens the patient-physician relationship that is so important to quality healthcare. When a physician takes the time to listen to the patient’s concerns, it can make a difference in the level of patient outcomes.

An article in the Georgetown University Journal of Health Sciences notes interesting gender differences in physicians’ ability and practice when communicating empathetically. Published evidence shows that “female doctors are generally more empathic than male doctors when relating to their patients.” The journal article further explains that the “average duration of a female physician’s interview is ten minutes and forty-five seconds, compared to the seven minute and thirty-eight second average interview conducted by her male colleague.”

Communication is extremely important for the patient and the physician both during the visit and after the visit. When the physician has to spend excessive time on paperwork, there is less time for face-to-face conversation during the patient’s office visit. A tool such as EHR can provide increased patient data access so the physician can spend more time focused on listening to the patient, displaying empathetic communication skills, and less time searching through files for information.

After the visit, a patient may have questions or a physician may need to relay additional information to the patient. A communication tool that offers seamless, secure messaging for both patient and physician can also increase the empathy shown by the physician toward the patient’s concerns, thereby improving the quality of follow-up care.

Dante Capozzola
July 6, 2017

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

The Centers for Medicare & Medicaid Services (CMS) has deemed 2017 as the transitional year for independent physicians to comply with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). During 2017, there are a number of ways that independent practices can choose to participate in the program and remain compliant.

Reporting for the MACRA was officially kickstarted in January. The results of the reporting that begins in 2017 will be reflected in the payments that are issued beginning in 2019. This allows for the tracking of a composite performance score under which all physicians will be graded under MACRA.

The CMS Quality Payment Program, enacted by MACRA, enables independent providers to focus more on providing high quality care for their patients. The program offers two tracks for independent practices to choose from:

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

The MIPS track consolidates current fee-for-service Medicare programs (Meaningful Use, Physician Quality Reporting System, and Value-Based Payment Modifier) into a single program. When you choose the MIPS track, you also have the option to “Pick Your Pace” which, in the words of CMS, provides “an on-ramp to participating.”

Participating in MACRA in 2017

What are the options for independent practices to be able to participate in MACRA in 2017?

  • You can test the Quality Payment Program. As an independent provider, you simply have to submit some data from after January 1, 2017 to avoid the negative payment adjustment. This option exists to ease providers into greater participation in 2018 and 2019.
  • You can participate for part of the calendar year, for a reduced number of days. You will still qualify for a small payment if you submit data on how your practice is using technology and what you are doing to improve your quality of care. As a Clinical EHR participant, you can demonstrate that you are taking steps to improve your patient care while streamlining and optimizing your clinical workflow.
  • You can participate for the full calendar year. To take advantage of this option, you would have been ready to fully participate in the Quality Payment Program for a full calendar year as of January 1, 2017.
  • You can participate in an Advanced Alternative Payment Model in 2017. With this option, you are excluded from the MIPS reporting required in the other options and you are given the opportunity to qualify for a 5 percent annual bonus.

We want to help ensure that you are MACRA compliant in 2017. Contact us to learn more about your options!

Tyler Comstock
June 21, 2017

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

Independent physicians often receive lower reimbursements than their hospital-employed counterparts. The state of Vermont recognizes the situation and is working toward alleviating the issue with new legislation. The Vermont State Senate passed a bill in May 2017 that would level the playing field for independent physicians.

The independent private practice physician has long received smaller reimbursements from insurance companies than the physician employed by a hospital. For the past four years, the Vermont legislature has been trying to rectify the situation. In fact, in 2015 they ordered two of the state’s insurers to restructure their billing method to be more equitable. However, that resulted in very little change, over a long period of time.

The new bill, designed in part to keep independent private practice physicians from leaving the state, puts into place plans to “reduce pay disparities between independent physicians and academic medical center physicians by the ‘maximum achievable’ amount in the next three years.”

The pay parity verbiage was added to the original bill, known as H.29, which was originally written to address Medicare supplemental insurance issues. Hospitals and insurance companies, along with two Senate committee chairs, opposed the bill.

Why independent physicians should care

At Elation, we work to help every independent private practice physician succeed, both in terms of quality patient care and practice management. Particularly, as the healthcare industry shifts the focus to value-based care, being able to provide quality, coordinated care for each patient and have it be efficient and cost effective will become more important.

We realize that costs are high and inconsistent for an independent physician. We focus our efforts on small and solo practices, helping you optimize your practice through streamlined electronic records, interoperability, and collaborative health records.

Explore a sample chart to see how Elation’s EHR solutions can benefit your independent private practice.

Dante Capozzola
June 15, 2017

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