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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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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Starting a Direct Primary Care Practice: A Quick Overview

starting a direct primary care practice - direct primary care - header

Opening a medical practice, although challenging, is very rewarding for many physicians. Lots of new doctors are turning toward a direct care model for their practices. It offers a better work-life balance, reduced practice overhead, and higher per-patient revenue. In this model, providers contract directly with patients to provide care — instead of today’s traditional method of working through insurance providers. It gives physicians more control within their practices and it provides patients with better care.

The direct primary care model provides doctors with a better work-life balance, reduced practice overhead, and higher per-patient revenue.

Want to start your own direct primary care practice?

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Here’s a list of everything you need to do when starting a direct primary care practice:

  1. Find an office
  2. Staff up
  3. Determine your pricing
  4. Select an EHR
  5. Market your practice
  6. Optimize for success

It may sound like a lot of steps, but getting started on the right foot will put you on a path to success. This post will offer you a quick overview of all of these steps — if you’re looking for a more detailed guide, download our complete Direct Care Playbook.

Steps to Starting a Direct Primary Care Practice

1.     Find an Office

There are many things to consider when finding your office space. You should begin by determining your budget to whittle down the list of potential spaces. Keep in mind that direct care practices often have a smaller number of patients, so you can probably get by with a smaller office than you think. You must also consider location, as this will have an impact on your ability to get and retain patients.

Direct primary care practices tend to be a little smaller than standard primary care practices — keep this in mind when determining how much space you will need for your office.

2.     Hire Staff

Once you have an office secured, you’re going to need people to work in it. Some doctors operate direct care practices with no staff, but most people need a little bit of help to get administrative tasks done.

Many doctors find that a visionary office manager is one of the key players on their team. Beyond that, the number of additional staff members is really up to you. It’s important to find people with the right skills for your practice. We recommend reaching out to your existing network to find people who you can recruit to work in your office. If you’re relocating and no longer have a local network, there are also plenty of professional firms that can assist you with this process.

A welcoming presence and great communication skills are two things you will want in all of your staff members.

3.     Establish Pricing

Determining per-patient pricing is a key step in setting up your practice. After all, this can be the difference between a thriving, profitable practice and one struggling to stay afloat. Direct care practices use membership fees on an individual or family basis that are determined by age, geography, and patient demographics. Of course, these numbers should be determined by working backward from desired salary and fixed expenses. We recommend calculating it as follows:

Pricing Calculation Baseline

As a starting baseline, you can assume 300–500 patients per physician as an average panel size. Using this formula will give you a break-even point. Then you can determine what you want your take-home to be and use that to decide the final pricing model for your practice.

4.     Select an EHR

There are numerous technology tools that you will need in your practice, but your EHR is the most important one. You will be working with this tool every day, so you want it to be easy to use and not get in the way of your patient interactions. Here are some questions you should consider to find the right solution:

  • Will this system allow me to document without compromising patient-physician interactions?
  • Is there a focus on care quality rather than reimbursements?
  • Can I document visits without any mandatory billing and quality reporting workflows?
  • Does this platform have integrated practice management tools?
  • Can I leverage patient engagement features?

The right EHR will help you optimize and improve practice management without interrupting your workflow.

5.     Market Your Practice

Now that back-office operations are taken care of, you need patients. We find that the most successful marketing strategy for direct primary care physicians is word of mouth. It’s important that you help educate your patients on the benefits of direct primary care, so they can act as ambassadors for your practice. If you want to formalize this process, you can also create a patient referral program that incentivizes new referrals.

In addition, you should use online methods to grow your practice. Create a website that makes it easy for patients to find you and has information on the services you provide. Once your website is built, you will need to optimize it for search engines, a process called search engine optimization (SEO). This will improve the chances of your website showing up when your future patients search for specific terms.

Additional marketing tactics include:

  • Social media
  • Printed brochures / flyers
  • Sponsorships / media outreach / advertising
  • Physician listing websites

Word-of-mouth marketing is the best way to get new patients and grow your practice.

Legal Considerations

Medical businesses have legal needs outside the scope of a physician’s training. Utilizing legal help and resources can help your practice avoid serious problems down the line. As part of starting a direct primary care practice, you need to:

  • Find a lawyer with experience in direct care models and establish a schedule or scope of work to determine a budget in advance.
  • Purchase malpractice insurance to protect yourself and your practice against potentially damaging lawsuits.
  • Research direct care policies to understand what is required of you at both state and federal levels.

6.     Optimize for Success

Once your practice is up and running, you must continue to optimize for success. Setting goals based on practice metrics will allow you to evaluate and determine your progress. Some key performance metrics are:

  • Average patient encounter time
  • Number of visits per patient per month
  • Average time to an appointment
  • Patient wait times
  • Number of patient visits per day
  • Number of patients per panel

Establish your practice goals and then revisit them regularly to review your progress.

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Lynley Norberg
September 23, 2019

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Alternative Payment Models for Independent Primary Care Physicians

This is a three-part series on the critical components you must address to maintain a thriving independent practice. Part 1 reviews the importance of embracing your patients, and part 2 explains how technology can support you.


Run a thriving primary care practice.

Get all three parts plus additional bonus material in our eBook.
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While embracing your patients and utilizing technology are important components of running a practice, financial stability cannot be ignored. Many independent primary care physicians have turned to alternative payment models to provide the funds they need to keep things running smoothly. Here’s a quick review of available alternative payment models as well as an alternative practice model.

Exploring Alternative Payment Models

Value-Based Care

The Centers for Medicare & Medicaid Services (CMS) defines value-based care as those programs that “reward health care providers with incentive payments for the quality of care they give to people with Medicare.” CMS began emphasizing value-based, quality health care over the quantity of provider visits in 2008. Since then, programs like MACRA and CPC+ have set forth reporting requirements and reimbursement payments.

We think a better definition of value-based care is where your practice is responsible and accordingly compensated for the population health of both publicly and privately insured patients. When done right, it can be a great way to improve the financial performance of your practice.

Value-based care provides payment bonuses to doctors who provide high-quality care for Medicare patients.

MACRA / QPP

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the Medicare Sustainable Growth Rate and replaces it with a new program known as the Quality Payment Program (QPP). Beginning on January 1, 2017, qualified providers now participate in one of two tracks: either Advanced Alternative Payment Models (Advanced APMs) or the Merit-Based Incentive Payment Program System (MIPS). Bonuses for participating in MIPS or APMs can be significant.

MIPS Advanced APMs
  • Payment track for ~95% of physicians
  • Payment track for ~5% of physicians
  • Replaces Meaningful Use (MU), PQRS, and Value-based Payment Modifier (VM)
  • Exempt from MIPS incentives and penalties
  • Adjustments to Medicare payments based on performance, varying by program year:
    • 2019: +/- 4%
    • 2020: +/- 5%
    • 2021: +/- 7%
    • 2022: +/- 9%
  • 5% annual payment bonus between 2019 and 2024
  • Additional incentive from $500 million pool to provide positive adjustments
  • Multiple payment structures

The right technology solutions, like Elation, enable practices to achieve success with quality programs like MACRA by committing to the health IT requirements needed to support practices.

If a practice invests in technology that is built around making reporting and participation easy, physicians can save time and painlessly receive the financial incentives from these programs. Elation’s platform gets at the heart of care coordination and reporting at the point of care. More specifically, the EHR’s built-in quality measures dashboard makes it easy to track your progress on quality measures. At the same time, Elation provides clinical decision support and reminders at the point of care. Both features, along with 24/7 support to answer any MACRA-related question, enable and empower independent physicians to take advantage of MACRA while providing phenomenal care.

Primary Care First

Primary Care First (PCF) is an exciting initiative announced by CMS in 2019 that begins in 2020. PCF will offer providers a simple “flat stream of revenue” for each patient. When a patient stays healthy and out of the hospital, the practice will receive a bonus. But if a patient ends up sicker than expected, the practice will bear responsibility for the extra spending up to a certain share of its revenue.

Primary Care First provides a “flat stream of revenue” for each patient and gives doctors bonuses if they keep patients out of the hospital.

PCF is geared toward smaller primary care practices that are centered around comprehensive care management and coordination for Medicare beneficiaries and high-risk, seriously ill patients.

  • Physicians need a minimum of 125 Medicare beneficiaries to qualify for participation.
  • Providers are incentivized for keeping patients out of hospitals (i.e., performance is measured against hospital utilization).
  • There’s a 50 percent potential upside and 10 percent potential downside. So, doctors who earn $200,000 today could earn up to $300,000, depending on their ability to keep patients healthier.
  • Must be using a 2015 CEHRT platform with API data exchange capabilities and a connection to a regional Health Information Exchange (HIE) to facilitate care coordination. (Such capabilities are provided by Elation EMR.)

Direct Care

Direct care is a medical practice model rather than an alternative payment model created by CMS — but because it offers another financial alternative for practices, we felt it made sense to include it with APMs.

Direct care is a medical practice model where providers contract directly with patients. For almost all of America’s history, Americans paid their providers directly for care. It was only in the 20th century that health insurance outpaced out-of-pocket pay as the primary revenue source for medical practices. But since the turn of the 21st century, direct care has made a resurgence.

In 2005, there were fewer than 150 physicians practicing in direct primary care, concierge, and other direct care models. This number grew five times in the next five years, to 756 in 2010, and then even more rapidly to an estimated 6,500 direct-care physicians across the country by the end of 2015.

Download the complete Direct Care Playbook

For physicians, adopting a direct-care model can improve work-life balance, reduce practice overhead, bring higher per-patient revenues, and maintain physician autonomy.

For patients, direct care can mean a greater degree of access to, and time with, physicians. Improved communication and more regular, engaged care lead to fewer unnecessary tests, less frequent hospital visits, and lower total cost of care.

Although not a CMS directed payment model, this model can help independent practices stabilize their finances to help them remain independent.

Alternative Payment Models Give You Financial Freedom

Alternative payment models are just one of the factors that allow independent primary care physicians to have thriving practices. New payment models and changing reimbursement rates provide the financial stability you need. Plus, combining these new payment models with the right technology and optimized practice schedules will help you have a thriving practice in no time.

Explore all the critical components of running a successful independent practice

Download our free 12-page eBook
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Lynley Norberg
September 16, 2019

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Primary Care EHR: Finding the Right Tools for an Independent Primary Care Physician

This is a three-part series on the critical components you must address to maintain a thriving independent practice. Part 1 explains how you must embrace your patients, and part 3 reviews alternative payment models.


Run a thriving primary care practice.

Get all three parts plus additional bonus material in our eBook.
Download Now

Independent primary care physicians across the US are thriving, despite what media outlets claim. How is this possible when it seems like every day you hear of another independent doctor getting gobbled up by a larger practice? Thriving practices are using newly architected models that focus on optimizing practice processes to provide better patient care more sustainably. Specifically, practices are using new tools in order to reduce administrative burden so they can focus on patients.

Embrace Updated Technology

The promise of technology changing practices instead of becoming another burden has been heard in medicine many times before. But in reality, you and your colleagues are unlikely to flourish without adopting effective tools that automate and streamline practice management. Reporting and administrative requirements have increased, and unless you’re running a truly cash-only practice, they’re bound to increase even more.

There are only three ways to handle this administrative burden:

  • Staff up
  • Do it yourself
  • Automate and delegate to third parties

The only sustainable approach is the third. In today’s economy, if something can be automated, it will be. And those who stubbornly stick to old methods will find themselves uncompetitive.

  • Every staff member on the payroll drives up your fixed costs, as well as the number of patients you have to see every week just to break even. In an independent practice, you have only so much control over your revenue numbers. Take control of your fixed expenses.
  • Doing it yourself may seem like a good idea for a while, but this is exactly the kind of repetitive work that results in burnout, broken marriages, and physician despair.

You’ve probably been burned before by failed expectations around EHRs, practice management software, and billing…but the reality is that you will need to try again.

Find the Right Primary Care EHR

If you adopted an EHR or billing software during the gold rush and find yourself still struggling with it on a weekly or daily basis, it’s time to dump it. You and your staff spend your entire day working within your EHR. You should love it, not loathe it or merely tolerate it.

It’s easy to get lost in feature comparison charts, but checklists don’t capture the day-to-day reality of using a given piece of software.

Fortunately, evaluating your current clinical software is surprisingly simple. Does it do everything that you need it to do, and do you and your staff enjoy using it?

If the answer is “no,” then get rid of it.

The days of hating EHRs are over. There’s good, affordable software that will enhance and support your clinical practice.

You wouldn’t tolerate a stethoscope that barely functions, needs constant maintenance, and looks hideous. Don’t put up with it from your software.

See what a thoughtfully crafted EHR looks like.

Technology Is Just One Part of the Puzzle

Of course, the right primary care EHR is just one part of the puzzle to running a thriving independent practice. The right platform will help you optimize across your practice so you can remain financially sustainable while giving patients the time they deserve.

Want to learn about all the components of running a strong independent primary care practice?

Download our free 12-page eBook
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Lynley Norberg
September 9, 2019

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Improving Doctor-Patient Relationships as an Independent Primary Care Physician

This is a three-part series on the critical components you must address to maintain a thriving independent practice. Part 2 explains how technology can support you, and part 3 reviews alternative payment models.


Run a thriving primary care practice.

Get all three parts plus additional bonus material in our eBook.
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Many independent primary care physicians are feeling pressured to join larger medical groups or work longer and harder to keep their independent practices. But many other independent primary care physicians across the US are flourishing by re-architecting traditional practice structures. These new patient-centric practice models are improving doctor-patient relationships and allowing doctors to focus their attention on what really matters.

Improving Doctor-Patient Relationships

Embrace Your Patients

Every patient and physician satisfaction survey shows that the single most important aspect of the practice of primary care is the relationship between physicians and their patients. Yet quality time and interaction are often the first things sacrificed in the name of “efficiency.”

If you feel that you’re unable to spend as much time with your patients as they deserve, stop everything and concentrate on that first. Patient care is why you got into medicine in the first place. It has to be non-negotiable. We’ll discuss how you’re going to “pay” for this later, in part 2, with other tasks that can be automated, delegated, or just plain avoided. But for now, figure out how much time you have and how much time your patients need. Build your staffing and financial plan around that, rather than the other way around.

Design your schedule so you can focus more on your patients. This is the one thing you can’t and don’t want to automate or delegate.

The Road to Chaos Was Paved with Well-Intentioned Incentives

A significant percentage of the maligned paradigms faced by independent primary care physicians today were accidentally introduced by well-meaning public and private reforms such as meaningful use, electronic reporting, payor reforms, quality reporting, etc. While all of these reforms had good intentions, in practice, they have produced massive problems for primary care physicians.

In reality, the needed tools, underlying infrastructure, and physicians themselves were simply not ready when these changes were forced onto the market. The technology to make all of this run smoothly was theoretically possible but not yet practical. The fine-tuning and behind-the-scenes logistics just weren’t there.

This first gold rush of EHRs was driven by VCs, IT people, and government spec sheets — not clinicians. As a result, a mercantilist philosophy took hold at many companies, with market share trumping quality concerns.

Initial EHR design was driven by VCs, IT people, and government spec sheets — not doctors.

Most EHRs were poor substitutes for day-to-day charting, much less the digital heart of the practice that doctors needed them to be. Doctors have been slow to recover from their disappointment at these early attempts to digitalize medicine. However, with the right tools and approach, physicians can now leverage digital tools to elevate their patient care, quality of life, and financial performance.

The result is an EHR that isn’t optimal to doctor workflows — bogging them down with extra work that takes them away from their patients.

Start with Your EHR

A robust EHR solution, like Elation Health, will provide the tools you need to improve practice management. Optimized practice management processes mean you spend less time completing admin tasks, submitting labs, and sending referrals, so you have more time to spend with patients. Improving doctor-patient relationships is just one piece of the puzzle — download our complete eBook to explore how you can flourish as an independent primary care physician.

Interested in exploring the details of independent primary care?

Download our free 12-page eBook
Download Now

Lynley Norberg
September 2, 2019

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