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.


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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.

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Lynley Norberg
September 2, 2019

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Independent Primary Care Physician: How to Flourish Independently

independent primary care physicians - header

Mainstream media is flooded with stories about physician burnout, doctors giving up medicine, and practices being gobbled up by unwanted acquisitions. Independent physicians feel that their choices have boiled down to:

  • Working more hours
  • Seeing more patients (while spending less time with each)
  • Cutting down their compensation
  • Giving up their practices

Some new doctors even view becoming an independent primary care physician as a dead-end and immediately seek employment with hospitals, large groups, or the government.

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However, this is a false narrative built by the media. The truth is that independent primary care physicians are flourishing across the country with private primary care practices that provide outstanding care, nurture patient relationships, and are financially stable. These practices have re-architected traditional models in order to succeed. Here’s how you can do it too.

Independent primary care physicians are thriving across the US — you just need to focus on the right things to remain successful.

How to Take Control of Your Practice as an Independent Primary Care Physician

Focus on Your Patients

The single most important aspect of the practice of primary care is the relationship between the physician and their patients. Unfortunately, quality patient-doctor interactions are often one of the first things sacrificed in the name of “efficiency.”

Spending time with patients should be a top priority, especially since taking care of patients is why you got into medicine in the first place. Concentrate on spending as much time with your patients as they deserve. It may feel impossible, but we’ll discuss how you’re going to “pay” for this later. As a first task, figure out how much time you have and how much time your patients need. Build your staffing and financial plans around that, rather than the other way around.

Design your schedule so you can focus more on your patients.

Utilize Technology

To handle the demands of your independent practice, you need effective tools that automate and streamline practice management. As reporting and administrative requirements continue to increase, this is more important than ever. The only way you can handle this increased burden is to staff up, handle it yourself, or automate and delegate to third parties.

In reality, automating and delegating tasks with advanced technology is the only sustainable solution to helping your practice thrive.

While you may have been burned before by EHRs, the latest platforms have the solutions required to optimize your practice management. If you’re struggling with an EHR that you adopted during the mad gold rush to digitize practices — it’s time to ditch it. You and your staff spend all day working within your EHR; you should love it, not loathe it or even just tolerate it.

It’s easy to get lost in feature comparison charts, but checklists don’t provide an adequate picture of what it’s like to actually use a product. Fortunately, it’s easy to determine whether you should be looking for a new solution. Simply ask yourself: “Does it do everything I need it to do?” and “Do me and my staff enjoy using it?” If you answer “No,” then it’s time to find a new solution.

See what a thoughtfully crafted EHR looks like.

Consider Alternative Payment Models

Payment options are rapidly moving beyond traditional fee-for-service models. It’s important to explore these new options to determine if they can make an impact on your practice:

  • Value-based care: CMS designed this program to “reward health care providers with incentive payments for the quality of care they give to people with Medicare.” Reimbursements are determined based on several reporting requirements that encourage better patient care rather than more patient visits.
  • MACRA / QPP: The Medicare Access and CHIP Reauthorization Act (MACRA) replaced an older program with the new Quality Payment Program (QPP) in 2017. Qualified providers are split into two tracks: Alternative Payment Models (Advanced APMs) and the Merit-Based Incentive Payment Program System (MIPS), each of which provides different bonuses based on provider performance.
  • Primary Care First (PCF): PCF, a brand-new program that will go into effect in 2020, promises that doctors will receive a simple “flat stream of revenue” for each patient. If that patient stays healthy and out of the hospital, then the doctor will receive a bonus. But if the opposite occurs, then the practice will be responsible for the extra spending associated with that patient’s care up to a certain share of its revenue.
  • Direct Care: This is not a CMS reimbursement program, but rather the re-emergence of an older medical practice model where doctors contract directly with patients instead of working through insurance companies. Implementing a direct care practice often improves work-life balance, reduces practice overhead, brings higher per-patient revenue, and helps physicians maintain their autonomy.

Maximizing these reimbursements or implementing a new practice model requires the right tools to ensure that you meet the necessary reporting requirements. A robust EHR solution provides an easy way to track not only individual patient health but population health as well — a critical component of many reimbursement programs. Using these tools will keep your practice running smoothly.

Make sure you have an EHR solution that includes the reporting tools you need to meet reimbursement program requirements.

Flourish at the Heart of Patient Care

Maintaining a thriving independent primary care practice is no simple feat, but optimizing processes with the right tools makes it easier. The right EHR system is at the heart of practice management, and it’s what drives a successful independent primary care practice. It can help you effectively complete reporting for internal use as well as for maximizing reimbursements. Even better, it will help optimize processes so you can focus on patients and give them the time they deserve.

Interested in exploring the details of independent primary care?

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Lynley Norberg
August 26, 2019

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25 percent of physicians want a new EHR according to survey

The latest technology can be helpful to independent physicians as a tool for optimizing their practice as well as for providing high quality care to their patients. However, technology must typically be updated or replaced to keep up with new capabilities and with the changing needs of the independent practice. Sometimes physicians find that they need to replace their practice technology for other reasons, as was the case with many of the respondents to a recent survey conducted by Reaction Data.

The research organization “wanted to know which technologies providers are considering, which solutions they may be replacing and why” so they asked 153 physicians several questions about their current – and future – technology needs. The survey participants were made up of physicians in internal medicine (20%), family medicine (12%), pediatrics (17%), orthopedic surgery (27%), and other specialty areas. The survey also include participation by practice leadership (10%) and chief medical officers (5%).

Results of the Outpatient EHR Replacement survey included the fact that 39% of those outpatient providers surveyed were considering replacing technology solutions for their practice within the next 18 months. While more than a quarter of the providers (27%) were considering replacing their electronic health record (EHR) solution, the physicians were also considering replacing their patient engagement technology (18%), revenue cycle management (12%), and population health technology (12%).

Reasons given for replacing technology within the next 18 months varied. A third of the survey respondents (33%) said their current solutions were not fitting their practice needs. A fifth of the providers participating in the survey indicating that they recognize that other technology systems in the market offer their practices better value. Other reasons including having a negative experience with their current service model, including the support level (19%), lack of new functionality released for their current technology (18%), the cost of their current system (5%), and the fact that their organization is planning to align with another entity (5%).

When looking for a new technology solution, a fourth of the survey participants (25%) indicated they would need to consider the product’s ease of use, 23% said the product’s features and functionality would be a major consideration, and 21% indicated that interoperability and integration capabilities were important factors in their choice of a new solution.

Justin Watts
August 1, 2019

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Top 5 questions to ask when choosing an independent practice EHR

The choice of an electronic health record (EHR) system can significantly impact your independent practice. As an independent physician, you have a lot on your plate, including ensuring that your practice is financially successful and that your patients receive the highest quality care, and so you want to find the right EHR for your specific needs.

The top five questions to ask when deciding which EHR is the one for your independent practice are:

Independent physicians don’t always work a 9-5 schedule, Monday through Friday. You may need support after hours or on the weekend, if you are updating charts or reviewing patient notes. Elation Health provides 24/7 support, and your urgent requests always get a response in 30 minutes or less. Our goal is to make Elation so easy to use, you won’t even need to contact us, but when something does go wrong, we are here to help. We go above and beyond to support your practice, so you can stay focused on your patients.

  • Is it difficult to get trained on the new system so my practice can ramp up quickly?

Training on Elation’s EHR solution takes one hour or less. Elation is simple and intuitive – proficiency comes quickly. We’re here to support you so can you continue providing the highest quality care to your patients.

  • How will I get my data moved over to the new system?

Elation can pre-populate your patient charts. With your consent, Elation automatically and securely creates your patient record for you — complete with medication history, labs, and demographics. You’ll be up and running quickly, with no disruption of service to your patients. If you’re switching from another EHR to ours, Elation can import all the data from your old EHR, no matter the brand, with exceptional results.

  • Will an EHR take face-to-face time away from my patients?

At Elation, we are focused on helping you spend more time with your patients and less time on your computer. Our Cockpit View surfaces everything you need in a unique three-pane console, providing more flexibility and more efficiency. All the necessary information is right in front of you, so you don’t have to switch back and forth between multiple screens.

Reviews from EHR users are important when debating which EHR to choose for your independent practice. Understandably, you want to know about other independent physicians’ experiences with the system you are considering. Our providers have a lot to say about the ease of use and intuitive features of Elation’s EHR solution, including: “Elation is by far the easiest and most complete one I’ve tried. What I like about it is that it thinks the way I think.”; “Elation has transformed my practice”; and “Elation has been a revolutionary tool in the way I practice medicine.”

Lynley Norberg
July 25, 2019

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Study shows time physicians spend on their EHRs

The electronic health record (EHR) was developed to enable independent physicians to be more effective and more efficient. Electronic records significantly reduce the possibilities of duplication and, worse, errors in healthcare records. EHRs also enable physicians to collaborate with other healthcare providers, ensuring that patients receive quality care in a timely manner.

Many physicians, though, are finding that they are spending more time with their EHRs than with their patients. A recent study found that “physicians from family medicine, internal medicine, cardiology, and orthopedics spent nearly 2 hours in the EHR and on other desk work for every 1 hour of direct patient care.” An article in the Annals of Family Medicine indicates that factors such as “increased structured documentation requirements, computerized physician order entry (CPOE), inbox management, patient portals, and a redistribution of tasks previously performed by clinical staff to clinicians has led to more work that is not direct face time with patients.”

At Elation Health, we understand that the patient-physician relationship is the key to providing quality healthcare and that physicians need to spend more face-to-face time with their patients. Elation’s EHR solution is designed to be more efficient so that the independent physician spends less time on the computer and more time interacting directly with the patient.

Entering and re-entering information has remained a time-intensive and cumbersome part of adopting electronic health records. Elation reduces this need by prioritizing automation throughout the workflow. While most EHRs rely on a linear workflow that forces back-and-forth screen toggling and extra clicks, Elation’s Cockpit View surfaces everything the independent physician needs in a unique three-pane console, providing more flexibility and more efficiency. All the necessary information is right in front of the provider, on two screens.

With Elation’s EHR solution, the independent provider is able to use the Dynamic Problem List when charting to pull in specific patient information, lab results, and notes from a previous visit with just one click — helping to maintain a more comprehensive and longitudinal patient record, more efficiently. The provider can focus on face-to-face patient interactions, knowing that the patient’s electronic medical record is accurate and current.

Tyler Comstock
July 8, 2019

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The importance of a certified EHR

Independent physicians that take advantage of certified electronic health record technology (CEHRT) will be able to participate in a number of incentive programs offered through the Centers for Medicare & Medicaid Services (CMS) and its Innovation Center. The newest CMS Innovation Center initiative, Primary Care First, requires the use of 2015 Edition CEHRT for participation in payment models designed to benefit smaller practices.

In addition, as described by The Office of the National Coordinator for Health Information Technology (ONC), “Using certified health IT improves care coordination through the electronic exchange of clinical-care documents. It provides a baseline assurance that the technology will perform clinical-care and data-exchange functions in accordance with interoperability standards and user-centered design. The benefits of standard data capture and interoperable exchange of information include enhanced patient safety, usability, privacy, and security.”

CMS now requires eligible providers to use 2015 CEHRT to meet the requirements of the Promoting Interoperability Program as well. CMS states that “CEHRT gives assurance to purchasers and other users that an EHR system or module offers the necessary technological capability, functionality, and security to help them meet the meaningful use criteria. Certification also helps health care providers and patients be confident that the electronic health IT products and systems they use are secure, can maintain data confidentially, and can work with other systems to share information.”

Another CMS payment incentive program, the Merit-based Incentive Payment System (MIPS) encourages independent physicians to use certified EHR technology to aid in the process of attaining the 25 points allocated to Advancing Care Information. In fact, using CEHRT is required for reporting Advancing Care Information measures for most providers participating in the program.

ONC emphasizes that certified health IT “plays a vital role in establishing a nationwide, connected, and interoperable health information infrastructure.” CEHRT can help an independent practice offer:

  • Electronic prescribing
  • Patient-specific education resources
  • Secure e-messaging

A Drummond seal guarantees that a product meets industry standards and that it is interoperable. Opting to choose an EHR software that is Drummond Certified™ has many benefits:

  • It can save an independent practice money as the Drummond seal guarantees the operability of the software. Exploring and investing in multiple products is no longer necessary.
  • It can save an independent practice time. By choosing to look for the Drummond seal, selecting an EHR is made easy since compliance, reliability and industry standards are all covered by the Drummond Certified™ seal.

Damien Neuman
June 21, 2019

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How to best utilize EHR technology as an independent physician

Picture it: Patient A needs to see a specialty physician. Her independent physician must send a referral and then, of course, will want to see the specialty physician’s notes and any test results. So, Patient A’s independent physician calls the specialty physician, then faxes over a written referral. After Patient A sees her specialty physician, those notes and test results are faxed back over to the independent physician. Many of the notes are handwritten and some are difficult to read. All of the paperwork is stored in a file on a shelf.

Now picture the independent physician using electronic health records (EHRs). The provider reviews the patient’s medical data before the visit, including all notes input by the specialty physician and laboratories that provided healthcare services to Patient A. Referrals are made online and all information is clearly written and categorized so there are no misunderstandings based on misread handwriting.

In the second picture, the independent physician has utilized the EHR technology to create more efficiencies within the practice, saving time and reducing the likelihood of potential errors that could be devastating to the patient and to the practice. The provider is able to chart faster, as the patient’s data is available with the click of a mouse and notes can be added and reviewed in real time.

Utilizing EHR technology can save the independent physician approximately 10-15 hours per week, time that can be better spent interacting with patients and responding to follow-up communications. A more efficient practice, more secure patient data, and less time spent on charting are keys in combating physician burnout and providing higher quality care for patients.

The Office of the National Coordinator for Health Information Technology (ONC) details a number of significant benefits for the independent physician who utilizes EHR technology:

  • Providing accurate, up-to-date, and complete information about patients at the point of care
  • Enabling quick access to patient records for more coordinated, efficient care
  • Securely sharing electronic information with patients and other clinicians
  • Helping providers more effectively diagnose patients, reduce medical errors, and provide safer care
  • Improving patient and provider interaction and communication, as well as health care convenience
  • Enabling safer, more reliable prescribing
  • Helping promote legible, complete documentation and accurate, streamlined coding and billing
  • Enhancing privacy and security of patient data
  • Helping providers improve productivity and work-life balance
  • Enabling providers to improve efficiency and meet their business goals
  • Reducing costs through decreased paperwork, improved safety, reduced duplication of testing, and improved health.

Tyler Comstock
May 30, 2019

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What is the patient load sweet spot for independent physicians?

Independent physicians tend to be more satisfied with their career choice, experiencing less burnout than their employed counterparts. Autonomy and the ability to make their own decisions about how they run their practice are significant components in their level of satisfaction as well as in the quality of care they provide their patients.

How many patients should the typical independent physician be seeing? The standard number for a primary care panel size has typically been accepted as 2500 patients per physician. However, a study published in the Journal of the American Board of Family Medicine (JABFM), “A Primary Care Panel Size of 2500 Is neither Accurate nor Reasonable,” states just that – 2500 is not an ideal number.

The authors cite the source of the 2500 figure as an article published in 2000 that “speculated about the upper range of a panel size that could be reasonable under certain circumstances.” No actual data or review of physician panel sizes were included as factors in deriving that number, though. As the study in JABFM points out, “on average, family physicians address approximately 3 problems per visit. It is estimated that a family physician would need 21.7 hours per work day to deliver recommended care to a panel of 2500 patients.”

Given that independent physicians are autonomous, they can have more control over exactly where the sweet spot is for their practice, in terms of their patient load. As Association of Independent Doctors (AID) executive direct Marni Carey points out, “Doctors who work autonomously in small practices … want a say in how their day goes and how the practice is run. If that means they can only see 15 patients a day and do a great job, rather than see 35, they get to make that decision.”

The JABFM study emphasizes that “There is not a simple equation for determining an ideal panel size. Multiple factors must be considered, including factors specific to the patient population, the physician’s personal needs, and the practice’s finances and infrastructure.”

The independent physician must manage patient load with practice efficiency and success. That means calculating how many patients it will take to ensure the practice is financially feasible and that the physician has ample time to devote to each patient. It also means calculating what it will take to continue the job satisfaction and lower rate of burnout that independent physicians tend to enjoy overall.

Tyler Comstock
May 30, 2019

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Are you an independent physician considering joining an ACO?

Accountable care organizations (ACOs) are attractive to independent physicians for a number of reasons. ACOs offer independent physicians the benefits of a larger organization while still enabling them to retain their autonomy. The Centers for Medicare & Medicaid Services (CMS) defines ACOs as “groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients.”

The independent physician benefits from an ACO because, in the words of CMS, “when an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings it achieves for the Medicare program.” A recent article in Modern Healthcare adds that “As the healthcare landscape grows more complex in the push to value-based care, independent-practice providers … are increasingly looking to ACOs as a way to successfully adapt to payment reform while also keeping their autonomy.”

Physicians like Dr. Pablo Quintela, based in Hollywood, Florida, and who joined the ACO Orange Care Group, say the decision is a relatively easy one. Orange Care Group “provides Quintela with support services to manage his small practice … through one of its four ACOs. It helps him correctly bill claims to the CMS, coordinate care for his Medicare population and prepare for the quality requirements of MACRA through educational sessions and tools.”

Dr. Mary Tilak, based in Indiana, joined Community Healthcare Partners, a Medicare ACO operated by three-hospital Community Healthcare System, and enjoys the ACO’s ability to invest in health information technology as a larger organization. Tilak says, “Without health information technology, you can’t do this kind of collaborative care and move up in value-based purchasing, so it becomes critical to make these investments. That is where these large organizations can come in to help,”

Orange Care Group also invested heavily in health information technology to benefit its 450 independent physicians who may need to coordinate care for their patients. Many of its members use different electronic health record (EHR) systems and the ACO’s ability to invest in IT enables those separate systems to “easily understand and compare patient outcomes data.” Orange Care Group has also partnered with hospitals on data sharing “so doctors are notified if their patients are admitted to the emergency room and require follow-up care.”

Tyler Comstock
May 30, 2019

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How to evaluate an independent clinic

For independent physicians, their practices are their businesses. Even though the obvious focus for the physician is the patient’s healthcare outcomes, the practice must also run efficiently and effectively in order to properly serve those patients. Evaluating the practice on a regular basis will help the independent ensure that the practice is in the right place and on the right track to success.

When evaluating an independent clinic, the physician should look at a number of factors that determine the practice’s success, both financially and in terms of its patients’ well-being.

Practice management efficiency – workflows. Does the practice have in place an efficient workflow system? An evaluation should include a close look at clinical staff, in particular as to whether they are performing appropriate jobs in the most efficient manner. What are the responsibilities of the front desk staff? Review the technology workflow as well. Does the patient have a well-laid out path from the front door to the exam room, in terms of human contact as well as the transfer of the medical record?

Financial stability. Independent physicians know their trade well and have a sincere desire to focus on patient needs. However, the practice is a business and must be financially stable to ensure its success. A review of the practice’s financial records is necessary to have a clear picture of where the practice stands. The independent physician and the appropriate practice team member can take advantage of industry resources to determine the best way to manage payer reimbursement, cash flow, payroll, and budgets.

Communication. An evaluation of the independent clinic must include a close examination of the communication processes and effectiveness, both internally and with patients. Patient engagement is critical for the independent physician. Providing a convenient and secure method of communication will help both patient and physician ensure that patients’ questions are answered promptly and accurately, contributing to improved healthcare outcomes for those patients.

Accessible patient data. Is the independent practice taking full advantage of an electronic health record (EHR) solution? An efficient system provides the patient’s medical data at the touch of a finger and offers the independent physician access to other providers’ notes on that patient, to optimize care based on a coordinated care plan. An EHR designed for practice success allows the independent physician to document visit notes, order lab tests, e-prescribe, and write referrals in any order, all from the same screen.

Tyler Comstock
March 27, 2019

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