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


How to search for a new EHR for an independent practice

Searching for a new electronic health record (EHR) solution can be a daunting task for anyone. For the independent physician managing a practice, overseeing staff, and providing quality healthcare to patients, it can be even more challenging. There are a few things to keep in mind in the search for a new EHR that will help the transition go a little smoother.

Making the decision to implement a new EHR is the first crucial step. Understanding what the practice needs in terms of efficiency and the ability to provide quality care is critical. Before making a final selection, the independent physician should exam certain criteria, including:

Cost. The American Academy of Family Physicians (AAFP) stresses the need to compare “apples to apples” when looking at the cost of EHRs. It is important to understand the pricing structure as well as anything that might be included in the contract related to licensing, leasing, and purchasing. Creating a spreadsheet that outlines the details of each EHR’s cost will help the independent physician clarify the various cost structures.

Ease of implementation. A busy medical practice is focused on patient needs. The independent physician and the practice’s staff should not have to spend extraordinary amounts of time on implementing an EHR. The independent physician should contact EHR vendors to request proposals, asking for details on the implementation procedure, including the total time required to get set up and to be fully functional.

Training. Another consideration that should be included when asking questions in the search for a new EHR for an independent practice is whether the vendor offers training for all staff members who will be involved in using the system.

At Elation Health, we understand that the primary focus of the independent practice has to be on providing quality healthcare to patients. That’s why we designed our clinical first, cloud-based EHR to take less than an hour to learn. We’ll even migrate previous patient data free. In addition, with Elation’s extraordinary 24/7 support, independent physicians and their staff are assured of being able to get help from our team of dedicated user success specialists within 30 minutes or less – 365 days a year.

Tyler Comstock
March 22, 2019


Health Affairs article suggests CMS may need to support small practices more for MIPs

The Centers for Medicare & Medicaid Services (CMS), in its zeal to reinforce the need for value-based care among all healthcare providers, may be slighting smaller independent practices, according to an article published in Health Affairs earlier this year. Performance data from CMS’s Merit-based Incentive Payment System (MIPS) shows that “small practices performed considerably worse in terms of Composite Performance Score (CPS) and financial penalties compared to their large practice counterparts.”

Health Affairs suggests a number of ways in which CMS can be more supportive of the many small practices participating in MIPS, so that all can be more profitable and more successful.

Medicare could implement additional incentives for quality reporting. Small, independent practices may not have the resources available to them for “information technology and other support systems to facilitate automatic reporting, perform manual reporting, or achieve the MIPS end-to-end quality reporting bonus.” As a result, they often are not able to adhere to CMS reporting requirements that are necessary to earn the bonus. Health Affairs suggests that possible solutions could include “scoring adjustments that apply only to small practices, such as a higher end-to-end reporting bonus amount (for small practices only) or increasing the bonus points per measure (i.e., earning more points for fewer measures reported for small practices only).”

CMS could modify MIPS rules to reduce quality reporting burden for small practices. Simplifying or reducing the 50 potential measures for independent physicians to report would significantly reduce the reporting burden on those smaller practices. In fact, “CMS has set a precedent in the Improvement Activities domain, where small practices receive double weighting for reporting relevant activities.”

CMS could also adapt approaches from other payment models to provide small practices with resources necessary to meet MIPS goals related to quality reporting or care redesign. Other models, including the Accountable Care Organization (ACO) Investment Model and the Comprehensive Primary Care Plus (CPC+) model offer alternatives for financial strategies and incentives.

Finally, the article suggests, “new fee-for-service billing codes implemented through the Physician Fee Schedule could be encouraged, or their use could even be incentivized as part of quality measures, among small practices in MIPS to offset costs from initial investments required to deliver care coordination services, improve quality, and/or contain costs.”

Greg Miller
March 5, 2019


Why cloud-based EHRs are on the rise

Convenience, reliability, and security are critical features of an electronic health record (EHR) system. For the independent physician, a cloud-based EHR can mean additional time spent with the patient and less time spent with maintenance and necessary updates to the system. Cloud-based EHRs are on the rise as more physicians find that these valuable features are important to their practice success and their ability to provide quality healthcare to their patients.

Globally, the healthcare cloud computing market is projected to reach $44.93 billion by 2023, from an estimated $19.46 billion in 2018. One of the major factors in this growth is the advantage of cloud usage. According to a report posted on PRNewswire, North America accounts for the largest share of this market, which can “primarily be attributed to the increasing adoption of EHRs among medical professionals.”

Independent physicians are recognizing the advantages of cloud-based EHRs in increasing numbers. With cloud-based EHRs, much of the administrative and maintenance burden is shifted to the Software as a Service (SAAS) provider, allowing physicians and their clinical staff to spend fewer resources on the installation and upkeep of the server and more time with the patient.

Cloud-based EHR systems actually solve many of the issues that practices may be worried about when choosing to adopt an EHR system. In server-based EHR systems, thousands of dollars can be spent in order to install and implement a server, hardware, and software. Additionally, regular maintenance and management from a local IT department is also needed.

Cloud-based EHR systems are already established by a SAAS provider, meaning the expense of money and time diminishes dramatically. Much of the configuring, security and software is handled by the SAAS provider, thus cancelling a significant bulk of the anticipated work. And because 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 practice does not have to worry about the capacity of the servers or any additional licensing fees.

Technology tends to advance rapidly and incrementally. Regulatory requirements also require updates to EHR systems. Cloud-based EHRs are on the rise as more independent physicians recognize that they offer the convenience, reliability, and security they need for their practice to keep up with changes and to provide quality healthcare to their patients.

Tyler Comstock
February 19, 2019


How to choose a new EHR for an independent practice

When deciding to purchase and implement a new electronic health record (EHR) solution for an independent practice, there are a number of considerations to review. A new EHR, as with any new technology, can be a significant change for the independent physician and clinical staff. With the right information at hand, however, choosing a new EHR for independent practices can be a smooth and beneficial process.

The first question to ask is where the practice needs a new EHR or a new EMR, or electronic medical record. Many healthcare professionals use the terms interchangeably, but they are actually slightly different. The office of Health Information Technology (IT) clarifies the differences between the terms:

Electronic medical records (EMRs) are digital versions of the paper charts in clinician offices, clinics, and hospitals. EMRs contain notes and information collected by and for the clinicians in that office, clinic, or hospital and are mostly used by providers for diagnosis and treatment.

Electronic health records (EHRs) are built to go beyond standard clinical data collected in a provider’s office and are inclusive of a broader view of a patient’s care. EHRs contain information from all the clinicians involved in a patient’s care and all authorized clinicians involved in a patient’s care can access the information to provide care to that patient.

Another question to ask when choosing a new EHR is whether the system enables independent physicians and their patients to communicate with each other using seamless, secure messaging. Elation’s EHR solution provides this capability and more, to support the physician-patient relationship.

A critical question for a new EHR for independent practices is whether the system will be cloud-based or server-based. The difference between the two is quite simple: 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. With cloud-based EHRs, much of the implementation and maintenance burden is shifted to the Software as a Service (SAAS) provider, allowing the doctors and the practice to spend less resources on the installation and upkeep of the server and more time with the patient.

Finally, a new EHR for independent practices must come with vendor support and minimal training requirements. With Elation’s EHR solution, training takes less than one hour. Elation is simple and intuitive – proficiency comes quickly. In addition, Elation’s support of independent practices is available 24/7, so providers can focus on their patients without interruption.

Tyler Comstock
February 6, 2019


When did EHRs begin?

The electronic health record (EHR) dates to the 1960s, when computer systems were first being developed and honed for practical use. Paper medical files continued to be used for some time (and are actually still being used in some medical practices today), but the computer revolution added significantly to the evolution of the medical record. So when was the EHR first implemented?

The earliest known predecessor to today’s EHR was the Problem-Oriented Medical Record (POMR) developed by Dr. Lawrence Weed “so that medical students and practitioners could function in a structured, rigorous way more like that of workers in the scientific community.”

As noted by the American Health Information Management Association (AHIMA), “From the moment technological advances moved data entry from punch cards to keyboards, and data display from printed results to video display terminals, innovative physician tinkerers around the country have seized on the opportunity to improve healthcare delivery.”

The AHIMA, in its HIM Body of Knowledge, identifies several of the earliest efforts to implement EHRs, known by various names in the 1960s and 1970s, including electronic medical records, computerized medical records, longitudinal patient records, and electronic charts. Those “more well-known efforts include:

  • Lockheed Corporation, in 1971, created a system for El Camino Hospital, featuring computerized physician order entry (CPOE) and allowing multiple, simultaneous users.
  • In the early 1970s, the University of Utah, 3M, and Latter Day Saints Hospital deployed the Health Evaluation through Logical Processing system.
  • Researchers at Massachusetts General Hospital launched the Computer Stored Ambulatory Record project in 1968, which had modular design and accommodated flexible clinical vocabularies through vocabulary mapping.
  • The Regenstrief Institute in Indianapolis created the Regenstrief Medical Record System in 1972, incorporating then nascent object-oriented programming principles to automate integration of structured, electronic clinical data from their sources, such as laboratories and pharmacies.
  • The Veterans Administration (now known as the Department of Veterans’ Affairs) began work on the Decentralized Hospital Computer Program, the progenitor of the Veterans Health Information Systems and Technology Architecture, which innovated an enterprise-wide EHR system spanning hundreds of clinical settings across the country.”

Tyler Comstock
January 28, 2019


How well-conceived EHRs could make things easier for independent physicians

The ideal electronic health records (EHRs) solution will enable physicians to operate more efficiently and effectively, providing higher quality care to their patients. Maintaining patient records on paper, kept in files on a shelf, was not only time-consuming but increased the possibility of errors when handwriting could not be deciphered or papers were lost. The EHR provides the opportunity to input patient data during the visit and to easily access it before and after the visit.

Physicians have been challenged by the transition to EHRs, in part because their system may not have been designed to truly make things easier for them. The ideal electronic health records (EHRs) solution, such as Elation’s Clinical First EHR, keeps in mind the specific needs of very busy doctors who want to spend more time caring for their patients than interacting with technology.

A white paper published recently by Stanford Medicine cites the results of an online survey conducted in March 2018, of 521 primary care physicians in the fields of Family Practice, General Practice, and Internal Medicine. Asked how EHRs affected them and their practice, almost three-fourths of the survey respondents said that “the first order of business should be improving the user interface of EHRs to enhance efficiency and reduce screen time.”

Suggestions ranged from shifting data entry to clinical support staff to including a “highly accurate voice recording technology that would act as a scribe during patient visits.” Additionally, almost half of the primary care physicians participating in the survey noted that ideal electronic health records will be “transformed into a powerful tool that helps with clinical care, predictive analysis to support disease diagnosis and prevention, and population health management.”

Interoperability was the top concern for the primary care physicians. The Stanford Medicine white paper cites “the need to make patient data available easily and readily to professionals from all parts of the health care system for the benefit of the patient.”

Elation Health understands that well-conceived EHRs will make things easier for doctors by enabling them to access patient data easily and securely, coordinating with other healthcare providers for the patient’s care. Elation’s EHR solution provides physicians the ability to spend less screen time and more face time with their patients, as they chart, e-prescribe, and order lab tests all from the same screen. The Cockpit View eliminates back-and-forth linear workflows, letting doctors click less and do more for their patients.

Tyler Comstock
January 22, 2019


How to take advantage of 2019 tax benefits from medical expenses as an independent physicians

Tax laws are changing over the next few years. Some of those more significant changes have to do with eligible deductions for medical expenses. Independent physicians should be aware of the 2019 tax benefits from medical expenses, for themselves and for their patients.

The tax changes include an increase in the standard deduction as well as a lower threshold for medical expenses for those who do itemize. In the 2018 tax year, medical expenses that exceed 7.5 percent of a person’s gross income can be written off. However, with the 2019 tax year that number reverts back to 10 percent of gross income.

AARP reports that eligible medical expenses include:

  • Out-of-pocket fees to doctors, dentists, chiropractors, psychiatrists, psychologists, podiatrists and other medical professionals that are not covered by Medicare or other health insurance
  • Health insurance premiums — as long as they weren’t paid with pretax dollars, as most employer-based health benefits are. You can deduct Medicare Part B premiums and any premiums you pay for a Medigap policy, Medicare Advantage plan or a Part D Prescription drug plan.
  • Premiums for long-term care insurance and payments to nursing homes and other long-term care facilities
  • Inpatient alcohol and drug treatment programs
  • Wheelchair ramps and other modifications you make to your home for medical reasons
  • Transportation to and from doctor and other medical appointments — including taxi or bus fares, or out-of-pocket costs for using your personal car, including parking.
  • Copays for prescription drugs
  • Copays for physical or occupational therapists
  • Payments for dentures, prescription eyeglasses or readers, hearing aids, crutches, wheelchairs or other durable medical equipment
  • Payments for smoking-cessation programs and weight-loss programs related to a specific disease diagnosed by a doctor, including obesity

According to AARP, Medicare beneficiaries spend an average of $5,680 on medical expenses each year. The current threshold of 7.5 percent will help those patients as they tend to have lower incomes. In fact, AARP states that 49 percent of those taking advantage of the medical expense deductions have earnings of less than $50,000 per year.

In other tax-related news, the House Ways and Means Committee introduced a tax package on December 10, 2018, that “includes a five-year moratorium on the medical device tax; a two-year delay for the so-called Cadillac tax on high-cost employer plans, which won’t expire until the end of 2021; a two-year delay of the health insurance tax; and a full repeal of the tax on indoor tanning,” according to Modern Healthcare. However, that tax package is not expected to pass in the Senate.

Tyler Comstock
January 9, 2019


Former independent physician goes back to becoming independent doctor

Although the percentage of physicians in independent practices has fluctuated in recent years, at least one doctor has decided to return to her roots as an independent physician after practicing for 30 years. Erica Swegler, M.D., a member of the AAFP Board of Directors, explains in an article recently published by AAFP why she is returning to a solo practice, where she started her career as a physician just after her residency.

So why return to independent practice? It’s not all about the money, obviously. Dr. Swegler cites the lower rates of burnout among independent physicians as one positive aspect of working in an independent practice. In fact, a recent survey of 235 health care professionals in 174 small independent primary care practices in New York City found their burnout rate to be only 13.5 percent.

Dr. Swegler enjoys the autonomy in her practice, in particular the ability to focus on her patients’ needs and not the needs of the organization. As she says, “I have the satisfaction of taking care of my patients by placing their needs first…. I can practice to the highest level of my license and ensure that my patients have only the right, appropriate care they need.”

Tyler Comstock
December 14, 2018


EHR tips for solo primary care physicians

Independent physicians must run an efficient practice, to be financially solvent and to provide quality healthcare to their patients. The right electronic health record (EHR) system can help do just that, but some providers may find that their EHR system is challenging or actually requires more of their time than they are able to give it. The right technology solutions offer an EHR for solo primary care physician practices that benefit both provider and patient.

Salvatore S. Volpe, MD, a New York-based solo primary care physician, spoke with Health Leaders in 2016, to offer tips for using an EHR for solo primary care physician practices in an efficient, effective manner. At the time, Volpe had been using an EHR for his practice for eight years. He also belongs to the board of directors of the New York eHealth Collaborative and serves as chair of the health information technology committee for his state medical society.

Volpe’s tips on optimizing an EHR for solo primary care physician practices include:

Take a team approach. Independent physicians with a small staff should involve that staff in the EHR process. Training each team member on the features of the EHR system can help the provider significantly when it comes time to input or retrieve patient information. Medical assistants and other clinical staff can take the time to pull up relevant screens and even add certain patient notes, so the provider has more time to spend with that patient during the visit.

Invest in prep time. Volpe advises that reviewing patient data, including test results, prior to the patient visit can better prepare the provider for the visit as well as reduce the time needed to review that information while the patient is in the room.

Ask for help. Independent physicians can ask for help within their practices, from their team members, as well as from the EHR provider. At Elation Health, we understand there will be questions about the EHR system. With our extraordinary 24/7 support, providers and their staff get the help they need from our team of dedicated user success specialists within 30 minutes or less – 365 days a year.

Tyler Comstock
December 10, 2018