Understanding Cultural Context Is Important in Your Medical Practice

Lea Chatham October 15th, 2014

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Tweet this Kareo storyBy Lisa A. Eramo

Taking the time to understand a patient’s cultural context not only enhances a physician’s ability to diagnose and prescribe treatment, but it also helps create a closer bond that can lead to better outcomes.Tweet this Kareo story
In an increasingly diverse society in which racial, ethnic, socioeconomic, and cultural health disparities exist, it’s important for physicians to evaluate their own cultural competence to ensure that they can deliver care that is both sensitive and informed.

The Office of Minority Health defines cultural competence as a “set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.” In medical practices, being culturally competent means that physicians understand, respect, and take into consideration patients’ health beliefs, health practices, and cultural and linguistic needs.

In a video about how effective healthcare communication contributes to health equity, the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) identifies the following cultural factors that can contribute to health disparities: gender, gender identity, sexual orientation, socio-economic status, language, physical and mental capacity, age, religion, housing status, and regional differences. There is also often further diversity within specific cultural and ethnic groups. Identifying these factors can help to ensure positive health outcomes.

HRSA provides a web-based training course, “Effective Communication Tools for Healthcare Professionals,” that helps providers respond to patients’ cultural and linguistic needs. HRSA also provides various other resources to help providers address patients’ unique needs.

It’s important for today’s physicians to be culturally competent because they practice in an increasingly diverse society, says Darci L. Graves, MPP, MA, MA, senior health education and policy specialist with the Health Determinants and Disparities Practice (HD&D Practice) at SRA International, Inc. The HD&D Practice currently manages Think Cultural Health, an online clearinghouse of resources hosted by the Office of Minority Health. To become culturally competent, physicians need to consider a patient’s cultural framework as well as their own biases and assumptions, she says.

“Even if you look the same on the outside, chances are, you’re still having a cross-cultural encounter,” says Graves. Differences in religion, for example, may exist. Being culturally competent and sensitive means that physicians don’t ask cookie cutter questions but rather take the time to get to know each patient individually and adapt questions accordingly. This allows for a much more thorough and accurate history and exam, she adds. It also helps answer questions such as why a patient may not take a certain medication or follow through with treatment recommendations. In general, understanding cultural context can enhance the overall clinical picture and help providers render more informed care.

Cultural competency also enhances communication and understanding. A patient who won’t make eye contact, for example, isn’t necessarily disinterested in the clinical information a physician provides, says Graves. “That could just be their way of showing deference,” she says, adding that in certain cultures, this behavior is commonplace.

More thoughtful questions and communication can also help patients feel more connected to their physicians.Tweet this Kareo story
This, in turn, can lead to better patient engagement, compliance with medical treatment, and outcomes. Physicians who take the time to understand their patients’ complete stories may experience better patient retention.

According to kevinmd.com, responding to the unique needs of each patient, including his or her spirituality, contributes to patient-centered and family-focused care can enhance both patient safety and satisfaction.

Cultural competence is important for all providers, which is why it’s a focus area for the Association of American Medical Colleges (AAMC). More specifically, the AAMC strives to promote a “culturally competent, diverse, and prepared health and biomedical workforce that leads to improved health and health equity.”

However, today’s physicians practice an increasingly challenging and regulatory-driven environment that minimizes the time they’re able to spend with patients. Cultural competence is just one part of this complex environment, and it’s one that’s constantly evolving.

Graves says physicians shouldn’t feel burdened by cultural competence but rather empowered by it. “It’s not about adding something extra—it’s about tweaking what you already do. It’s about making sure that the questions you’re asking as well as how you’re asking those questions is culturally appropriate,” she says.

The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (the National CLAS Standards) include several principles designed to foster health equity.

The Office of Minority Health also provides a blueprint that practices can use to operationalize these principles. Providers can register for free to download this document titled, “A Blueprint for Advancing and Sustaining CLAS Policy and Practice.” For example, the blueprint encourages providers to inform all individuals of the availability of language assistance services clearly and in their preferred language (verbally and in writing); provide easy-to-understand print and multi-media materials and signage in the languages commonly used by the populations in the service area; and partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness.

The Commonwealth Fund suggests that providers should modify intake forms to include questions regarding health literacy, English proficiency, language spoken at home, and use of complementary and alternative medical practices.

Providers can also complete a cultural competence self-assessment, such as the one developed by Tawara D. Goode of the National Center for Cultural Competence, to identify areas in which they may be able to improve the quality of care provided to diverse populations. This assessment asks providers to evaluate their physical environment, communication style, and values and attitudes.

Looking for additional ways to make your practice more welcoming and culturally inclusive? Refer to these resources on the Think Cultural Health Web site. You can also download this terrific guide on improving patient engagement!

About the Author

LisaEramofreelanceLisa A. Eramo is a freelance writer/editor specializing in health information management, medical coding, and healthcare regulatory topics. She began her healthcare career as a referral specialist for a well-known cancer center. Lisa went on to work for several years at a healthcare publishing company. She regularly contributes to healthcare publications, websites, and blogs, including the AHIMA Journal and AHIMA Advantage. Her focus areas are medical coding, and ICD-10 in particular, clinical documentation improvement, and healthcare quality/efficiency.

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Free Webinar: Learn How to Define Your Online Reputation with Kevin MD

Lea Chatham October 13th, 2014

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Register Now for Kevin MD WebinarDefine Your Online Reputation: A Social Media Approach
Thursday, October 16, 2014
10:00 AM PT, 1:00 PM ET

Learn best practices from social media’s leading physician voice! Tweet this Kareo story

Kevin MD will provide practical guidance from his decade-long social media journey, enhanced by case studies of other practicing physicians who are active on social media.

This webinar is framed by three key questions:

  1. Why is an online reputation important?
  2. How can I establish my online reputation?
  3. How can I protect my online reputation?

To address these questions, Dr. Pho will discuss topics including  monitoring your online presence, the benefits and risks of physician  rating sites, tips for online professionalism, and pearls of wisdom on  top social media platforms.

Register Now!

About the Speaker
Register Now for Kevin MD WebinarDr. Pho is a practicing board-certified internal medicine physician and a healthcare social media leader since 2004. He is co-author of the book, “Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices.”
Dr. Pho received his medical degree at Boston University School of Medicine and practices primary care in Nashua, NH. He is a member of the New Hampshire Union Leader’s 2010 class of New Hampshire’s 40 Under Forty, and a 2013 inductee to the Healthcare Internet Hall of Fame.

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October Kareo Newsletter Takes a Look at Social Media for Physicians

Lea Chatham October 9th, 2014

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The October edition of the Kareo Getting Paid Newsletter takes a look at using LinkedIn, some best practices for work life balance and some handy tools to improve your medical billing. The newsletter also provides a chance to discover upcoming events, news, and resources from Kareo. Plus, you’ll learn about how to register for our upcoming free educational webinar, Define Your Online Reputation: A Social Media Approach, presented by physician social media expert Kevin Pho, MD. Read all this and more now!Tweet this Kareo story

October Kareo Getting Paid Newsletter

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Why I Recommend LinkedIn to Physicians by Kevin Pho, MD

Lea Chatham October 8th, 2014

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LinkedInBy Kevin Pho, MD

When I talk to physicians about dipping their toes into the social media waters, I advise starting with LinkedIn. Spend about 45 minutes or so and create a LinkedIn profile, which is essentially a digital translation of your CV. LinkedIn profiles get ranked highest among the social media platforms, and can push down the influence of negative news stories or physician rating sites.

Howard Luks is a social media thought leader, and whose opinion I respect tremendously. He wrote an insightful piece explaining why LinkedIn may not be right for doctors:

“As a physician on LinkedIn, not only do you have a virtual “please sell to me” sign on your forehead, most will perceive their presence on LinkedIn as a huge waste of time. Unless you are an aspiring entrepreneur, etc. you will find that the connections you make on LinkedIn are weak at best. In addition, while your patients are looking you up online, for the most part they are not looking at your LinkedIn profile.”

He goes on to suggest doctors spend their time on physician rating sites like Vitals or Healthgrades, Google+, or Yelp.

When it comes to establishing an online reputation, there are essentially two ways of doing it.Tweet this Kareo story

  1. “claiming” a profile on an existing physician rating site
  2. creating your own online presence, either with a website or through a social media platform

While I generally recommend the second approach of proactively defining yourself with social media, the first option of utilizing existing sites is viable.

First, much of the information in Vitals or Healthgrades is inaccurate, and can lead to the so-called Google Maps problem, where Google may use the information on these sites.

Second, physicians can leverage the high search engine visibility that these sites generally garner.

The downside of this approach is that these sites are for-profit and generally don’t have physicians’ best interests at heart.  Their physician profile pages are littered with ads, which can subtly imply a physician’s endorsement.

Also, consider the terms of service of one of these sites, which are heavily skewed against the doctor:

“You acknowledge that your Physician-Provided Material may be used without restriction for any purpose whatsoever, commercial or otherwise, without any compensation or obligation to you.”

Because of those reasons, I prefer doctors create social media profiles instead, where they have more control over how their online identity is controlled and presented.

Howard also recommends Google+ and Google Places for Business. However, there is more friction in taking this approach, namely the cumbersome way Google verifies your business address. If this can be overcome, this does indeed have the highest search engine impact, as seen below:

kevin-pho LinkedIn

But any friction whatsoever prevents the majority of physicians from defining themselves online. From talking to doctors across the country, many are petrified of taking even minimal steps to be visible online.

Which brings us back to LinkedIn.

While it isn’t perfect for the reasons Howard mentioned, LinkedIn is a low-threat, low-resource, high-yield action.

I acknowledge that there are tradeoffs involved, and after considering those, continue to recommend it as a reasonable first step to establish a physician’s online reputation.

This piece originally appeared on KevinMD.com. For more tips an strategies from Kevin Pho, register now for his upcoming free webinar, Defining Your Online Reputation: A Social Media Approach.

About the Author

Kevin Pho for Health LeadersKevin Pho is an internal medicine physician and co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is on the editorial board of contributors, USA Today, and is founder and editor, KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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6 Tips for Creating Work Life Balance

Lea Chatham October 8th, 2014

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Tweet This Kareo StoryBy Erin Kennedy, MCD, CMRW, CERW, CEMC, CPRW

Balancing work and family can seem like an impossible task. According to the Physicians Practice Great American Physician Survey, sponsored by Kareo, many physicians struggle with creating work life balance and they want to improve this area. As a mother of two young children, figuring out how to juggle everything has become a personal quest of mine. A recent article in The Atlantic looks at some of the numbers in recent studies on work-life balance in the U.S., and it makes an interesting read. Why do so many struggle with this balancing act? Is there ever a happy medium?

The reality is that the process of balancing is dynamic, and it changes as the situations change. Here are some tips to help put this seemingly impossible task into perspective:

  1. Recognize that family life has seasons. The demands on your time and energy will change as new members are added to the family and as kids get older. Homework becomes more independent for kids as they get older, meaning less homework for mom and dad to help with.
  2. Schedule family times, just as you schedule your appointments. It might sound cold, or not spontaneous, but it works–especially if you are like me and live by your calendar. Plan some vacation time now and block it on your calendar. It doesn’t have to be two weeks at the shore, but you do need to have fun together as a family. A weekend at a cabin, a walk through town or your neighborhood, or an evening at an ice cream store works, too.
  3. If the traditional family dinner hour doesnt work for you, set a 8:30 meetup in your family room with a snack. The idea is to connect at least once a day for a short time because it is cumulative: all those short times build on one another to maintain relationships.
  4. Turn off the electronics during that connection time! Think face-time instead of screen-time. You can’t give your full attention to anyone if you’re getting texts.
  5. Say “no” to a few things. Choose not to “do it all” and just do one extra-curricular activity per family member.
  6. Delegate and get help when you are overwhelmed. You can’t do everything. Sometimes you need to break down and ask for help. I finally did just that. After years of taking care of children, keeping a clean house, and managing a growing business, I finally had to break down and admit I needed some help–in one area in particular–my landscaping. Now, I must add that my husband is a huge help in keeping the house organized and picked up, and is a great with the kids and their schedules, but does he know the difference between a weed from a Spring bud? NO. To him they all get pulled out. So, I hired Joanna, Master Gardener and Savior of Pitiful Landscaping. She came in, took one look at what I was attempting to do with the yard, talked with me for awhile about what I wanted to see, and went to work. Just a few hours from her took such a load off my mind. What a difference a professional makes! I never knew my landscaping could look so good. Finally, curb appeal! Delegating that task was the best thing I ever did.

There will be times when family has to be the priority over work: sudden illnesses, crisis situations, school activities, etc. There will also be times when work has to have priority over family because of call schedules or a patient crisis. Balance is that shifting of resources to adapt to changing needs and keeping your focus on the priorities you’ve set.Tweet this Kareo story

Most of us would say that we work to provide for our family and that our families are also a priority. Deliberately investing your energy into connecting with your loved ones on a daily basis with occasional longer times together helps you maintain that critical balance between work and family. Delegating, limiting commitments, and asking for help allows you to focus on what is important.

 About the Author
erin-photo-200X300Erin Kennedy, MCD, CMRW, CERW, CEMC, CPRW is a Certified Master & Executive Resume Writer/Career Consultant, and the President of Professional Resume Services, Inc., home to some of the best resume writers on the planet. She is a nationally published writer and contributor of 14+ best-selling career books and has written hundreds of career-related articles. Erin and her team of executive resume writers have achieved international recognition following nominations and wins of the prestigious T.O.R.I. (Toast of the Resume Industry) Award and advanced certifications. She also is a featured blogger on several popular career sites.



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Third-Party Rating Sites Important in Health IT Purchase Satisfaction

Lea Chatham October 7th, 2014

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According to the 2014 Black Book Survey, 89% of all physician practices agree their billing and collections systems/processes need upgrading. In addition, throughout 2014, industry experts have been saying that there is a strong trend towards EHR switching happening right now.

As a result, there are lots of physician practices out there looking to buy Health IT software to manage practice management, billing, and clinical process. But, choosing and implementing new software is no easy task, and many put it off as long as they can. And no wonder when there are hundreds of EHR solutions alone.

TechnologyAdvice“Finding the best technology solution for your specific needs is often stressful, time-consuming, and expensive,” says Rob Bellenfant, CEO and Founder of TechnologyAdvice, a technology ratings and review service. “With access to more information than ever before, it’s easy for a buyer to get overwhelmed in the research process and question what sources are reliable.”

Unbiased, reliable third-party rating sites can be a very useful tool to help practices narrow down the search for Health IT solutions.Tweet this Kareo story

These sites can provide three key benefits:

  1. They allow you to refine your search quickly by entering practice information such as size and specialty while also enabling you to select items like key features.
  2. You can easily see reviews and ratings from current users. This can make it easier to push a few solutions to the top of your list.
  3. There are often other resources available like unbiased surveys, articles, and in-person expert assistance to further help narrow the scope of your search.

Recently, Melissa McCormack, medical researcher at EHRSoftware Advice buyer resource Software Advice, conducted some research in collaboration with Research Now on the use of online ratings and reviews when making software purchases.

According to McCormack, “buyers are increasingly making use of crowdsourced research, such as online reviews, before making software purchasing decisions. Nearly three quarters of buyers today consult reviews before making a decision, and more than half say they would select one product over another based on reviews.”

It turns out that using reviews to help refine your purchasing process actually impacts the satisfaction with the purchase. In another study conducted by Software Advice, researcher Ashley Verrill found that buyers who did not check vendor references were 5.2 times more likely to be extremely dissatisfied with their software purchase than buyers who checked references, and consulting references had a positive impact on both the outcome of a software selection project and buyer satisfaction.

“With the advent of sites like Yelp, TripAdvisor and the like, buyers have become accustomed to using customer opinions to help make important purchasing decisions,” explains Verrill. “In fact, these crowdsourced opinions have become an essential part of the online consumer research process. It allows them to confirm that customers had a positive experience before they buy.”

For healthcare providers there is a lot at stake when choosing new technology. It impacts your bottom line, the care you provides, and your ability to stay independent. Being able to narrow down the search to a small handful of solutions the you be assured meet your criteria is invaluable.

It is so much easier to do further research and schedule demonstrations of five systems than 50. And what healthcare provider or practice manager has the time to look at that many solutions. Using solutions like TechnologyAdvice, Software Advice, or American EHR, can save time and according the McCormack’s research increase your overall satisfaction with the final purchase.

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Is Joining an IPA for You?

Lea Chatham October 2nd, 2014

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Tweet This Kareo StoryAs physicians look at whether to stay independent (or start an independent private practice), there are many options to consider and questions to ask. One of these is whether or not to join a group like an Independent Physician Association (IPA).

Also known as an Independent Practice Association, these groups can often take some of the risk off your shoulders while also providing costs savings and even some care coordination opportunities.

Typically, IPAs serve to negotiate contracts with insurance companies on the behalf of their members. Participating physicians are usually paid on a capitated or modified fee-for-service basis but may also care for patients outside of the insurers contracted through the IPA.

As the industry moves towards more of a value-based model and away from fee-for-service, these groups can be better positioned to make the shift since they are often set up this way already. Their structure also makes them more readily in a position to shift to an ACO model.

Often, the IPA has a staff who do the contract negotiations, disburse payments to participating physicians, and manage other tasks based on the structure of the group. By centralizing many of the administrative costs, using the group’s bargaining power in contract negotiations, and offering other benefits like group purchasing, an IPA can help smaller practices reduce overhead.

In her recent webinar, Taking the Leap: Best Practices to Start Your Own Medical Practice, practice management expert Audrey McLaughlin talked a bit about IPAs. “Determining if you should join one depends on many factors. Often, small practices find IPAs advantageous in achieving savings, support, structure, and networking.”

While your practice remains independent, an IPA is a legal entity and you do sign a contract to join.Tweet this Kareo story
So it is important to be clear on the ins and outs. IPAs can vary widely so read the fine print.

Here are some things to consider before you sign on the dotted line:

  1. Does the IPA have a solid organizational structure? There needs to be an effective Board of Directors, an experienced leadership team, and a well-qualified staff. There also needs to be a large enough staff to manage the aspects of the IPA. Some groups grow too fast without the infrastructure to support that growth. As a result, they may fail—or flail—both of which can hurt the physician members and their patients.
  2. Is there sound fiscal management? You don’t want to join a group that doesn’t manage its money well or spends more than it earns. You should ask to see the financials and have someone walk you through the budget, profit and loss, and long term plans for financial success.
  3. Are the business operations and service style a match? You want to be part of an organization that reflects your values. Don’t get into bed with a group that has a radically different approach to customer service or management than what you are comfortable with.
  4. Information Technology: Does everyone in the IPA use the same practice management and EHR technology? How is that paid for? What is involved in making the switch? What is the cost to your practice? Ask all these questions and gets a hands on demonstration of any software you’ll have to use.

One last piece to think about before you join an IPA is whether or not you are comfortable giving up some control to reduce some of your risk and management responsibilities. There are always pros and cons. If you are more comfortable having a lot of control over which payers you contract with, negotiating those contracts, and being involved in the details of your billing and administrative tasks, an IPA might not be for you. However, if your most interested in providing care and would prefer to hand off more of those tasks to someone else than an IPA might be the right fit. Because an IPA functions like a larger medical group, it can also help you to grow a small or new practice faster.

An IPA could be a great fit to help you manage and grow your practice, but always invest the necessary time to look at every angle before you commit yourself.

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3 Good Reasons to Conduct Patient Surveys

Lea Chatham October 1st, 2014

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Tweet this Kareo storyBy Lisa A. Eramo

Customer satisfaction is important in any business, and healthcare is certainly no exception. In order to be a contender in today’s competitive healthcare market, physicians need ongoing feedback from their patients. Not only can this feedback help improve processes, but it can also enhance patient retention. Surveying patients directly is one way in which practices can glean this important information.

Surveying patients about the quality of care they receive—including what they like and more importantly, what they don’t like—is definitely a smart business move, says Tom Jeffrey, president of the SullivanLuallin Group, which helps administer patient surveys and establish patient satisfaction improvement plans for practices of all sizes, including solo practitioners and groups of a hundred or more physicians.

“Right now, in the industry, 70% of new patients are word-of-mouth referrals,” says Jeffrey. Tweet this Kareo story
“When patients have good things to say about your practice, that’s generally where you get new business.”

A well-constructed survey can also help physicians understand how they can connect with patients. This connection can actually improve the efficacy of the care they provide, says Jeffrey. “When patients connect with their physician and feel that the physician listens to them and communicates well, the likelihood that the patient will follow and complete the treatment regimen is higher. This leads to better outcomes.”

Consumers want to voice their opinions, and they also want to know the opinions of others. According to USA Today, one in four consumers checked the online ratings for their physician when choosing a primary care doctor in 2012. If physicians don’t know what these ratings say or imply, they could be missing out on opportunities.

Surveying patients internally gives physicians a first-hand glimpse into how their patients feel about them. Many public websites have been publishing this information for quite some time. Healthgrades®, for example, is a website that allows patients to take an online survey to give feedback about a provider’s ability to listen, ease of scheduling appointments, office cleanliness, and more. Other sites, such as Vitals, Consumer Reports, Yelp, and even Angie’s List have similar purposes.

Most physicians today are becoming more interested in patient satisfaction because it’s such an important driver in healthcare reform, says Jeffrey. Not only is patient engagement and satisfaction important in terms of Meaningful Use, but surveying patients using the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey is also a requirement for providers in an Accountable Care Organization (ACO) or a Medicare Shared Savings Program, according to CMS.

It behooves providers to survey patients now so they can gauge overall satisfaction before these ratings and scores continue to become publicized via Physician Compare and other sites. Some providers are already banding together to make scores public.

For example, the Maine Quality Forum launched an initiative to encourage the use and public reporting of patient experience survey data to improve quality. Each practice site that participates in the initiative will partner with a vendor to administer either the six or 12-month version of the CG-CAHPS PCMH survey or CG-CAHPS core survey instrument. The Maine Quality Form will pay $8.65 per completed survey or 90% of actual survey costs (whichever is less). Survey results will be publically reported at the practice level at http://www.mainepatientexperiencematters.org/.

Prevea Health, a 200-physician multi-specialty group in Green Bay, WI has been using the Press Ganey survey at each of its sites since 2006, according to a white paper developed by Physicians Practice and sponsored by Press Ganey. Not only does the specialty group provide reports to individual physicians, but it also posts survey results internally for all physicians to see.

Even if your practice isn’t part of a larger initiative, it can still solicit feedback from patients using something as simple as a comment box at the receptionist desk, says Jeffrey. If physicians want to administer a more formal survey, they can do so using one of several surveys available, such as the one provided by SullivanLuallin Group at http://tinyurl.com/ohulk6k.

Providers may also want to partner with a vendor to administer the survey. Doing so allows physicians to compare their data with practices nationwide. SullivanLuallin Group, for example, has compiled more than 300,000 patient responses in just the last 12 months, allowing practices to benchmark their data by specialty, says Jeffrey.

Jeffrey provides the following tips for practices that want to try doing it themselves:

  • Administer the survey to a random and representative sample of your practice’s population.
  • Include as many questions as you feel necessary; however, try not to exceed 40 questions.
  • Ask about access to care (ease of scheduling appointments), communication with physicians and other staff members, thoroughness of the exam, ability of the provider to listen thoroughly, and ease of obtaining answers to billing questions.
  • Survey patients at least once per year or on an ongoing basis. Use the first survey as a baseline. Take steps to improve the patient experience and then re-survey to compare results.
  • Provide patients with options for completion, such as email, telephone, mail, or point-of-service (at the office via a tablet or paper).

The bottom line is to do something—anything—to evaluate performance and solicit feedback from patients because it will help you achieve three key goals—improving satisfaction, retention, and outcomes. “You need feedback from your patients at regular intervals,” says Jeffrey. “Surveying is just the first step. Without it, it’s just business as usual, and this could be problematic when competition heats up.”

For more tips and best practices watch, Nothing but the Facts: Find Out What Your Patients Really Think, a free webinar sponsored by Kareo and presented by Judy Capko.

About the Author

LisaEramofreelanceLisa A. Eramo is a freelance writer/editor specializing in health information management, medical coding, and healthcare regulatory topics. She began her healthcare career as a referral specialist for a well-known cancer center. Lisa went on to work for several years at a healthcare publishing company. She regularly contributes to healthcare publications, websites, and blogs, including the AHIMA Journal and AHIMA Advantage. Her focus areas are medical coding, and ICD-10 in particular, clinical documentation improvement, and healthcare quality/efficiency.

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Private Practice Is Challenging, But Even More Rewarding

Lea Chatham September 30th, 2014

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Tweet this Kareo storyBy Scott E. Rupp

It’s often said that independent physicians enjoy the flexibility that comes from being on their own, the owner of their own business, and the driver of their destinies.Tweet this Kareo story

This flexibility helps them define the culture of their practices and have the final say about the direction of the practice, including patient volume, the hiring of staff, and implementing new technologies to better manage day-to-day operations.


Employment trend not all it seems
Even as the trend seems to be toward employed physicians, especially among those who are under 40, many doctors remain steadfast in their desire to maintain their entrepreneurial spirit and are building practices based on their own personal and professional goals.

In regard to operating an independent practice, there are certainly pros and cons. Ultimately, it’s up to the individual physician to decide what he or she wants out of a career and from their lives. For those entering the field, there’s much to consider—do you go for the comfort and stability of employment and give up the autonomy that comes with independent practice?

The challenge of independent practice is clear. According to Medical Economics, “Growing regulatory pressures, privacy rules, the burdens of billing and collections, steep investments to incorporate electronic health record (EHR) systems, and onerous requirements of data collection are all difficult to manage on one’s own. These forces, coupled with declining revenues, are causing more doctors in small practices to consider employment over independence.”

However, the pros of private practice still outweigh the lure of a steady paycheck for many providers. An example of this can be found among orthopedic surgeons, a population that seem to be among the employment holdouts, at least according to the American Academy of Orthopaedic Surgeons. Census data from 2010 suggests that more than 40% of orthopedic surgeons are still in private practice and 20% of those physicians are in solo practitioners. Only 8% of those surveyed reported being employed by hospitals.

According to respondents of this particular survey, a major advantage listed of maintaining a private practice is the autonomy the physicians claim over their careers and their professional lives. “They can make decisions based on care instead of hospital policy, and they can change processes more quickly because they are smaller than hospitals.”

Of course, physicians in small practices must continue to adapt, change, grow, and evolve with the times—probably more aggressively than their hospital-employed counterparts. Luckily, for those willing to take the risk, there are more and better options to help them meet the challenges as well.

Independent impulse really remains strong
The impulse to remain independent is still strong among a significant number of doctors in practice today, reports Medical Economics. Based on the results of a 2012 survey of more than 5,000 physicians, conducted by The Doctors Company, 56% of respondents said they were unlikely to change practice models in the coming few years.

Flexibility and autonomy don’t end with being the boss of a business; the concepts have deeper roots than that. Work life balance is important, of course, but so is patient care. Many solo practitioners say they have a stronger bond with their patients than those who work in health systems or hospital-owned practices. From a patient perspective, receiving care at a large practice means they’re likely not seeing the same physician every time they seek an examination, and there’s a good chance that their doctor (or doctors) do not know them personally nor are they likely to be highly involved in all aspects of their care. In many cases, small practice physicians not only know their patients, but they also get to know their families and their patient’s stories beyond their health.

Independence offers flexibility, options, and higher satisfaction
For those leading independent practices, they also are able to engage in all areas of the business they run and become more well-rounded. For providers who have a passion for the business side of care or like to have a say in decisions, they get everything they want.  They have a voice in everything from HR and marketing to managing finances, IT, contract negotiation, revenue cycle management, and facility management.

For a doctor who wants the independence but doesn’t want to manage the day-to-day, it is actually easier for a small practice to outsource many billing and office tasks affordably. There is less bureaucracy and decisions can be made more quickly. A nimble practice like this can shift to outsourced tasks or take back tasks much more easily. This is part of the flexibility that is so appealing.

Finally, according to a 2014 survey conducted by Medscape, self-employed doctors are somewhat more satisfied with their situation than are employed doctors. Additionally, about 70% of physicians who left employment in favor of self-employment are happier now. Only 9% who went to self-employment are unhappier now. According to the study, in contrast, less than half (49%) of physicians who left self-employment for employment are happier now, and a quarter (25%) are unhappier now. All in all, those responses seem indicative of a sentiment towards independence.

“I am so lucky,” says Michelle Meyer-Ban, RNC, MSN, WHNP-BC, a board certified Women’s Health Nurse Practitioner who went out on her own. “It has only been five years, and I have grown to this point, which is just amazing. The practice model and the technology fit with and support my professional and personal goals. And I would just reiterate that this endeavor is totally possible for anyone. You can go into private practice and create a thriving practice with the right technology that lets you keep costs low and be efficient.”

To learn more about how you can successfully step out on your own, check out the recording of the recent webinar, Taking the Leap: Best Practices to Start Your Own Medical Practice.

About the Author

SRuppScott E. Rupp is a writer and an award-winning journalist focused on healthcare technology. He also works as a public relations executive, and has spent time working in house with a major electronic health record/practice management vendor. In addition to writing for a variety of publications, Scott also offers his insights on healthcare technology and its leaders on his site, Electronic Health Reporter.


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The Great Healthcare Payment Switch: Fee-for-Service to Pay-for-Performance

Lea Chatham September 25th, 2014

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Tweet this Kareo storyBy Charles Settles

Everyone agrees the United States’ healthcare system needs improvement, but nobody can agree on how that should happen. Transitioning from a fee-for-service payment model to a pay-for-performance model is one of the more popular solutions being touted as a potential fix. It could improve service for everyone—or make it worse.


As far as the United States’ government is concerned, the debate is over.
Fee-for-service in healthcare is out, and performance-based compensation is in. Tweet this Kareo story
Incentive programs have been designed and deployed, and new acronyms such as HVBP and PQRS have entered the medical lexicon. Billions of dollars in incentives have been paid to providers and care organizations to encourage them to adopt electronic health records (EHR) software. This technology gives regulators and payers access to an ocean of patient data, which will presumably help improve population health modeling, and ultimately treatment outcomes—if the hype is to be believed.

‘Big Data’ has already transformed sales, marketing, logistics, and innumerable other industries—why not healthcare? Normalizing healthcare data is not without challenges though. Many providers refer to the same procedures with different names. For example, a ‘heart attack’ could be referred to as a myocardial infarction, MI, or just simply as the layperson’s aforementioned ‘heart attack’. A person reading notes with those terms would identify them all as the same condition, but a machine reading those notes would identify three separate conditions. This is one of the biggest problems with data-driven medicine: subjectivity. Disparate terminology isn’t technically subjectivity, but the root problem is that freethinking, and most importantly—unique—humans will have varied habits, speech patterns, subjective opinions, and other nuances that objective machines struggle to decipher, let alone match.

Reconciling disparate terminology for the machines’ benefit is one of the reasons behind adopting new codes sets, such as ICD-10, that turn physicians’ narratives or superbills into machine-readable diagnoses and progress notes. If the idea of health 2.0/3.0 is going to be realized, this is something that must happen. Natural language processing software has made great strides, but it would still be a struggle finding regulators, lawyers, or patients willing to have a machine fully interpret a doctor’s note. It will always be necessary to have a trained human to interpret and perform medical procedures—in some capacity—barring science-fiction levels of advancement in artificial intelligence.

While population health modeling and data-backed treatment protocols are all seen as positive outcomes of such standardized systems, physicians can sometimes end up feeling like glorified data entry specialists at best, or as one physician said, off the record, “barcode machines” at worst. The same physician went so far as to say that having clinicians collect the data being provided to payers and CMS is “akin to having a condemned man dig his own grave.”

Hyperbole aside, the most cited problem with American healthcare is the high cost of treatment. The only data important to the bottom line in a fee-for-service, non data-driven payment model is the number of procedures performed. In a performance-based system, instead of doing more procedures to earn more money, physicians must instead improve treatment outcomes.

Starting this transition now gives providers the ability to not only get used to the coming changes, but also influence the metrics by which their performance will be measured. If the story is in the data, it benefits organizations to capture as much data as possible, and analyze that data to discover trends in their own patient outcomes.

The elephant in the room, of course, is whether or not outcome-determined compensation will negatively affect the amount, variety, and quality of care available. Exceptions will likely be made to encourage clinical trials, but where will the line be drawn elsewhere, if at all? If any sort of approval, arbitration, allocation, or negotiation process is necessary, data will likely be the determining factor. Being able to demonstrate outcome ‘improvement’ in any treatment-attributable, measurable way will be necessary for proactive providers and organizations.

In short, anyone holding out on electronic health records, data analysis, or other technologies because of supposed complexity or expense is rapidly running out of time to get in front of new mandates. If expense is an issue, Meaningful Use Incentive Program eligible providers have only until Oct. 3, 2014 to take advantage of over $23,000 in incentive payments, and only until next year to avoid a one percent penalty in Medicare reimbursements. Even non-eligible providers have reasons to learn more about data analysis in healthcare—even if they’re only monetary.

About the Author

charles settleCharles Settles is a product analyst at TechnologyAdvice. He covers topics related to healthcare IT and gamification. Connect with him on LinkedIn.




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