Entries by Heidi Hallett

How to Market to Millennials

August 2, 2018 in /by

Pearls | Aug 1, 2018 | Marketing, Pearls, Technology

By 

Original published at www.physicianspractice.com

Millennials have a completely different set of expectations than prior generations when it comes to engaging with the world around them. They are the digital natives and, as such, are used to interacting with their social networks, accessing services, and having the world’s knowledge all at their fingertips.

Marketing Your Practice to the Self-Funded Employer Market

October 31, 2017 in /by

Pearl | August 02, 2017 | Payers, Operations, Pearls, Practice Models
By 

Original published at www.physicianspractice.com

The self-funded employer market is growing with groups of 50 employees and beyond now entering the market. In fact, according to The Henry J. Kaiser Foundation’s 2016 Employee Benefits Survey, 61 percent of covered workers are in a plan that is completely or partially self-funded, a market that has been steadily increasing, up from 49 percent in 2000.

How Your Payer Directory Profile May Harm Your Practice

March 22, 2017 in /by

March 15, 2017 | Payers, Contracts, Patients, Pearls

By 

Original published at www.physicianspractice.com

Are you aware that insurance companies are ‘grading’ you? Do you know what your grade is? Do you understand how your profile can impact your patients, particularly if your score is not enough to make ‘top tier’? If you don’t, now is the time to pay attention to this issue.

An Introduction to Value-Based Payment Models

February 21, 2017 in /by

Pearl | November 30, 2016 | Payers, Healthcare Reform, Pearls, Population Health, Practice Models
By

Originally published at: www.physicianspractice.com

For many physicians and practices, their introduction to “value based” contracts will come in the form of understanding Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). However, if you are getting paid on a “pay for performance” basis from the commercial payers, you are already participating in value-based contracts.

The “value-based purchasing” model evolved from work done by the University of Michigan Center for Value-Based Insurance Design, a non-profit that was established in 2005 to develop, evaluate, and promote value-based insurance initiatives. Their initial research studied the impact of healthcare costs and paying for care “events,” rather than outcomes. Eventually value-based reform helped to shape the Patient Protection and Affordable Care Act (the ACA) signed into law in 2010.

So what does all that mean to you? The bottom line is that “payers” — insurance companies, employers, and now consumers themselves — are looking for more value for the money they spend on healthcare.

How to Utilize Medical Practice Consultants Effectively

September 1, 2016 in /by

Pearl | August 31, 2016 | Managers Administrators, Law & Malpractice, Operations, Pearls
By 

Originally published at: www.physicianspractice.com

As a consultant, my job is not just to help clients to solve business problems, but also to help educate clients on the best ways to maximize their return on the investment they are making for our services.

Naturally some physicians are afraid to use consultants. They may know that they need help with their practice but are often concerned about costs, and frankly, how to even go about engaging one!

1. Do you need a consultant?

Consultants are best utilized for highly specialized areas, such as insurance contract negotiations, succession planning, strategic business planning, coding audits, practice assessments, practice valuations, mergers, practice start-ups, EHR selection, and those sorts of occasional, single-need projects. If you have needs like these, hiring an experienced expert who knows how to do it right will be worth your investment.

Do not use consultants for things like billing and credentialing, day-to-day management and finance, and human resource management. These are longer-term, daily activities, and as such, you should either hire the in-house experience you need or outsource these functions altogether.

MACRA, MIPS, and APMs — Are You Ready?

July 11, 2016 in /by

Pearl | July 06, 2016 | Healthcare Reform, Payers, Pearls, Physician Compensation, Physician Compensation Survey
By 

Originally published at: www.physicianspractice.com

With the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), CMS has proposed a Quality Measure Development Plan that will combine all of the existing quality reporting programs into one new system. To report quality measures, providers will participate in either the Merit-Based Incentive Payment System (MIPS) and/or Alternative Payment Models (APMs).

First, do you qualify?

If you have $10,000 or less in Medicare chargesand 100 or fewer Medicare patients annually, then you are exempt from MIPS participation. Otherwise, you need to participate in a MIPS or APM model.

Physicians Contract with Self-Funded Employers

October 30, 2015 in /by

Pearl | October 28, 2015 | Payers, Patients, Pearls, Physician Compensation, Revenue Cycle Management

By Susanne Madden

Originally published at: http://www.physicianspractice.com/payers/physicians-contract-self-funded-employers

Some medical practices are cutting out insurance companies and providing services directly to employers (direct care), thereby reducing overhead and cost to patients.

First, let me define what is meant by “direct care.” Similar to charging patients cash for your services, the difference here is that you are charging employers directly for services delivered to their employees. There is no middle-man insurance company; simply two parties exchanging cash for services. So “direct” here means that you, the physician, are selling your services directly to the purchaser of healthcare, the employer.

This is not as novel an approach as you might think. Employers, particularly those that are “self-funded” (meaning those that carry the financial risk for employee claims rather than the insurance company), have already been investing in medical tourism for years. They contract directly with providers of care overseas (or through medical tourism companies) and send employees for such services as bariatric surgery, knee and hip replacements, and hernia operations, which are far less expensive than here in the United States. Even some insurers, like Anthem Blue Cross and Blue Shield, are exploring the idea of including medical tourism as a part of their coverage.

The Potential of Patient-Centered Specialty Practice

September 3, 2015 in /by

Pearl | September 02, 2015 | Practice Models, Healthcare Reform, Patients, Pearls, Physician Productivity
By 
 

What is PCSP?

Patient-Centered Specialty Practice (PCSP) is a recognition program from the National Committee for Quality Assurance (NCQA) that went into effect in 2013. The PCSP program was designed in many ways to complement the success of NCQA’s Patient-Centered Medical Home (PCMH) program and expand its reach. The goal of the program is to encourage excellent care coordination by specialty practices in the outpatient setting, leading to less duplication of procedures and fewer hospitalizations.

Much like the PCMH program, the PCSP program focuses on proactive coordination of care, information sharing among clinicians involved in a patient’s care, and a centering of care around the patient (versus around the care setting).

According to the NCQA, “Specialists who achieve NCQA PCSP Recognition will show purchasers (consumers, health plans, employers and government agencies) that they have undergone a rigorous and independent review to assess their capabilities and commitment to excellence in sharing and using information to coordinate care.” What this means practically is that practices that undergo the process will be better placed to meet the challenges of the marketplace.

Building Effective Patient Education Programs

August 27, 2015 in /by

Pearl | April 22, 2015 | Patient Relations, ACO, Healthcare Reform, Patients, Pearls
By 
Patient education programs have been around for a long time, but typically these programs have been geared toward only the chronically ill and those that needed extensive management. In this era of the Patient-Centered Medical Home patients and insurers are looking more to physician practices to provide effective patient education in all aspects of their care. In fact, many insurance companies are actively measuring physicians’ performance on quality metrics. Current accountable care models factor in patient utilization of emergency rooms, hospital visits, and prescriptions, and attribute that cost to the patient’s primary-care doctor, which may also include specialties such as cardiology.

So what does this mean to your practice? With more accountability comes the need to manage patient populations more effectively to be able to hold the line on costs. If you are not doing a good job in actively engaging patients to “self manage” their own care, and utilizing lower-cost opportunities for managing your patients’ care, then you may soon find yourself failing to achieve a targeted level of care and cost utilization, and that will cost you money.

Independent Integrated Networks: What You Need to Know

July 2, 2015 in /by

Pearl | July 01, 2015 | Practice Models, Payers, Pearls, Performance, Physician Compensation
By 
Many physicians are by now familiar with such terms as “clinically integrated networks” (also known as CINs), but a slightly different model is beginning to emerge as independent practices resist being swallowed up by hospital systems, and physician organizations become more savvy. You can think of this model as a hybrid between the “super group” (or clinically integrated practice) model and the more familiar hospital-based offering whereby care coordination and data is managed centrally there. Rather, these independent integrated networks (IINs) are being driven by independent physician organizations, coalitions, and alliances between physicians themselves.

What is “clinical integration” anyway?

The Department of Justice and the FTC define clinical integration as an active and ongoing program to evaluate and modify practice patterns by the CIN’s physician participants and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality. Generally, the FTC considers a program to be clinically integrated if it performs the following:

1. Establishes mechanisms to monitor and control utilization of healthcare services that are designed to control costs and ensure quality of care;

2. Selectively chooses CIN physicians who are likely to further these efficiency objectives; and

3. Utilizes investment of significant capital, both monetary and human, in the necessary infrastructure and capability to realize the claimed efficiencies.