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How to Utilize Medical Practice Consultants Effectively

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

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Building Effective Patient Education Programs

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Pearl | April 22, 2015 | Patient Relations, ACO, Healthcare Reform, Patients, Pearls
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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.

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Independent Integrated Networks: What You Need to Know

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Pearl | July 01, 2015 | Practice Models, Payers, Pearls, Performance, Physician Compensation
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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.

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Patient-Centered Specialty Practice for Specialists

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Pearl | June 25, 2014 | Patients, Operations, Partnerships, Patient Relations, Pearls, Practice Models
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While still in its infancy, word about the National Committee on Quality Assurance’s (NCQA) medical home program for specialists is spreading fast. The program was released last March and appears to be gaining considerable momentum. We receive inquiries daily from practices asking how we can assist them with meeting the program’s standards; from gastroenterologists, oncologists, nephrologists, orthopedists, even ophthalmologists.

Unlike the primary-care Patient-Centered Medical Home (PCMH) program that has taken several years to become firmly established, it appears that specialists are “early adopters” of this new similar program — Patient-Centered Specialty Practice (PCSP) — designed especially for them.

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How You Can Successfully Participate in P4P Programs

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Pearl | April 30, 2014 | Performance, Payers, Pearls, Physician Compensation
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Participating in pay-for-performance (P4P) programs can work out well for both provider and payer. By “performing well” on certain clinical and administrative measures, savings are created that can be shared with both parties. That is, if providers can meet specific metrics that appear to produce some savings by, say, coordinating patient care better or ensuring that the population is receiving timely preventive care, then everyone wins and costs go down.

However, it can be a little perilous to participate in these programs if you don’t have a good understanding of your own data. Signing up to meet specific goals without first knowing where you currently stand or without being able to monitor progress as you go along a defined time period can mean falling short of expectations and losing out on additional revenues. So, it is vital that you must be able to run reports in your own system to either validate or dispute the data that the payer will be producing, in terms of how your providers have performed. Depending on your IT infrastructure, this may or may not be an easy task!

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