overcoming the struggles of small practices

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Small practices face many struggles on the road to success. This webinar overviews the top obstacles they face, addresses the reasons behind the decline in numbers of independent practices, and provides solutions for them to remain successful despite the challenges.


  • OvercomingtheStrugglesof SmallPrac5ces Wednesday, March 19, 2014 Disclaimer: Nothing that we are sharing is intended as legally binding or prescrip7ve advice. This presenta7on is a synthesis of publically available informa7on and best prac7ces.
  • Ques%ons/Challenges Describes the future for small prac%ce physicians uncertainty. ACA is now underway What happens when new, previously uninsured pa%ents poten%ally overwhelm your oce? Can you aord to upgrade / implement / support an EHR system?
  • Dicul%es Implemen%ng/Upgrading an EHR Providers and sta not comfortable with the system / changing systems Centralizing pa%ent charts Hardware Limita%ons Cost advantages & Disadvantages Privacy concerns
  • Key Issues with Medical Records Lost Charts Secure Record Storage Lack of Clinical Documenta5on for Coding HIPAA and Regulatory Compliance Processing Requests for Pa5ent Charts Very important or important 84% 78% 87% 96% 80% Somewhat or not important 16% 22% 12% 4% 20% Source: HealthPort. Key Issues with Medical Records. Customer survey. Results may not total 100 due to rounding.
  • Decline in Independent Prac7ces Independent prac%ces are declining. AAFP report in 2011 shows that 60% of ac%ve members were fully employed by hospitals Same report shows that just 35% were sole or par%al owners of their prac%ces An AMA survey shows more than 18% of physicians work in a solo prac%ce. Down 24% from a study in 2008
  • Why the decline? Lack of good business knowledge on the part of physicians Top ve issues aec%ng physicians in 2013 as iden%ed by the Physicians Founda%on. Ongoing uncertainty over the ACA Consolida%on Introduc%on of millions of newly-insured pa%ents Erosion of physician autonomy Growing administra%ve burdens
  • Aordable Care Act An es%mated 8-9 million Americans have obtained health insurance. Many implementa%on details are frustra%ng physicians, including, The Insurance Marketplace Accountable Care Organiza%ons (ACOs) The Medicare Physician Fee schedule The Independent payment advisory board
  • Alphabet Soup Government Mandates arent helping either. Hard to keep up with items such as without high cost: PQRS penal%es ACA ICD-10 (small breather, but coming soon) etc
  • How to Survive? The best way to survive the changing landscape is to decide: Should I be acquired (and what are we worth), Should I acquire (and what does that entail) Or how do I make myself strong enough to survive?
  • Solu%ons? Lots of problems, what can we do about it?
  • Finance Management Plan for the Financial Future Work with vendors and consultants to es%mate long-term maintenance and upgrade costs early on to avoid unan%cipated costs Maximize Ways to Oset Costs Take the %me to assess thoroughly pa%ent mix, incen%ve eligibility, and the availability of addi%onal funding (grants, etc.) to maximize the ability to oset costs, engaging the RECs and consultants as needed.
  • Maximize Ways to Oset Costs Take the %me to assess thoroughly Pa%ent mix Incen%ve eligibility Availability of addi%onal funding (grants, etc.) to maximize the ability to oset costs Engage the RECs and consultants as needed.
  • Comprehensive Management Par%cipate In Collabora%ve Rela%onships Collaborate with other small oces to overcome selec%on, nancing, and implementa%on challenges through the pooling of resources and shared nego%a%ng power. Leverage External Resources (due diligence) Seek external resources and exper%se to oset gaps in internal capacity throughout the process of nancing, product selec%on, installa%on, workow integra%on, and advancement of func%onali%es.
  • Product Selec7on Selec%ng the Right Product Choose a product based on oce-specic use, in addi%on to assessing its aordability, interoperability, and capacity for basic vs. advanced features. Nego%ate Vendor Contracts that Meet Expecta%ons Communicate needs and implementa%on plans with vendors: unrealis%c expecta%ons can cause a minor setback to become major as sta buy-in decreases in rela%on to their percep%on of the process.
  • Implementa7on and Use (Cont.) Integrate Technology Into the Workow Engage users with the systems to overcome expecta%ons that it replaces exis%ng paper processes and work with vendors to build sooware based on best prac%ces, while integra%ng the health IT into the workow. Invest In Training (one place not to skimp) Beyond vendor training, train sta on complex or infrequently used system interac%ons, train new sta members, and provide supplementary training based on ambulatory-specic processes
  • Treat the Prac%ce as a Business A business that must prot Oer the same conveniences to pa%ents that the big players do, such as weekend/evening hours Find inexpensive ways to market the prac%ce Social Media Mul% faceted sta that can perform in clinical and administra%ve capacity Conveniences of allowing pa%ent access to a portal to schedule appts and pay bills online to reduce the burden on the sta
  • Reform Exemp%ons Claim exemp%ons for MU requirements where applicable. In addi%on to vendor issues, eligible professionals and hospitals can apply for hardship exemp%ons because of: Lack of infrastructure Unforeseen/uncontrollable circumstances Lack of control over the availability of cer%ed EHR technology Lack of face-to-face interac%ons And more
  • Interfaces a blessing Lab Interfaces Facili%es ooen foot the bill Reduce scanning %me Document Interfaces to reduce scanning %me Especially in the case of local hospital feeds Get crea%ve with interfaces Automate CCs if possible to reduce scanning
  • Automated Pa%ent Reminders Great case studies suppor%ng ROI here. Even a slight reduc%on in pa%ent no-shows can mean large prot increases Case study of small oce:
  • Gained Revenue in a Year Appointment Reminders Average Cost per visit $90.00 Provider Salary $62.50 Total No Show Cost $152.50 Total Pa%ent Visits 25,000 No Show Rate 19% # No Shows 4,750 Cost per No Show $152.50 Total No Show Cost $724,375 Total Pa%ent Visits 25,000 No Show Rate 19% No Show Reduc%on 4% Visits gained 1,000 Revenue gained $90,000
  • Final Thoughts These are only the most high-prole impacts to the healthcare industry during the current year. Tremendous pressures are coming to bear within a limited %meframe. Were seeing an industry in the midst of tectonic change, with 2014 as the fault line. Its unclear whether these disrup%ons will be for beter or worse. But there certainly will be winners and losers, and those who plan ahead are most likely to survive.
  • Q&A dan.holleran@quirkhealthcare.com tamina.vahidy@quirkhealthcare.com