Take Control of Your EHR
As of 2017, 86% of office-based physicians had adopted an electronic health record (EHR). Since 2008, this has more than doubled, from 42% to 86%. While the promise of EHRs was to improve our access to patient data and streamline ordering and billing, increasing evidence suggests it is making our work day more difficult. A study published this past year found that the use of EHRs contributes significantly to physician stress and burnout, adding to our daily frustration level. Physicians also reported having inadequate time for documentation and spending large amounts of time working on EHRs at home. It is not too late to optimize your current EHR.
1. Ensure you are up to date on your version of your EHR. While upgrading may seem laborious and unnecessary, upgrades are usually better versions, often with additions recommended by providers. This also ensures ongoing interoperability with your practice management software and other IT tools.
2. Ensure adequate training after upgrades. The amount of training providers get on their EHR correlates with satisfaction levels. This is not only true during initial instillation but also for upgrades. Have a “provider champion” review the upgrade notes and share the info with all the providers.
3. Ensure your clinical workflow takes advantage of your EHR capabilities. Maximize the amount of information your front desk, then medical assistant or nurse can enter into the EHR before sending the patient chart to you. Document as much of the chart note as you can while the patient is still in the office, leaving less to have to go back to later.
4. Let individual providers adapt processes that work best for them. Not everyone has to do it the same way. Some providers may do better typing their notes into the EHR, some may prefer to dictate parts or all of their notes, and some may do better with a medical scribe.
Ongoing optimization can be crucial to keep your EHR working for you.
Percentage of office-based physicians using any electronic health record (EHR)/electronic medical record (EMR) system and physicians that have a certified EHR/EMR system, by U.S. state: National Electronic Health Records Survey, 2017 pdf icon[PDF – 371 KB]
Rebekah L Gardner, Emily Cooper, Jacqueline Haskell, Daniel A Harris, Sara Poplau, Philip J Kroth, Mark Linzer, Physician stress and burnout: the impact of health information technology, Journal of the American Medical Informatics Association, Volume 26, Issue 2, February 2019, Pages 106–114.
Monica Kate. 11 Ways Medical Practices Can Get More Out of Their EHR Systems. Accessed 28 July 2019
Hiring the Right Staff for Your Practice
Your patients’ perceptions of your allergy practice depend not just on the care provided by the physician, but also on their interactions with your practice staff, from the front desk to the MA to the nurse. How can you ensure you’re hiring (and keeping) high quality staff?
• Make sure the job description is up to date and potential employees are clear on expectations and responsibilities.
• Review applications carefully to ensure applicants have the right experience and training, and don’t be afraid to contact references.
• Ask open ended questions during the interview, and if possible, have the final candidate spend a couple of hours shadowing staff in the practice.
• Once hired, make sure the new employee gets a thorough orientation to the job and the practice.
For more insights on hiring the right staff for your practice, pre-order the recordings from the 2019 Practice Management Workshop, or read the chapter on Staffing and Human Resources Issues in the Practice Management Resource Guide.
Implementing the New USP 797 Standards in Your Practice
New USP Chapter 797 standards on sterile compounding were released June 1 and take effect December 1. Practices have the option of preparing extracts using an ISO Class 5 Primary Engineering Control (PEC) OR in a dedicated Allergenic Extracts Compounding Area (AECA). Additional personnel qualifications and training is also required to be in compliance.
The AAAAI website has a variety of resources to help your practice meet these standards, including:
• An overview of the new standards and requirements for allergy practice compounding areas
• Personnel qualifications, hygiene and training requirements
• A podcast episode with Andrew W. Murphy, MD, FAAAAI, where he breaks it all down and provides background, details about Chapter 797, and tips for implementation
The AAAAI Practice Management Workshop, July 12-14 in Cincinnati, will feature an expert session on implementing the new USP 797 standards in your practice, along with other important practice management topics. Online registration is open through July 1.
HIPAA for the Practicing Allergist
HIPAA is an acronym for the Health Insurance Portability and Accountability Act of 1996. “Privacy” and “Security” are not in the name HIPAA, but they present our biggest challenges.
The Office of Civil Rights revenue from HIPAA violations has doubled every year since 2012. Practices of all sizes are at risk, but smaller size practices are at higher risk. The practice or business can be fined for HIPAA violations even if a breach doesn’t occur. That is the case when a Business Associate does not comply with the HIPAA rules.
Business Associates (BAs) are individuals or entities who create, receive, maintain, or store private health information on behalf of a covered entity. Answering services, medical transcription, IT groups, billing companies, and shredding services are considered BAs.
HIPAA requires that BAs must now:
• develop policies and procedures for HIPAA, as well as train staff
• conduct risk analysis
• be subject to federal inspections
• monitor covered entities where a Business Associate Agreement exists and have Business Associate Agreements with sub-contractors
• be subject to the HIPAA Breach Notification Rule
In 2019 the major issue is communicating with patients and providers utilizing emails and text messaging while complying with the HIPAA rules.
To learn more, attend the 2019 Practice Management Workshop, July 12-14 in Cincinnati, Ohio.
Practice Tip of the Month: Be Aware of Insurer Skin Testing Limits
Insurers are beginning to limit the number of skin tests a patient may have over a period of years (the time varies with insurer). If your new patient has had previous testing, you may not get paid. Be sure to familiarize yourself with the limitations of your most prevalent insurers so you are not surprised! The AAAAI Office of Practice Management is working with insurers to make sure that these limitations are reasonable. For example, there should be no skin test restrictions when a patient is changing allergists.
Click here for more information on additional AAAAI advocacy activities.
Looking for other great practice management ideas? Register for the 2019 AAAAI Practice Management Workshop, July 12-14 in Cincinnati, Ohio.
Practice Tip of the Month: Don’t Be Afraid to Negotiate Your Employment Contract
Whether you’re starting your first job after fellowship or are well into your allergy career, you can successfully negotiate (or renegotiate) your employment contract. Here’s how to start:
• Read up on negotiation strategies and practice your pitch.
• Research the market value for allergists in your area so that you have an idea of what you can reasonably expect.
• Remember that base salary is only part of your overall compensation package, which can include benefits like health, malpractice and life insurance, paid time off, CME days/CME allowance, relocation or moving allowances, and more.
The AAAAI Practice Management Resource Guide has more specific information on contract negotiation strategies, and this post on the KevinMD blog includes some great ideas for how to determine your market value.
Early career allergists can learn contract negotiation strategies from seasoned employment attorney Penny Phillips, JD, at the 2019 AAAAI Practice Management Workshop, July 12-14 in Cincinnati, Ohio.
Practice Tip of the Month: Payer Relations
Many insurers are requiring proof of reversibility of airway obstruction for the approval of biologics. By the time the patient needs biologics, however, documenting reversibility may be difficult.
Remember to be sure that this test is performed at some point early in the course of asthma, if appropriate, so you have documentation when the time arrives. The AAAAI Office of Practice Management is corresponding with these insurers about the practicality of this requirement.
Practice Tip of the Month: Successful Practice Transitions
With increasing mandates and complexities of practice, many physicians are either selling or closing a practice or joining larger entities in order to reduce financial and administrative burdens. Here are some things to consider if you’re:
Selling your practice
- Plan as far in advance as possible, and have a timeline for specific tasks.
- Assemble a team of experts – accountant, lawyer, appraiser – to help the sale go smoothly.
- Eliminate as much practice debt as possible, and hold off on making major technology investments.
Closing your practice
- Review your vendor, service and managed care contracts for notice requirements.
- Notify patients, staff and your insurance carriers as early as possible (at least 90 days prior to closing).
- Make arrangements for record storage and maintenance according to state regulations.
For more tips on transitioning your practice, view this presentation from the 2017 AAAAI Practice Management Workshop.
Start the New Year Off on the Right Financial Foot
Get yourself and your practice off to a good start in the new year by taking some time to think about your financial goals now.
Physicians start their first real job relatively late in life, and many have little or no financial experience and a significant debt load. It’s never too early (or too late) to get yourself on the track to fiscal fitness:
• Live below your means. Aim to save 15% of your gross income every month and set up a sensible household budget that covers your needs and wants. Consider buying a smaller house or less expensive vehicle until you are financially well-off.
• Build an emergency fund, then prioritize paying down debt (higher interest rate loans first).
• Whenever possible, use low cost, index mutual funds to invest.
• Diversify your investments to include an appropriate allocation of stocks and bonds, and make sure you are investing appropriately for your age and risk tolerance.
• Never try to time the market. Rather, periodically rebalance your portfolio to ensure that your desired asset allocation is maintained.
• Maximize your tax efficiency. Take advantage of tax-deferred plans like 401(k), 403(b), IRAs, 529s and HSA accounts. These allow your investments to grow tax-free.
For Your Practice
• Do you have patients with high deductible health plans (HDHPs)? Consider utilizing a credit card on file to automatically collect payment at time of service, or use them for monthly budget payment plans.
• Review your payer contracts and update your fee schedule annually. Keep a master list of your payers and their allowed charges to help you identify potential problems early.
For more financial tips, view these presentations from previous AAAAI Practice Management Workshops:
Revenue Cycle Management: From Appointment to Payment and Beyond
Personal Finances and Investing for the Physician: A Boglehead’s Approach
Practice Tip of the Month: Do You Know Your Practice Culture?
Studies show that a high performing medical practice with a strong culture:
• Can adapt more easily to changes in the marketplace
• Has employees who are more engaged, productive and aligned with the practice mission
• Benefits from lower employee turnover and less stress and burnout among physicians and staff
All of these factors contribute to higher patient satisfaction and a better bottom line for the practice. For more information on how to assess and improve your practice culture, view these slides from the 2016 AAAAI Practice Management Workshop.
Is Your Practice Prepared for an Audit?
Today, it’s a matter of when, not if, your practice will be audited. While audits can be nerve-wracking, there are things you can do now to ensure your practice is prepared for the inevitable.
• Keep meticulous records of your expenditures. File them on a regular basis (preferably monthly) and store them by calendar year. This will make it easy for you to assemble documentation quickly for the auditor.
• Create a checklist for your financial activities, from front desk collections to tax filing procedures. Make sure the staff responsible for these activities follow the checklist, and train new staff in your procedures as part of your onboarding system.
• Keep personal and business accounts separate.
For more practical details, listen to A Step by Step Guide to Surviving Practice Financial Audits from the 2018 AAAAI Practice Management Workshop.
Disaster-Proof Your Practice
Extreme weather events such as hurricanes, tornados, floods and wildfires are occurring at an increased rate. Is your practice positioned to weather the storm? Here are some lessons learned by Coastal Allergy & Asthma in Savannah, Georgia after Hurricane Matthew:
• Have a written disaster plan/procedure and make sure your staff is familiar with it. When emergencies arise, initiate your plan to ensure the safety and well-being of practice staff and patients.
• Closely review your business interruption insurance policy to make sure it will cover your operating expenses in the case of an unexpected shut down. It is also important to know what events trigger the insurance. As Coastal Allergy & Asthma found out, a mandatory evacuation order for an impending hurricane was not enough.
• Make sure you have a back-up generator in case of power failure and know how to start it manually.
• After the disaster, carefully inspect your property for potential damage.
Get more disaster preparedness tips and a sample plan here.
Does Cyber Insurance Make Sense for My Practice?
Allergy practices are experiencing escalating day-to-day operating expenses, but one expense we may no longer want to delay is the purchase of cyber insurance. In a 2017 survey by the American Medical Association and Accenture, 83% of physicians reported experiencing some sort of cyber attack. An accidental or deliberate patient data breach can cost your practice over $100,000 plus penalties.
What does one need to look for in a cyber policy? There are key categories that seem to be standardized in each cyber policy, but a comprehensive policy will cover losses resulting from patient data being stolen, exposed or improperly shared. It will cover breaches from deliberate actions, such as hacking or ransomware, as well as accidents (such as a lost laptop containing unencrypted patient data). You’ll want to sit down with your insurance broker and compare policies side by side to determine which option is the most cost effective for your practice.
Looking for more practice tips? Order the recordings from the 2018 Practice Management Workshop. Topics include billing, coding, financial benchmarking and more.
Maximize Your Revenue by Avoiding Common Billing Blunders
Conducting an annual audit of your practice’s revenue cycle management processes will help you avoid costly errors that can negatively impact your collections. Make sure to:
• Determine the patient’s benefits prior to the appointment (when possible) and collect co-payments at the time of the visit (always).
• Review all insurance payment guidelines at least every 6 months to ensure you are submitting appropriate and timely documentation for claims. This will decrease denials and staff time required to file appeals.
• Code each patient encounter appropriately, to the highest level of service supported by documentation.
AAAAI coding consultant Teresa Thompson and Tessie Adams will be reviewing these tips and more at the 2018 AAAAI Practice Management Workshop in Salt Lake City during their session “Beyond Correct Coding: Getting Paid for What You Do and Avoiding Billing Blunders.” Can’t make it out to Salt Lake City for the workshop? Preorder the recordings here.
Implementing Telemedicine into Your Practice
Have you seen a decline in growth in your practice? Telemedicine may help increase that growth with some considerations.
• Decide what the best work flow may be for your practice, whether it’s practicing telemedicine one day a week, in between in-person consultations or something else.
• If you implement telemedicine it must be secure and compliant with state and federal regulations.
• It is important to confirm that medical liability coverage includes a provision for telemedicine services.
• You don’t want to water down your current level of care so ensure your live interactive video visits with patients be at the same standard of care, professionalism and ethics as your in-person consultations.
For more tips on incorporating telemedicine into your practice, register for the 2018 Practice Management Workshop, July 20-22 in Salt Lake City, Utah.
Navigating the Solo Allergy Practice
Although the majority of fellows-in-training and young physicians join existing single specialty and multispecialty groups as well as academic institutes, a number of new grads are either considering or have already started solo practices. If you are in solo practice or considering solo practice, these tips are for you.
1. The stability and survival of a medical practice depends on its financial success. And the financial success depends on having a steady flow of patients, providing excellent patient care, good management and controlling the overhead while delivering the best care. Recruiting patients in solo practice is highly dependent on the physician’s reputation, which is in contrast to group practices where the flow of patients is greatly influenced by the reputation of the group or senior partners. To this end:
- Make sure your patients are having a great experience when they visit your office from scheduling to billing and collection.
- Learn appropriate scheduling to avoid having patients wait in the exam rooms or waiting room more than 10 minutes to see you.
- Listen and address patients’ concerns.
- Explain why you are doing any investigations or testing.
- Involve your patients in the decision making regarding treatment options and remember: satisfied patients are the best free advertisement for your practice.
2. When seeing a patient, communicate with the primary care provider even if the patient was not referred to see you.
3. Don’t speak negatively about other physicians. Not only it is unprofessional, but patients will not respect you or your medical opinion.
4. Hiring an experienced practice manager may not be financially feasible in first 5 to 7 years of practice and in some instances might discourage you from learning how to manage a practice. Consider hiring an assistant manager or attending the annual AAAAI Practice Management Workshop. The workshop will provide you with tools to understand all aspects of hiring, training and retaining staff, as well as scheduling, billing and understanding financial benchmarks. You also have the opportunity to network with a large group of allergy/immunology physicians and office managers with a wide range of expertise.
Utilizing Nurse Practitioners and Physician Assistants in an Allergy Practice
Are you considering hiring a nurse practitioner (NP) and/or physician assistant (PA) in your practice? Adding an NP or PA can:
• Expand physician schedule capacity
• Generate additional practice revenue
• Allow quicker access for acute visit patients
At Allergy, Asthma & Immunology Center of Alaska, one NP and one PA support five allergists at one location, according to Melinda Rathkopf, MD, FAAAAI. “Our NP and PA do routine follow-up visits (like annual immunotherapy visits), not new patient visits. They often have more availability to see acute visits quickly and are the first to respond to shot room reactions. They are an invaluable addition to our clinic and allow the allergists to focus on more complex patients.”
To ensure a good fit for your practice, you’ll want to assess if the NP or PA candidate shares your practice philosophy and is able to collaborate and adapt to your style of medicine.
For more tips on incorporating an NP or PA into your practice, view this presentation from the 2016 AAAAI Practice Management Workshop or register for the 2018 workshop, July 20-22 in Salt Lake City, Utah.
Practice Management Tip of the Month: Physician Wellness
Given the current and future healthcare climate, physician health and wellness is and will remain a significant issue. Tips for reducing physician burnout from a daily medical practice perspective were discussed in the October 2017 edition of Practice Matters! Now, here are some tips for the individual physician to help improve wellness and reduce burnout:
• Take care of yourself. Physicians are often involved in taking care of family members, including spouses and children, in addition to treating patients. Maintaining adequate sleep, nutrition and exercise is important, as is making sure to address your own physical and emotional issues by regularly seeing healthcare providers.
• Find a sanctuary outside of medicine. Take up a hobby or volunteer for a cause you believe in to help alleviate the daily stresses of practice.
• Take your scheduled vacation time to destress and allow a “recharge” of energy. Many physicians do not fully use their allotted vacation times.
• Take small breaks during the work day, including breaks from electronic devices.
• Focus on the positive aspects of work as well as family and personal issues, and maintain a sense of humor regarding these topics.
Remember, as healthier allergists/immunologists, we can be even better advocates for our patients and our wonderful specialty.
Reference: Nanda A, Wasan A, Sussman J. Provider Health and Wellness. J Allergy Clin Immunol Pract 2017; 5: 1543-8.
Practice Management Tip of the Month: Sample Anti-Harassment Statement and Policy
allegations have made the news repeatedly in the last few months. The AAAAI has added a sample anti-harassment statement and policy here
for your consideration, but remember to always consult legal counsel in your own state before adopting any new policies and procedures in your practice.
Looking for more ways to improve your practice? Select recordings from the 2017 Practice Management Workshop are available for purchase in the AAAAI Continuing Education Center. Registration for the 2018 Practice Management Workshop, July 20-22 in Salt Lake City, Utah, will open March 1.
Use Social Media to Engage with your Patients and your Community
A recent Google Think survey found over 76% of patients were getting their healthcare information online. Make sure your practice website is up-to-date and engaging, and then leverage other social media platforms to engage with your patients and your community.
• Facebook: Establish a Facebook page for your practice and post information regularly (weekly, at a minimum, is best). Ask patients to “like” your practice page. Keep your personal Facebook page separate and don’t accept “friend” requests from patients.
• Twitter: Why Tweet? It’s a real time network with more than 328 million monthly active users. Use Twitter to communicate simple messages like pollen counts, shot hours and office hour changes. Build up a network of followers and connect with other allergists on Twitter.
• YouTube: This video sharing site can help you market your practice. Post short videos on key allergy topics, procedures (patch testing, etc.), or to answer common patient questions. You don’t need expensive equipment. You can use your smartphone to record and upload the video.
Find more tips on our Social Media 101 page, or Take a look at the slides from the 2017 Practice Management Workshop session on new practice marketing techniques. (Only AAAAI members can access this document.)
Practice Management Tip of the Month: Do You Need an Employee Handbook?
An employee handbook is needed whether you are a solo physician, practicing in a single specialty or part of a multispecialty group. It is the document that will provide your employees with the proper guidelines and rules that govern your practice and will allow you to reward or discipline an employee when needed. Fair employee treatment cultivates loyal employees. The employee handbook should include the following:
1. Mission and vision of the practice. It’s important to invest in developing a mission and vision that reflects your goals and beliefs and fits your practice style. Great mission and vision statements will motivate your staff.
2. Job titles and descriptions for all categories of the office staff.
3. The office hours of the practice.
4. What constitutes part-time and full-time employment and what benefits each are entitled to receive.
5. An outline of all benefits (medical and dental insurance, life insurance, CME allowance, PTO) and how to qualify for them.
6. A description of what actions result in disciplinary actions, as well as steps for disciplinary actions.
7. Rules about use of cell phones during office hours and personal use of office computers.
8. A statement and mandatory education on the Health Insurance Portability and Accountability Act (HIPAA) including the consequences of HIPAA violations.
9. Your sexual harassment policy, including your complaint or investigation procedure.
Employees must read the handbook and sign an acknowledgment that they read it. The signed acknowledgement should be page kept in each employee’s file.
Looking for more ways to improve your practice? Select recordings from the 2017 Practice Management Workshop are available for purchase in the AAAAI Continuing Education Center. Registration for the 2018 Practice Management Workshop, July 20-22 in Salt Lake City, Utah, will open in March.
Practice Management Tip of the Month: Negotiating Managed Care Contracts
Is your practice experiencing declining reimbursements? Here are some tips consultant Ron Howrigon shared during the 2017 Practice Management Workshop:
• Negotiation is a process, not an event. Your first plan generally won’t survive the first round; be prepared to adapt, adjust and overcome.
• Set goals for your negotiation. Reimbursement rates are essential, but contract language can be just as important. Set your opening position, identify areas open for negotiation and be clear on your walk away points.
• Knowledge, analysis and planning are essential for a successful negotiation. To strengthen your position, make sure you:
- Create a master fee schedule of each payer’s reimbursement level.
- Know your payer mix. How hard do you want to negotiate with a company that is only responsible for 6% of your payments?
- Know your contracts. Create a contract summary form that includes the fee schedule, effective dates, contract point outliers, etc. for each payer.
This session and other select recordings from the 2017 Practice Management Workshop are available for purchase in the AAAAI Continuing Education Center. Mark your calendar for the 2018 Practice Management Workshop, July 20-22, in Salt Lake City, Utah.
Practice Management Tip of the Month: Reducing Physician Burnout
Physician burnout can be caused by excessive workload, poor work-life balance and lack of control. Here are some tips from the American Medical Association (AMA) Steps Forward Campaign to reduce physician burnout:
1. Daily huddle with your team: Spend 5 to 10 minutes each day talking to your nurses and other office staff to plan how your day might go. Discuss the scheduled patients who might need more time with the provider or need any labs, tests and records to be retrieved or done before seeing the provider.
2. Have a documentation team: Nearly half of providers say they spend too much time on clerical tasks. Have your nurses help you enter clinical data. Train them to get better on their technology skills. Increasing the number of your support staff might actually save you more money. Consider hiring a medical assistant to serve as your scribe and as your nursing assistant.
3. Better prescription management: When prescribing a medication, consider prescribing a 90 day supply of medicines with 2-4 refills and try to be consistent in doing this. It will reduce the number of calls into your office for refills and other prescription changes. If a patient calls asking for refills, then you and your staff know immediately that a patient has not been to your office in a while and needs a follow up appointment.
Visit the AAAAI Continuing Education Center to order the recordings from the 2017 AAAAI Practice Management Workshop, which includes the topic "Practice Transformation: Reducing Burnout and Rediscovering the Joy in Practice."
Practice Management Tip of the Month: Handling Biologics in Your Practice
Here are a few tips from the 2017 Practice Management Workshop presentation on How to Handle Biologics in Your Practice:
1. Determine the number of patients that your practice has on biologics. It might be time to assign or hire a person on your staff to solely manage the handling, billing and administration of biologics.
2. Keep a detailed inventory and tracking log, and update it every day. The log should include patient names and insurance and specialty pharmacy information, payment information, dosage, and vials and milligrams used.
3. Do not forget about disaster management. In light of the most recent weather-related disasters, do not forget about having disaster insurance on your inventory of biologics and allergy extracts and vials. Even a simple prolonged power outage can destroy thousands of dollars’ worth of biologics, extracts and medicines.
To learn more tips, the AAAAI is offering select recordings of the 2017 Practice Management Workshop for purchase at the AAAAI Continuing Education Center.
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