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MAGAZINE
Business Lifestyles and Opportunities Vol. 3, Issue 2, 2015 Tampa Bay Edition
PRIVATE PRACTICE ENTREPRENEUR REDUCING RISK PLANNING FOR SUCCESS
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From the Publisher
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his issue is dedicated to Private Practice Physicians. I have huge respect for those that choose to dedicate their life to practicing medicine. As with any career choice at which serving society for the greater good becomes your motivation. Teachers, Military, First Responders and many more are examples of such. However, I have an even higher level of respect for the very same people that choose the same path as an Entrepreneur.
Practicing medicine has become more difficult in recent years. Physicians have been feeling squeezed by rising cost, flat reimbursements and increasing administrative and regulatory burdens. Such complex issues have brought a definitive trend toward salaried positions with hospitals and larger medical groups. Younger physicians and residents just entering practice are a significant portion of this trend. Choosing the path of entrepreneurship will have both pros and cons. As an entrepreneur myself, I know all too well. The freedom, flexibility and unlimited income potential are a few of the top reasons, along with the sense of gratification of building something of your own. The flip side of self-employment is it can feel isolated especially when you’re new. The buck always stops with you. Business owners wear many hats, shoulder all the responsibilities, and take the blame whenever something goes wrong. However, entrepreneurship when done correctly with great work ethic can bring huge rewards both financially and personally. A mentor of mine always says, “Entrepreneurs should work nothing less than half days... 8:00 am - 8:00 pm”. In this issue we feature two doctors that know exactly why they became entrepreneurs and share the quest that brought their practice to the success it is today. We thank Dr. Phillip Henkin and Dr. Tien Le for taking the time to share their story and Full Circle PR for all the help facilitating the physician spotlight, feature article and cover shoot. This whole issue is filled with great advice and direction. The Legal Corner guides you through the legality of supervision and Scott Jarred, CEO Jarred Bunch and contributor for our Wealth Management section discusses the steps of protecting today for the unknowns of tomorrow. Nick Hernandez, CEO ABIZA, LLC breaks down the important elements of successful operational planning and our security specialist Suze Shaffer provides some key issues on keeping your practice running securely and efficiently. Practicing medicine, serving and creating a difference is presidential. I think I can speak for most when saying, doctors you are rare and a compassionate breed. The decision to serve as entrepreneur or an employee is neither right or wrong, better nor worse. What matters most is that you serve. We solute and thank you, Be Well,
-Edd
MAGAZINE
Business Lifestyles and Opportunities Vol. 3, Issue 2, 2015 Tampa Bay Edition
PRIVATE PRACTICE ENTREPRENEUR REDUCING RISK PLANNING FOR SUCCESS
TAMPA BAY
™
Tampa Headquarters 1208 East Kennedy Blvd. #1029 Tampa Fl, 33602 813-419-7788 Group Publisher Edd Suyak publisher@doctorslifetampabay.com Creative Director Bryan Clapper Editorial Director Danielle Topper Associate Publisher CJ Cooper Advertising Account Executive Ryan O’Neil Editorial Advisory Board Scott Jarred Robert V. Williams Contributing Writers Nick Hernandez Suze Shaffer Scott Jarred Robert V. Williams Dr. Seth Flam Heather Urquides Doctor’s Life Magazine, Tampa Bay is always seeking events, stories and remarkable physicians. Please email the publisher if you have an event, an editorial idea or you know of a doctor or dentist who may have done something extraordinary. We want your suggestions and feedback. publisher@doctorslifetampabay.com Doctor’s Life Magazine, Tampa Bay does not assume responsibility for the advertisements, nor any representation made therein, nor the quality or deliverability of the products themselves. Reproduction of articles and photographs, in whole or in part, contained herein is prohibited without expressed written consent of the publisher, with the exception of reprinting for news media use. Printed in the United States of America.
Edd Suyak Group Publisher publisher@doctorslifetampabay.com 4
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Doctor’s Life Tampa Bay
Issue 2, 2015
Physician Spotlight
Dr. Philip Henkin 1. How long have you lived in the Tampa Bay area? Seven years.
2.
What is your favorite Tampa Bay restaurant? Donatello Restaurant on Dale Mabry Highway in Tampa.
3.
Where is your favorite place in Tampa Bay to relax? Out on my boat, with a fishing pole in hand.
4. How important is it for physicians to be involved with
their communities and how important is it to you personally? It’s important. The call that we answer is to help build a better community. It’s also important that people know you outside of work. I’m involved in my daughters’ schools and their sports activities.
5.
What are a few key reasons you decided to open a Private Practice? If I were to make a top ten list, 1-9 would be being my own boss. That’s the great thing about private practice. You get to set the policies. You determine the priorities for the practice, you determine what’s important to the patient and what’s important to you. That’s important to me. It’s also the great thing about American medicine. We have more choices for healthcare than anywhere else in the world, and it’s because of the private practice model.
6.
What are a few of the challenges you face while operating a Private Practice? The challenges include the changing landscape of medicine. Every year is different from the year before. A lot of people think every year is going to be similar, but I’ve found that every year is dramatically different. It’s based on market conditions. It’s based on regulatory influences from the federal government. It’s influenced by research, by patient studies, by your own practice, whether you’re in expansion mode, adding partners, adding services. All those things add challenge.
7.
How do you view the Affordable Care Act professionally and personally? The Affordable Care Act is very destructive to American medicine, especially the provision that outlawed physician-owned hospitals. The ACA is trying to institutionalize physicians into large group practices to be able to control healthcare costs and then ultimately have hospitals control physicians. The result will be you’ll just get the standard cook book medicine and there won’t be that freedom of choice. People will have a lot fewer options for care.
8. In your opinion, what are the most important
elements of a successful practice? Quality patient outcomes. Respecting the physician-patient relationship and realizing that you have to provide significant value to people is critical. Also, the ability to adapt and embrace 6
Dr. Philip Henkin is a Board-Certified Neurosurgeon who has been practicing in Florida for 17 years. He graduated in 1985 with a chemical engineering degree from MIT. After working as an international engineering consultant for two years, he returned to school in 1987 and graduated from Ohio State University in 1991 with an M.D. degree. He completed his post-graduate residency training at Duke University Medical Center from 1991 to 1998. He has maintained neurosurgical practice in Florida since graduating from Duke. new technology. It’s also important to diversify into different markets and different hospital systems and work with different providers.
9.
Rising operational costs, heavier administrative burdens, new technology requirements and reimbursement models shifting from a fee-for-service to a value based payment model are a just a few of the top concerns in Private Practice. Do you feel Private Practice is slowly being pushed out or do you still vision a successful future and why? I think right now the trend is very hostile toward private practice, but everything in medicine is cyclical. Eventually the pendulum will swing back again. People will always demand high quality care. There’s a big push toward consolidation, but all it’s going to do is decrease choice for the consumer and decrease choice for physicians, who are going to lose their autonomy.
10.
Knowing Yourself: If you could go back in time and provide your younger self advice, what would it be? I would probably choose a specialty that is less affected by the government’s influence and more driven by market, like plastic surgery. As plastic surgeon doesn’t necessarily rely on insurance payments or have the government limit his fees.
Doctor’s Life Tampa Bay
Issue 2, 2015
“Simplifying HIPAA” “Simplifying HIPAA”
The The Future Future Health Health of of your Practice Depends your Practice Depends Upon the Partners you Upon the Partners you Choose Today. Choose Today. Is your private practice Is your private alive and well? practice alive and well?
In this day and age, it is getting more In this day age, it is getting more difficult for and a private practice to thrive difficult for arules private to thrive with all the andpractice regulations that with all the rules and regulations that they have to adhere to. The responsibilities theyrisks haveinvolved to adhere to.also Thetaking responsibilities and are its toll andmedical risks involved areofalso takingSo itswhat toll on practices all sizes. on medical practices of all sizes. So what can a p practice do? Building a foundation can ap practice do? Building a foundation of partners to help you within and around of partners toishelp you within and around your practice essential. Know that you your practice is essential. Know that you don’t have to do it all yourself! don’t have to do it all yourself! Who do you trust? Who do you trust? Word of mouth has always been the best and still is. Once a company has been Word of mouthto has always the best and company recommended you, mostbeen companies will bestill ableis.toOnce give a you a letterhas of been recommended to and/or you, most companies will be able to givehealthcare you a letter of recommendation some testimonials from satisfied clients. recommendation and/or some testimonials healthcare There are also organizations out there that from have satisfied come together as a clients. package There are also organizations out there that have come together as a to help practices. They are a one-stop shop for all your needs. If you package select an to help practices. Theyask arethem a one-stop shop for all your needs. If you select organization like this, how they determine who is permitted to joinan organization like this, ask themon. how they determine who is permitted to join and what criteria is this based and what criteria is this based on.
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Wealth Management
Protecting Today for an Unknown Tomorrow
F
eeling the effects of regulatory and legislative implementations, shifts in practice ownership, and profitability demands, the healthcare landscape doesn’t look the same as it did 10 years ago. But what does all of this mean? Simply put, it means one thing: change. More specifically, change that can affect a physician’s key area of exposure: risk management in both their personal life and their practice. Scott Jarred, CEO of Jarred Bunch Consulting What does change really mean? For many practice owners, change can evoke feelings of uncertainty and even anxiety, because change puts unknown variables into play. However, what change should mean for practice owners is that it’s time to review your risk management strategies, and stress test them against the changes. Unfortunately, this is a commonly overlooked topic during the rush of the whirlwind. 8
WHERE DOES RISK MANAGEMENT FIT IN YOUR LIFE? While true risk management is meant to act as a hybrid function that spans multiple areas, too often for physicians it is compartmentalized into personal and practice risk management, which is often the result of practice owners operating under the idea that the financial risk Doctor’s Life Tampa Bay
in their personal life and their practice live in different hemispheres. Instead of reinforcing the fact that the two actually share a symbiotic relationship, with a physician’s practice tied to the health of their personal financial well-being, this can create a disjointed gap between the two. Efforts in risk management can either be proactive (preventative) or reactive (damage control). A proactive approach Issue 2, 2015
doesn’t come from simply having risk management strategies in place, but from whether or not they’re operating in a cohesive manner; allowing them to operate separately between personal and practice life may actually be causing practice owners to take a reactive approach. The first step in a proactive approach comes by considering the physician’s complete current financial position, and taking a top down approach to evaluate their risk exposure.
PROTECTION FIRST AT HOME
Instead of trying to forecast a future that we know nothing about, it makes much more sense to focus on managing your risk exposure to the changing information of today. Practice owners are an extremely critical financial asset, and their first stop in risk management should be themselves. Thus, the pivotal shift from a future first to a protection first approach ensues. One of the first questions practice owners should be asked is: If something happens to you, what will happen to your family? As a business owner myself, I, like many practice owners, am the sole income provider for my family. Addressing the impact of losing that income stream, along with what any debts associated with your practice would do to their financial well-being is essential. The goal here is to develop a two-tonged, risk management strategy meant to protect you for your full economic value, and to protect your occupation through specialized definitions that apply specifically to physicians who are also practice owners; in other words, protecting that income stream from multiple angles. When practice owners think “protection,” they tend to automatically think malpractice or HIPPA violations. While important protective measures to have in place, they aren’t necessarily solo, bulletproof strategies that adequately span both your personal and practice life. I often compare physicians to the likes of a professional athlete: people know that they have capital, and if their protection doesn’t start at home, they Issue 2, 2015
leave themselves in a vulnerable state. Instead, enveloping a practice owner’s complete financial life in a blanket of personal protection lays a dynamic foundation that not only ensures their personal well-being is safeguarded, but that can ensure their practice’s well-being is safeguarded as well.
PROTECTION FIRST AT WORK
While practice owners are considering what will happen to their family if something happens to them, they should also consider this question: If something happens to me, what is going to happen to my practice? Here, the goal should be to produce a proactive business continuation plan or exit strategy, which will ensure that in an owner’s absence, the practice will still thrive.
Every practice owner will have to exit their business at some point, and efficient risk management strategies will allow for them to exit the practice on their terms, regardless of the circumstances. Many times, exiting a business will come through the seamless process of handing over the keys to a younger physician already in the owner’s practice; sometimes, the exit comes unexpectedly, with more twists and turns to be navigated. Not only can business continuation planning protect a practice from revenue loss if an unforeseen life event causes an owner to no longer be able to work, but it can also help ensure that the owner’s personal goals and wishes for the continuation of their practice are met in both ideal and unideal circumstances. Managing the risk that Doctor’s Life Tampa Bay
comes with exiting a practice isn’t limited to simply choosing which continuation strategy to implement, but also how to fund that strategy; an ideal source of which can come from the practice owner taking the time to protect themselves at home as well.
RIDING THE TIDE OF CHANGE
Change doesn’t have to open the floodgates for fear and anxiety in a practice owner’s mind. Rather, it should imply that a time of innovation and refreshment is upon them, giving them the perfect opportunity to review their current risk management strategies.
For those practice owners who want to ensure that they are engaging in proactive risk management, it’s essential to recognize the overlap between your personal life and the life of your practice. With these two entities operating in a practice owner-centric manner, taking a protection first versus a future first approach can help you keep pace with managing the changing information of today, and ensure that your current strategies will still allow for your personal goals concerning your practice to emerge triumphant no matter the circumstances. 9
ICD-10 How to Minimize Impact on Your Practice and Revenue
U
nless it is delayed once again, the current deadline for ICD-10 implementation is October 1, 2015. This is the latest of a long series of deadlines, each of which has been delayed, beginning in 2009. The transition has been delayed several times due to delays in software readiness by some vendors and the extent of the retooling required for medical practices and hospitals. By Dr. Seth Flam, CEO and Co-Founder, HealthFusion
A
ssuming the deadline is not delayed again, the implementation of ICD-10 will likely have a significant impact on your practice in several ways. However, with the right preparation and planning, ICD-10 does not need to be a disaster for your practice. In 2008 the impact of ICD-10 on small medical practices was estimated to be $83,290, with the cost for a typical large practice estimated at $2.7 million. More recently, however, a survey by the Professional Association of Health Care Office Management (PAHCOM) found that the costs associated with implementing ICD-10 in small physician offices were significantly lower—approximately $8,167 for practices with six or fewer providers.
10
The key to insuring that the impact to your practice is on the low end of that scale is preparation. Practices that wait until the last minute to prepare for ICD-10 run the risk of paying higher prices for training, coders and other resources, in addition to being more likely to experience delays or even a stoppage in reimbursement. Here are the key steps you should take to protect your practice from a poor ICD-10 transition:
1. Evaluate the expected impact on your practice. You need to determine what ICD-10 means to your practice in terms of revenue and productivity. Any weaknesses in the
Doctor’s Life Tampa Bay
Issue 2, 2015
practice are likely to be exacerbated by ICD-10, so now is a good time to address any issues with Days in Accounts Receivable and patient collections. Next, check with your vendors to make sure that they are or will be ready for ICD-10. HealthFusion’s MediTouch EHR has been ICD-10 ready since December 2013; if your vendor is not ready, especially given the delays, that should give you pause. Some good tools for the evaluation process are: ICD-10 Cost Prediction Model Tool — The Healthcare Information and Management Systems Society (HIMSS) has designed a model to help healthcare providers predict the financial impact of the transition to, and use of, ICD-10 codes. Users can see and change assumptions in the model to reflect their organization’s circumstances. CMS has developed some guides to assist in discussions with your vendor, including: • Talking to Your Vendors About ICD- 10: Tips for Medical Practices • Questions to Ask Your Systems Vendors about ICD-10
Issue 2, 2015
2. Establish a plan, team and timeline.
Once you’ve evaluated the potential impact on your practice, you should begin to develop a plan for implementing ICD-10, with strategies for minimizing the risks involved. Assemble a team that represents various functional areas within the practice, and be sure to include each area that will be affected, such as front desk, billing, and clinical. Be sure to have a physician sponsor on the team to encourage physician buy-in. Build a timeline with your team that addresses the needs of the different functional areas yet enables you to meet the deadline – set due dates and make specific people accountable. As you proceed through your plan, be sure to reevaluate to make sure the plan is still working and you are on schedule. The American Health Information Management Association (AHIMA) offers two very useful resources to help you with this key step: • ICD-10 Implementation Toolkit • ICD-10 Preparation Checklist To train your team on the codes themselves, you can use resources including: • Daily ICD-10 Code Quiz • ICD-10 Code Search
Doctor’s Life Tampa Bay
3. Protect your practice cash flow. Denial rates are projected to increase by as much as 100-200 percent after ICD-10 is implemented, so your revenue could be significantly impacted by the switch-over. As hard as we’ve worked to prepare our EHR software, and as hard as you work to learn the new code set, you have no control over payers’ readiness. As a result, many experts are recommending that practices establish a line of credit well before Oct. 1 in order to avoid cash flow problems. Most importantly, don’t be overwhelmed; remember that you don’t have to eat the whole elephant. You’ll only need to learn the codes you use most often, and you’ll have references for those you don’t. Preparing now will help insure you have minimum problems on October 1, 2015. Dr. Seth Flam is one of the founders of HealthFusion and serves as the company’s CEO and President. He is board certified in Family Practice and is one of the creative forces behind MediTouch EHR. He blogs regularly on healthcare issues on the HealthFusion blog.
11
Legal Corner
The Many Levels, and perils, of supervision
Written by Robert V. Williams, Partner BURR FORMAN LLP
O
ne of the tenets of the Affordable Care Act was to provide access to care for all Americans. To that end, telemedicine is a piece of the healthcare transformation and the government is slowing helping with telehealth initiatives. Currently, states fall into one of twelve regional resource centers. Each resource center is funded by a federal grant to promote the use and expansion of telemedicine. Florida falls under the Southeastern Telehealth Resource Center, along with Georgia, Alabama, and South Carolina. Non-physician practitioners or physician extenders, as they are often called, are now common place in physicians’ offices and have been for some time. They are an integral part of the private practice of medicine for the simple reason that they provide very skilled and useful services to the physician’s practice and the patients that practice serves. They also provide a significant source of revenue which likewise augments the physician’s income. In short, physician extenders are good for both patients and physicians. Despite the many benefits that physician extenders provide, those benefits also come with conditions. One of those conditions is the requirements that physician extenders be appropriately supervised. It is the purpose of this article, therefore, to provide a brief introductory overview of the many different levels of the term supervision in the different settings that supervision takes place under both federal and state law.
FEDERAL
A
t the federal level, the degree of required supervision will usually depend on the applicable federal program. Of primary importance, of course, is Medicare. For example, the Centers of Medicare and Medicaid Services (CMS) define three separate levels of physician supervision for hospital outpatient departments: a) General Supervision - the physician must be available by telephone to provide assistance and direction if needed. 12
b) Direct Supervision - the physician must be “immediately available” and “interruptible” to provide assistance and direction throughout the performance of the procedure, but does not need to be physically present while the procedure is being performed. c) Personal Supervision - the physician must be in attendance in the room while the procedure is being performed. In the office setting under Medicare Part B, the focus is frequently on services furnished “incident to a physicians’ professional service.” 42 C.F.R. § 410.26. Although there are a number of conditions of coverage that must be met under the “incident to” provision, the supervision condition is of paramount importance. Thus, to satisfy that condition, the federal regulations require the physician to be present in the office suite and “immediately available” to provide assistance and direction during the period of time the service is being furnished. Finally, the role of physician extenders has also been expanded by the passage of the Patient Protection and Affordable Care Act in 2010. With the addition of more insured patients and the concomitant demand for health care services, physician extenders will play a larger and more expanded role in the provision of those services. And that expanded role will necessarily involve more physician supervision of those physician extenders. Doctor’s Life Tampa Bay
STATE
P
hysician extenders are also heavily regulated by the state where they practice. Indeed, state regulations are not only pervasive across the country, they are often very different between the states and even within the state itself. For example, in Florida, a PA is any person who is a graduate of an approved program or its equivalent or meets standards by the applicable boards (i.e., the Board of Medicine or the Board of Osteopathic Medicine) and is licensed to perform medical services delegated by the supervising physician. Florida Statute § 458.347(2)(e). As is clear from this definition, a PA in Florida can only work and carry out delegated health care tasks under the responsible supervision and control of a licensed physician. Indeed, the statutory definition specifically states that supervision means responsible supervision and control. Florida Statute § 458.347(2)(f). This supervisory relationship is manifestly a two way relationship. It is, therefore, critical that a physician or physician group that utilizes PAs have a thorough and meaningful understanding of what that supervision entails. Florida law is also quite clear that each physician or group of physicians supervising a licensed PA must be qualified in the medical areas in which the PA is to perform. Thus, a family practitioner Issue 2, 2015
generally would not be authorized to supervise a PA in an ophthalmology practice. The legal significance of this requirement is, of course, paramount because the statute also provides that the supervising physician or physician group shall be individually (or collectively) “responsible and liable for the performance and the acts and omissions of the PA” being supervised. In addition, Florida Statute § 458.347(15) provides that “each supervising physician using a PA is liable for any acts or omissions of the PA acting under the physician’s supervision and control.” And, obviously, a supervising physician’s failure to adequately supervise a PA under her control could also lead to a disciplinary action by the Florida Board of Medicine. For example, a Florida physician may delegate to a Physician Assistant (“PA”) only those tasks and procedures that are within the supervising physician’s scope of practice and which the supervising
physician, by training and experience, is also qualified to perform. Moreover, the decision to permit a PA to perform a task or procedure, whether under direct or indirect supervision, is based on the patient and the PA’s knowledge and skill in performing those tasks or procedures. Likewise, when a Florida physician enters into a formal supervisory relationship or standing orders with an emergency medical technician or paramedic, which relationship or orders contemplate the performance of medical acts, the physician must submit a notice to the Florida Board of Medicine to that effect within thirty days. A similar notice must be filed for advanced registered nurse practitioners under those same circumstances. PAs, on the other hand, have a distinctly different notice requirement. More specifically, the Florida Administrative Code provides further direction as to which tasks cannot be
delegated to a PA unless expressly permitted by statute, as well as supervisory restrictions relating to certain tasks and procedures. As is clear from the legislative intent statement at the beginning of the Florida Statute governing PAs, an important purpose is not only to encourage the use of PAs but also to encourage physician practices to utilize the skills of PAs to enhance physicians’ efficiency in the practice of medicine. The statute specifically recognizes that properly trained PAs can result in more effective utilization of a physician’s own skills by authorizing the delegation of health care tasks to qualified PAs. The use of physician extenders makes sense for any number of reasons, both from a professional and financial point of view. But, because of the potential liability, physicians are well advised to know the supervisory requirements under their state regulations and follow them carefully.
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Private Practice P
ENTREPRENEUR
hilip Henkin sold out. Once. It was 2005 when the hospital system came calling on the young neurosurgeon in Jacksonville. The allure was clear.
The hospital’s primary care physician base would guarantee him referrals. The hospital would pay his malpractice insurance at a time of skyrocketing rates. The job also came with regular hours and a steady income, important to the then 42-year-old physician with a wife and two young daughters. “There are advantages to institutional medicine,” Dr. Henkin says now. “But it wasn’t worth the control I had to surrender.” “Within six months, they wanted to fire all my office staff, people who had been with me for over 10 years. They told me what procedures they wanted more of and what procedures they wanted less of … they basically exerted too much influence.” He returned to private practice as soon as his two-year contract was up. It was a move that would pay in spades. Henkin, now 52, has a thriving practice in Brandon, Tampa Bay Neurosurgery & Spine Specialists, and a satellite office in Sun City Center. He is booked weeks in advance, and most of his patients come from recommendations from other patients. He also has a medical marketing group, Full Circle PR, to help spread the message about his superior care. But challenges still exist. He has been affected by the complexities of the changing healthcare landscape, the ever-increasing administrative burden, Medicare reimbursement rules and having to compete against the leverage hospitals carry. 14
People should just be reassured that private practice is the best model. People are always going to want superior care.” Doctor’s Life Tampa Bay
Issue 2, 2015
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I have a skill that has taken years to cultivate and I like achieving superior patient outcomes,” he said. “Seeing the appreciation from patients is really what makes it worthwhile.” “Right now conditions are somewhat hostile,” he said, “but the pendulum will swing back because people will realize the highest quality care is provided in the private practitioner model.” In fact, part of the reason he moved his practice to Brandon was because it was difficult to survive in the Jacksonville market in private practice. “Ninety-five percent of primary care physicians were referring to hospital employees,” he said. His secret, he said, is simply that he has continued to evolve and take risks. “Physicians in private practice have to adapt,” he said. “There are different avenues to make money. They have to diversify into services that are going to make them marketable or competitive in the future. You 16
see primary care physicians starting day spas, offering laser hair removal or concierge medicine. You have to distinguish yourself.” For Dr. Henkin, that was adopting minimally invasive spine surgery techniques in 2000, well before it was recognized as a revolutionary force in the field. “I realized it was a significant improvement in spine surgery, better than my training at Duke in the 90s,” he said. “You have to embrace technology and change to improve your practice. Practice requires lifelong learning.” He is now among a small group of neurosurgeons with extensive training and experience in minimally invasive spine surgery. Doctor’s Life Tampa Bay
The past 12 months have been especially good at Tampa Bay Neurosurgery & Spine Specialists. In August, Dr. Henkin brought a second physician into the practice, Dr. Tien Le, a neurosurgeon trained by Dr. Kevin Foley, regarded by many as the father of modern-day minimally invasive spine surgery. “We had too many referrals and not enough time,” Dr. Henkin said. “We realized we needed to bring someone in to help meet the demand and decrease patients’ waits.” Joining a hospital system or a large physician group was never an option for Dr. Le, who completed his neurosurgery residency at the University of South Florida. Issue 2, 2015
This year Drs. Henkin and Le, along with four other physicians, opened a 7,000-square-foot outpatient center, the Tampa Minimally Invasive Surgery Center. It offers more personalized service for about a tenth of the cost of the same procedure in a hospital, Dr. Henkin said. “It’s unique. It’s dedicated to spine. We think it’s the future,” he said. It was made possible in part by a change in Medicare this year that allows most of the common spine codes to be done on an outpatient basis. “Essentially, the government is admitting that spine surgery, because of technological advances and improvements in surgical techniques, can now be done as outpatient procedures,” Dr. Henkin said. But the battle isn’t over. A bill last year to allow overnight monitoring in outpatient surgery centers failed to win legislative approval, but Dr. Henkin believes it will eventually happen. Dr. Henkin performs about 20 percent of his surgeries at the new center, but believes that number will be 50 percent or more in as few as five years. “I think that’s what people want,” he said. “They want to come in, get personal care. They don’t want to be in an institutional setting where they’re at risk for getting infection and paying exorbitant fees for services they really don’t use.”
“I’ve always wanted to be my own boss and control as much of my destiny as possible,” said Dr. Le, 37. “There’s a safety net in joining a large hospital group,” he said, “but I didn’t like the idea of staying all these years in training and being at the top of the field and then all of a sudden being plugged into a system where there are so many layers above you and getting anything done is very difficult.” When Dr. Henkin approached him, it seemed like a perfect fit. “The opportunity was ripe given that Dr. Henkin was a much more senior surgeon and had a lot of experience that I could lean on if need be, but he still had hunger and ambition to continue to make something grow and not be satisfied with the status quo,” Dr. Le said. Issue 2, 2015
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r. Henkin is at a point in his life where he is enjoying the fruits of his labor. He has his own practice, and a substantial share of the new surgery
Doctor’s Life Tampa Bay
Private practice is a relationship business,” he said. “Patients are going to send friends and family members and neighbors to the guy who took care of them and gave them a good outcome.” center. But success has its costs, and for Dr. Henkin that’s come in the form of time. The job is demanding. He works 70 hours most weeks. “It wears on you physically and mentally,” he said. “There’s a definite price on your family and a lack of free time.” His wife of 17 years, Judith, is understanding, as are his teenage daughters, Madison, 15, and Lindsey, 14. But that doesn’t mean it’s been easy. “I essentially sacrificed my youth, from age 24 to 35” he said. “That’s what it takes to become a neurosurgeon. Seven years of residency and four years of medical school… You give up a lot.” “But the balance is, what you’re doing is something that changes the world in a positive way for a lot of people. To do it right requires time.”
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How to Keep your Private Practice Alive and Well… By Suze Shaffer Aris Medical Solutions
I
n this day and age, it is getting more difficult for a private practice to thrive with all the rules and regulations that they have to adhere to. The responsibilities and risks involved are also taking its toll on medical practices of all sizes. So what can a practice do? Building a foundation of partners to help you within and around your practice is essential. Know that you don’t have to do it all yourself!
A good staff goes along way. Employees can be your best asset or your largest liability. Education is the key in this area. Making sure they are up to date with state and federal regulations will help them, help you, to stay out of trouble! This 18
also includes ensuring they understand the value of the data they are responsible for. Criminals want your data, and one mistake is all it takes for them to get it. Educating your staff to be alert and not to fall for the phishing scams is extremely important. Doctor’s Life Tampa Bay
Sometimes bringing in an outside company is best to assist in areas that are most daunting. One area is medical billing. Although it seems expensive at first, once you see the return on your investment, it can work to your benefit. If your staff Issue 2, 2015
Want to help the world? Do nothing. Time is a scarce resource. And these days we all spend way too much of it with our noses buried in a phone. Even when we’re with family, friends, driving our cars – that darn phone is in our hands and in our faces. So we created an app that encourages you to take breaks from your phone on a daily basis. And as a reward for the time you spend doing nothing on your phone, we’ll go out in the world and do good on your behalf. The more breaks you take, the more good we do.
Just download the app. Start the timer. And take a break from your phone for the greater good.
donothingdogood.com
A good for nothing app from
continued from page 18 is stressed because of denied claims and simply do not have the time to work the denials properly, you may not be collecting all that is owed to you. Then there are the impending ICD-10 codes. You and your staff will need to understand the codes; your EHR can only do so much. Sure, it can “map” to the new codes, but instead of using one, you may have to choose from 40 codes. A good consulting/billing company will actually help you with your coding.
A
nother area that is necessary to take a closer look at is your IT. Most practices feel this is a waste of money. On the contrary - this can save you huge amounts of money from fines and penalties. Having an IT professional monitoring your computers/ network is just as important as educating your staff on the dangers of viruses and malware. You may not be fined for using an XP computer (they are no longer supported
by Microsoft), but if that usage leads to a data breach, you will be. The fines can be anywhere from $150K to $1.5M! Keeping your computers up to date is only part of what an IT professional does for you. Most of what they do is behind the scenes and you never know it. Reports from your IT professional will help you to understand the value of the service they provide. Plus, you need this documentation in the event of an audit or a breach. An additional valuable partner to have is a good insurance agent. Just like car and general liability insurance, medical malpractice and breach/cyber insurance are necessary. Most practices think they have cyber insurance since it is included in their med-mal policy. Unless you have purchased a rider, this is nowhere near what you need to have. A good agent that specializes in this type of insurance can guide you and make sure you have the coverage you need. This is an area you
need to make sure you have appropriate coverage! The cost of a medical record breach is approximately $350.00 per medical record. I am sure you can do the math and figure out how much coverage you may need in the event of a breach. Keep in mind; if you do not have good record keeping skills, and are not sure how many records where breached, you will have to assume ALL of your records were breached. This can add up very quickly. Speaking of breaches, you should have an established relationship with a healthcare attorney. They understand the breach notification laws and will help you with this process. It may not be necessary to have an attorney on retainer, but it is advisable to have one that you know. Time is of the essence during a breach, since Florida only allows 30 days for you to notify your patients. In order to protect your practice from all the mayhem that is out there; good policies, procedures, and documentation are critical. The internet has a world of policies and procedures available to you at your fingertips. Before you click the “Buy Now” button, make sure they include your State law requirements. State law trumps Federal if the State law is more stringent. It is recommended that you partner with a company that specializes in HIPAA and can help you with the process. HIPAA is no longer a one page form you have your patients sign that they received it! Then comes the question… who do you trust? Word of mouth has always been the best and still is. Once a company has been recommended to you, most companies will be able to give you a letter of recommendation and/or some testimonials from satisfied healthcare clients. There are also organizations out there that have come together as a package to help practices. They are a one-stop shop for all your needs. If you select an organization like this, ask them how they determine who is permitted to join and what criteria is this based on. For more information on Partnerships and Reducing Risks, contact Aris Medical Solutions at 877-659-2467, “Aris takes the fear out of HIPAA through Partnership, Education, and Support”.
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Doctor’s Life Tampa Bay
Issue 2, 2015
AFRICA
ASIA
EUROPE
LATIN AMERICA
MIDDLE EAST
NORTH AMERICA
&
Successful
Operational Planning P
hysicians are well aware of the need for planning. Indeed, they devise clinical plans on a daily basis as they formulate the best way in which to care for a patient. However, when is the last time you spent time working on operational planning for your practice?
Written by Nick Hernandez, MBA, FACHE, CEO ABISA, LLC
and difficult industry like healthcare, few things are as important or as difficult as setting clear and useful goals. This is a skill set requiring judgment and vision. The reality is that, given the nature of today’s healthcare environment, we will often have to act with unclear goals. Unclear goals are generally better than no goals, and waiting for clear goals before acting can paralyze your business. 2. Actions intended to achieve the desired outcome. Most plans include several actions which are organized in both time and space. These actions are usually tasks assigned to secondary components. Depending on circumstances, these tasks may be described in greater or lesser detail over farther or nearer planning horizons. 3. Resources to be used. In order to execute actions, the plan must describe the type, amount, and allocation of resources. Furthermore, the plan must include the how, when, and where those resources are to be provided. Resource planning covers the staff assigned to different tasks and other resources.
Many physicians reading this will be thinking, “Who has the time for that?” And while that may be true, those practices that do make the time or work with consultants to help them through operational planning are the practices that are better able to compete. There should be no argument on the value of planning. Operational planning will keep your practice oriented on objectives, despite the problems and requirements of the present situation. There are many types of planning that do (or should) take place within a practice and at varying frequencies. For example, capital planning is generally done annually while preparing budgets, whereas marketing planning may be done quarterly to coincide with various advertising timelines and community events. Nonetheless, all planning should contain four basic categories of information: 1. Desired outcome. This element of a plan includes the purpose for achieving that outcome and often includes a time by which the assignment must be accomplished. Goals and objectives here may be either general or specific. In a complex 22
4. Control process. This element allows you to supervise execution of the plan and includes necessary coordination measures as well as some feedback mechanism to identify shortcomings in the plan and make necessary adjustments. It is a design for anticipating the need for change and for making decisions during execution. In other words, the plan itself should contain the means for changing the plan. Some plans are less adjustable than others, but nearly every plan requires some mechanism for making adjustments. This is a component of plans which often does not receive adequate consideration. Many plans stop short of identifying the signals, conditions, and feedback mechanisms that will indicate successful or dysfunctional execution. Diligent operational planning will allow you to see if at some point your practice will encounter a problem. A solid operational plan will allow you to proactively adjust to an oncoming crisis, rather than face the crisis unexpectedly. Where do you want your practice to go? How are you going to get there? Every medical practice’s strategy should be distinctive. A qualified consultant brings a good planning process which will move your practice toward greater coherence; and greater coherence leads to added value.
Doctor’s Life Tampa Bay
Issue 2, 2015
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