Financial Forecast

Outside Advisors for your Physician Practice: A Key to Success

By Reed Tinsley, CPA

During my years in consulting, I have found that the successful medical practices out there are the ones that surround themselves with excellent advisors. Not only do they surround themselves with excellent advisors, they utilize them at every turn. I think it’s important to have people on the outside looking in, willing to offer advice when needed. I have never seen the “perfect” medical practice – it does not exist. Why? Because we are human and as humans, we make mistakes – It’s not a perfect world we live and practice in. However by surrounding yourself with a solid team of advisors, I think you can minimize these mistakes and maintain a healthy bottom line. Every medical practice has a variety of specialized team members that handle patient intake, billing, collections, office management, and, of course, the delivery of the actual medical care itself. In the best medical practices this system is continually refined and each member is carefully selected and trained to ensure that the practice runs as safely and efficiently as possible. What many physicians and practice managers often overlook however is the importance of the “outside” staff that supports the operations of the medical business. These outside professionals are just as vital to the success of a practice as any internal employee and must be chosen with the same degree of care. Here are, in my opinion, the key outside advisors you should surround yourself with: CPA Advisor Some will disagree but there is not much separating “tax preparers” these days. Any CPA worth their salt can prepare a good tax return. They should – it’s their job! This is a necessary skill set but in today’s economic conditions and reimbursement rates, you require more. You need a real “tax planner” — someone who is BOTH technically proficient at the paperwork and who is proactive about spotting and suggesting ways for you to pay the minimum amount legally possible. Which category does your current CPA fall into? Make sure they are working as hard to save you money as you worked to earn it. Healthcare Consultant Advisor If your CPA does not already provide healthcare consulting services, then seek to engage such a person. What can an outside consultant do for you? First, this person acts as a resource to your practice. This person can advise you and your team on any area/issue related to daily practice management. Working in unison, there should be no practice problem that can’t be addressed and resolved. A consultant can be that set of eyes from the outside looking into the practice. This kind of oversight is vital in today’s ever changing marketplace. Finally, working together, you and the consultant can strategize and implement ideas that will increase your bottom line. Remember there is only one financial benchmark that should matter to you – did I make more money this year than last year? Insurance Agent Insurance is your indispensible first line of defense against a variety of exposures from malpractice to data breach and even traditional life and health. In many cases these needs are served by two different agents, one who handles life insurance planning for the

see Financial Forecast...page 14

New Digital Tool Closes the Loop, Helps Clinicians Follow Up on Patient Care Referrals

Central Texas Patients with Low Income to Benefit from Integration Of Nonclinical Info Into Medical Record

For people with low income seeking medical care from community clinics, a visit to see a health care provider can also be an opportunity to connect with supportive social services. These critical local services – available through community organizations working beyond clinics and hospitals – provide resources such as ridesharing, food assistance and temporary housing that are key drivers to improve health. But when clinicians make social service referrals, it’s difficult to know whether patients access those services, and if so, to what extent they were helpful. In collaboration with community partners, a team of population health researchers at Dell Medical School at The University of Texas at Austin is leading the development of a two-way digital platform enabling clinicians and social service providers to close the referral loop by communicating whether, and how, local resources are accessed after a patient’s clinic visit. For the 56 million Americans with limited access to primary medical care, this effort will help support a system of whole-person care in which providers and support service organizations can collaborate to improve the health of individuals who are part of the most vulnerable communities. For example, a patient with diabetes who has a challenge accessing fresh, healthy foods to help control her blood sugar level may be referred by a clinic to a nearby food bank. With the patient’s consent, the new closed-loop referral system would ensure that the patient information is sent to the food bank and received back from the food bank if the needs of the patient were addressed after the referral. The system is compliant with the Health Insurance Portability and Accountability Act (HIPAA) to ensure patient privacy is maintained while information is exchanged. Similarly, asthma attacks can be triggered by home conditions, including environments with smoking, pets, mold or roaches. If such conditions are identified during a clinical visit, for example, the clinician may refer the patient to a social service organization to evaluate the situation and provide a solution for the patient to address asthma triggers in the home. “The digital system we are testing will make it easy and efficient to share all this information seamlessly between health and social service providers, and help coordinate care for patients by tracking whether their needs were appropriately addressed,” said Anjum Khurshid, M.D., Ph.D., associate professor and director of data integration in the Department of Population Health at Dell Med, who leads this work. “The system is designed to avoid adding to the burden on service providers, and to help patients navigate the health system easily.” Collaboratively Creating a Replicable Model The initiative is part of a two-year, Dell Med-led program with community partners to create a scalable, widely replicable model that can ultimately allow clinicians in and beyond Travis County more comprehensive access to relevant patient information in a seamless, secure way that does not interrupt clinical workflows. 

Physicians At St. David’s Medical Center Among First in Nation To Implant Neurostimulator Technology For Advanced Heart Failure

Doctors at St. David’s Medical Center recently became among the first in the U.S. to implant a new neurostimulator technology to help treat advanced heart failure. The Barostim System is the only technology approved by the Food and Drug Administration (FDA) to use the nervous system to control heart failure and improve the function of the cardiovascular system.

The system features a programmable device that is placed under the patient’s collarbone and sends electrical pulses to baroreceptors, which detect changes in pressure in the carotid artery. This triggers the baroreflex, the body’s main cardiovascular reflex, causing an autonomic, or involuntary, response to the heart.

“When the device is activated, it sends impulses through an electrode to the receptors in the carotid artery,” Dr. Jeffrey Apple, a vascular surgeon with Cardiothoracic and Vascular Surgeons who performed the procedure at St. David’s Medical Center, said. “This tricks the body into thinking that the sympathetic and parasympathetic nervous systems are working correctly. The brain then responds and sends messages to the body that the heart is working properly. This relaxes the blood vessels, slows the heart rate and reduces fluid in the body.”

The therapy is designed to restore balance to the autonomic nervous system and thereby reduce the symptoms of heart failure. “This approach to heart failure is designed to improve patients’ quality of life, including those who remain symptomatic despite taking medications and have no other devicebased therapy options,” Andrea Natale, M.D., F.A.C.C., F.H.R.S., F.E.S.C., cardiac electrophysiologist and executive medical director of the Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, said. “It allows them to live their everyday lives with fewer limitations.” -