Today's Practice

MARKETING ADVISORY SERIES:

LOCAL SEARCH ENGINE OPTIMIZATION & THE IMPORTANCE TO YOUR PRACTICE

MARKETING ADVISORY SERIES:

YOUR ONLINE

REPUTATION

FINANCIAL ADVISORY SERIES:

THE DECADE OF ELDERCARE

WHAT’S TO COME & HOW TO PREPARE

HOW DO YOUR PATIENTS PERCEIVE YOU?

PRACTICE MANAGEMENT SERIES:

FRAUD AUDITS WHAT YOU DON’T KNOW MAY HURT YOU

PRACTICE MANAGEMENT SERIES:

PROTECTING PHI PREPARING FOR INCREASED REGULATION, LEGISLATION AND PENALTIES

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In this issue: Practice Management

10

FRAUD AUDITS

IS THE FEAR OF FRAUD AUDITS KEEPING YOU UP AT NIGHT?

14

PROTECTING PHI

18

ICD-10

Finance

30

THE ULTIMATE FINANCIAL PLAN

DYING WITH A DOLLAR LEFT IN YOUR NAME

COVERED ENTITIES CAN EXPECT INCREASED REGULATION, LEGISLATION AND PENALTIES

TIME WASTED IS REVENUE LOST

22

THE PERFECT COMPLIMENT

26

WEIGHING YOUR OPTIONS

36

THE DECADE OF ELDERCARE

40

SAVINGS VS. INVESTING

WHAT’S TO COME & HOW TO PREPARE

NEW ENVIRONMENT, NEW TACTICS

THE RIGHT PARTNER MEANS THE RIGHT PATIENT OUTCOME.

OUTSOURCING YOUR BILLING

Today’s Practice is a Green Publication, and we endeavor to provide educational solutions to the physician community while conserving the Earth’s natural resources.

Today’s Practice Issue 2: Today’s Practice is published 6 time per year by Meridian Medical Practice Solutions LLC. Copyright 2012 by Meridian Medical Practice Solutions LLC, all rights reserved. If the postal authorities alert us that your magazine is undeliverable, we have no further obligation unless we receive a corrected address within 18 months. The ideas expressed by the researchers and experts cannot be used to diagnose health problems and are not intended in any way to provide financial guidance. A health professional or financial specialist can best guide you.

Legal

46

THE ELEPHANT IN THE ROOM

RECOMMENDATIONS ON HOW TO PROPERLY LET GO OF A MEDICAL PRACTICE EMPLOYEE

50

BECOMING AN EXPERT WITNESS

54

DEMYSTIFYING INTERNAL MANAGEMENT AGREEMENTS

MORE THAN JUST ADDITIONAL REVENUE

& PRACTICE GROUP ROLLUPS

Marketing

58

YOUR REPUTATION

WHY IT’S IMPORTANT & HOW YOU CAN USE IT TO YOUR ADVANTAGE

64

LOCAL SEARCH ENGINE OPTIMIZATION

70

SOCIAL MEDIA

& THE IMPORTANCE TO YOUR PRACTICE

A PHYSICIAN SPECIFIC APPROACH

Today’s Practice Issue 2: Today’s Practice is published 6 time per year by Meridian Medical Practice Solutions LLC. Copyright 2012 by Meridian Medical Practice Solutions LLC, all rights reserved. If the postal authorities alert us that your magazine is undeliverable, we have no further obligation unless we receive a corrected address within 18 months. The ideas expressed by the researchers and experts cannot be used to diagnose health problems and are not intended in any way to provide financial guidance. A health professional or financial specialist can best guide you.

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PRACTICE MANAGEMENT

fraud

audits

Is the fear of fraud audits keep ing you up a t night?

by Korby Miller, MS I/O Psych

Physicians face many c hallenges i n juggling all o f the moving p ieces of a productive and profitable practice. In addition to overseeing the entire health of t he b usiness, doctors are n ow f aced w ith increased scrutiny with regards to chart note documentation, c oding and b illing practices. Fraud and abuse audits a re o n the rise a nd more p hysicians find t hemselves f acing f ines, penalties a nd e ven investigations t hat may impact t hem c riminally and/or civill y.

According t o the Office of I nspector General, Convictions under Health C are F raud a nd Abuse Con trol have increased by over 27% (583 vs 743) since 2009. [1] Defendants facing c riminal c harges have increased by 49% c ompared w ith 2008 (821 vs 1676.) [ 1] T here h ave been 923 n ew healthcare fraud investigations opened, 2,690 pending invest igations and 743 convictions in the 201 1 FY. Daniel R. L evinson Inspector General o f US Dept. of Health and Human Services stated on October 4, 2012: "Today t he o ffice of i nspector general deployed o ver 200 s pecial agents...to execute arrests and search warrants across the country." [3] They are requesting a n additional $ 9 million f rom the Congressional Budget for the 2013 FY. They are expecting t o hire an additional 1 ,974 f ull-time employees. [3] continued on next page

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FRAUD AUDITS

You may be asking why the increased oversight and action being taken by the OIG and the FBI? According to the FBI, health care fraud costs the country Fall 2011 Semiannual Report to Congress, OIG reported savings and expected recoveries of approximately $25 billion for FY 2011. This includes $19.8 billion from legislative and other cost-saving actions that were supported by recommendations in audits and evaluations, $4.6 billion in investigative receivables and $0.6 billion in audit receivables. [4] Another noteworthy motivation may be that for every dollar spent on investigations, $7.20 is recovered. [2] It is a worthwhile venture for them to crack down on fraud and abuse. And why should you care about this other than for obvious reasons? According to the OIG, in FY 2011, the OIG excluded 2,662 individuals and organizations from participation in Federal health care programs. Additionally, penalties and fines are assessed at 3 times what was originally paid in addition to a $5,500 to $11,000 fine per claim. [4] Here is an example: A physician who submits 50 false claims for $50 each is liable for between $282,500 [($2,500 x 3) + (50 x $5,500)] and $557,500 [($2,500 x 3) + (50 x $11,000)] in damages under the False Claims Act. Here are some of the egregious acts considered fraud: Incorrect Coding - Assigning incorrect codes is considered misrepresentation of services; Medical Necessity - Performing inappropriate or unnecessary procedures; Unbundling – Using two or more CPT billing codes instead of one inclusive code; Double Billing - Charging more than once for the same service; Up Coding – Inflating bills by using diagnosis; billing codes indicating patient needs more expensive treatments; Improper Cost Reports – Submitting false cost reports seeking higher reimbursement than permitted by facts; and Routinely waiving copays and deductibles.

So what does this mean for you and your practice?

Education is key to knowing what problem areas are

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Korby Miller, MS I/O Psych

(continued)

2012

targeted by these departments and then taking action to ensure you are in full compliance. These two measures alone could ultimately help in mitigating these potential audits and worse, investigations.

The first step I suggest every physician take DON'T PANIC! Yes this is the new reality but you can start instituting policies and procedures now to better protect yourself and your practice. Education and implementation is crucial. Executing an effective compliance program is the next big step. Not only has CMS determined such a program is necessary but it will also assist physician practices in adhering to applicable laws and guidelines. “CMS has determined that all Medicare Contractors… shall have in place an effective compliance program. The compliance program may be tailored to the size and scope of the work to be performed…CMS has published its own “Compliance Guidance for Fee-for-Service Contractors” …it is not to be read as the sole pronouncement of desired substantive or procedural elements of an effective compliance program.

Most importantly, an effective program is not static, but is constantly evolving towards the ultimate goal of being proactive rather than reactive.” [5] Other actions to take in protecting your practice should be the use of an outside auditor to assess your chart notes against codes for diagnosis and billing, the training of applicable staff and ultimately surrounding yourself with professionals who know more than you. Seeking out help from these invaluable resources could prove the difference between a good night sleep and not having to refill your Xanax!

[1] [2] [3] [4] [5]

www.oig.gov http://www.fbi.gov/about-us/investigate/white_collar/health-care-fraud reference: https://oig.hhs.gov/newsroom/outlook/index.asp https://oig.hhs.gov/reports-and-publications/budget/index.asp CMS: Centers for Medicare and Medicaid Services 4/5/2012

Korby Miller is the owner of Remedy Billing Solutions, a medical billing company focused on maximizing client revenue and ensuring practice/billing compliance.

PRACTICE MANAGEMENT

protected health information

protecting phi: covered entities can expect increased regulation, legislation and penalties

By Dr. Ross Federgreen, CIPP/US, CIPP/G, CIPP/E Many medical offices struggle with the various and ever-changing requirements for privacy and security compliance. Increasing regulation and, most importantly, stringent enforcement of these regulations is a reality that all within the broad aspects of the medical community must face. The regulations and compliance are now tied to reimbursement, as in the case of HIPAA attestation for EHR meaningful use reimbursement. We predict that the list of regulations will continue to grow. No one is immune: from the smallest office or the largest hospital corporations to contractual financial intermediaries.

Zhou faced criminal misdemeanor charges related to HIPAA's prohibition of "knowingly" obtaining individually identifiable health information in violation of the law. It hammers home the point that those who access patient information without a valid reason could face jail time. This case has significant relevance because it sets a relatively low bar on what conduct may be deemed a criminal violation of HIPAA.

So what is the current state of the overarching Federal law known as HIPAA and HITECH 2009? The rules and requirements are being audited currently through various mechanisms.

We predict the Final Rule, while it is overdue and has not yet been promulgated, will be forthcoming imminently. The Office of Civil Rights (OCR) of the Department of Health and Human Services, which administers these rules, is actively working with and teaching State Attorney Generals how to administer and enforce these privacy and security obligations. In fact, the Texas House Bill 300 is in many ways more stringent than the Federal law which establishes the baseline for further regulatory activity.

Many small practices feel that their vulnerabilities are limited. This is a completely wrong assessment. The OCR released a sobering analysis of lost and compromised PHI records in major events (defined as 500 or greater records), that clearly indicates the assumption that the greatest vulnerability is a computer network is simply wrong! Loss from paper records topped the list at 35%; laptop loss was 32%; 20% from mobile devices or phones and only 13% from networks.

Criminal Liability for Violations of HIPAA/HITECH Can you go to jail for violation of HIPAA? The answer is YES! The U.S. Court of Appeals for the Ninth Circuit on May 10 of this year rejected a motion to dismiss criminal charges in a headline-grabbing case involving Huping Zhou.

Greatest Vulnerability in Handling PHI: The Human Factor

"There was a consistent lack of compliance measures, regarding the treatment of PHI at each of the smaller practices we acquired", stated John Reinecke, a former executive of a primary care initiative in Las Vegas, NV and currently VP of Healthcare Services for Atlantic-Pacific Processing Systems, Inc. "One of our first objectives was to create policies and procedures specifically tailored to each practice which thoroughly defined and outlined the handling of sensitive information. Small practices or groups need to take the time to understand continued on next page 16

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Protecting PHI

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Dr. Ross Federgreen, CIPP/US, CIPP/G, CIPP/E

the extreme importance of creating a system in which these vital protocols are established and kept as mandate of ongoing internal training."

A combination of increasing complexities, both physical and electronic, as well as increasing regulatory requirements have made these issues more pertinent and, at the same time, both challenging and demanding for all concerned. All practices, whether primary care, specialty or those associated with the ongoing provision of direct patient care now fall under the regulatory reach of HIPAA and HITECH.

Increasing Legislation and Regulation The Health Information Technology for Economic and Clinical Health Act (HITECH), enacted as part of the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology. Subtitle D of the HITECH Act addresses the privacy and security concerns associated with the electronic transmission of health information, in part, through several provisions that strengthen the civil and criminal enforcement of the HIPAA rules.

Increasing Penalties: Loss of License and Auditing In addition to Federal legislation, many states have either enacted or are in the process of enacting or enforcing HIPAA requirements. Texas was the first state to enact a law with significant sanctions including the loss of licensure for violations of these regulations.

EMR financial incentive reimbursement mandates acknowledgment and attestation that the applying entity must be compliant. CMS has determined that up to ten percent of all offices that apply for EMR incentives will be audited to determine that the requirements for HITECH compliance have been met.

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The average practice does not understand how to comply or have the facility to comply in a meaningful and measured manner. There are several key changes in the 2009 Federal enactment of HITECH. First, within the medical office all personnel are covered; not just those with direct patient contact. Next, the distinction between those offices with direct patient care (traditional covered entities), who had a different standard than those entities that serve the needs of direct patient care offices, known as business associates, no longer exists. In addition, sub-contractors of business associates are now covered as well.

Concerned that HIPAA and HITECH did not provide enough safeguards for protected health information (PHI), the Texas legislature passed H.B. 300 in 2011. This law, containing even more stringent regulation than the federal scheme, went into effect on September 1, 2012. The importance of the Texas Public Law is that it is serving as a model for other states.

Individuals and entities determined to be “covered entities” (CE) under H.B. 300 will face several new requirements, including new training for employees regarding PHI, additional patient rights related to electronic medical records, and the potential for increased penalties for noncompliance.

CE must provide ongoing, customized training for their employees regarding both federal and state laws related to the protection of PHI. The training should be tailored to employee responsiemployee must complete the training within 60 days after his or her hire date, and the training must be repeated at least once every two years. Notably, under HIPAA, training is only required within a reasonable amount of time after hiring and when there are any material changes in privacy policies.

Under both HIPAA and H.B. 300, “covered entities” attendance.

PRACTICE MANAGEMENT

Protecting PHI

(continued)

Dr. Ross Federgreen, CIPP/US, CIPP/G, CIPP/E

CE must provide patients with electronic copies of their electronic health records within 15 business

Six Key Elements Required for

(under HIPAA, records must be provided within 30 days of a request). Additionally, the new Texas law requires the Texas Attorney General to establish a website

Any HIPAA/HITECH compliance program that you utilize must provide the following important elements to be of value and to keep you in compliance with both Federal and potential State law. The program must:

under Texas and federal law. Also contained in H.B. 300 are provisions that prohibit the sale of PHI and require notice to patients regarding the electronic disclosure of PHI. CE that wrongfully discloses a civil penalties under H.B. 300 as well as any penalties for violating federal laws. The new Texas law allows for penalties ranging from $5,000 to $1.5 million per year. To determine the penalty amount, H.B. 300 lists five factors a court may consider:

1)

The seriousness of the violation

2)

history

3) 4)

deter future violations

5)

violation

HIPAA/HITECH Compliance Programs

1

Provide the policies and procedures that you will need

2

Operate as a GAP analytic in the form of a survey to determine where you might not be fully compliant

3

Provide a remediation schedule for resolution of identified deficiencies

4

Provide event-specific training and retraining

5

Enable the tracking of completion of training by each member of the staff, and finally,

6

Must be flexible to account for changes in law and circumstance.

While the complexity continues to increase, companies and non-profits who proactively tackle their compliance program will benefit greatly.

Dr. Ross Federgreen, Founder of CSR, the leader in data compliance solutions, holds professional certifications from the International Association of Privacy Professionals, addressing US government and panEuropean privacy law and is a Fellow of the European Privacy Association. Ross can be reached at rfedergreen@csrcorporate.com.

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ICD-10 The tran sition is comi ng... time w asted is r evenue l ost.

by Korby Miller, MS I/O Psych While the ICD-10 t ransition h as been p ushed back to O ctober 31, 2014, preparing f or it s hould not be put off. Those affected by this transition should use this delay to t heir advantage i n preparing for the impact t o their practice b oth in h ow t hey treat their patients and in how their day-to-day operations are run and sustained financially .

Let's review what ICD-10 i s and w here the United States fairs in relationship to the world. ICD-10 is an update and e xpansion of d iagnosis c odes used i n the medical environment. I t is e xpected that t he coding s ystem will g o from a pproximately 14,000 continued on next page NOVEMBER/DECEMBER 2012 SEPTEMBER/OCTOBER 2012

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ICD-10

Korby Miller, MS I/O Psych

(continued)

codes to 70,000 codes in the outpatient setting and 3,400 codes to 72,000 codes for inpatient when ICD-10 goes in to effect[1]. Currently ICD-10 is used throughout the world for diagnosing and treatment. The United States is one of the last countries still utilizing the ICD-9 coding system. As a matter of fact, the Beta draft of ICD-11 was made available online in May 2012 for initial consultation and commenting.

ing patients as their documentation and coding will also move to ICD-10. Billing and coding staff will bear the brunt of most of the training during this process. The required elements and sheer increase in codes will surely require ongoing training. When physicians decide that training their own staff is too much to oversee and pay for they will undoubtably seek the advice of experts and outside agencies, but at a much higher rate than they would pay today.

ICD-10 will happen, and preparing now will help mitigate disruptions in treatment, documentation practices, claims submission and ultimately payer reimbursement. Are you prepared to go without steady income for up to 6 months once the transition occurs? According to The American Health Information Management Association, providers may experience up to 6 months of delays in reimbursement [2]. Delay of payment should be expected, and physicians should prepare now to put enough money in reserves to cover their expenses during this transition. Remember, the payers will be on the same learning curve and will be processing claims according to the new guidelines much slower than the current system allows.

Business processes will need a complete overhaul to ensure the proper and full receipt of patient information necessary for physician documentation, coding and claims submission. Intake, insurance verification, financial and prior authorization forms should reflect the necessary elements. Patients will also need to be educated about the transition and told to expect increased claim denials. They should also be informed of the process you use to handle these rejections and the circumstances under which you will hold the patient responsible for the balance.

Being prepared financially is only one aspect to consider. Documentation and coding will be at the heart of how fast claims are submitted and paid.

Physicians should expect a significant increase in claim denials through this transition. Providers can mitigate the impact of this when they begin the process of analyzing their current level of documentation and start to adopt all of the required elements of ICD-10 now. More specificity is required, and the criteria for coding is more detailed. There are codes for where and how illnesses and injuries occurred.

The codes will tell the complete story, and the documentation must support the codes. If it doesn't the result is simple, you won't get paid!

Staff education and training cannot be emphasized enough prior to this transition. It will be crucial for front desk staff to know what information is critical to collect prior to and at the first patient visit. There will also be new information gathering for all exist-

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Finally, IT systems will be affected by way of software changes and updates. Have you really researched your current or potential EMR software and inquired into their preparation for the transition?

Most physicians are being sold on EMR systems claiming to do the coding for them. Beware of this type of talk. No system can analyze what is done in person and cannot replace personnel. Doing so may put you at risk for audits and scrutiny. An entire article could be devoted to this subject, but for now just be objective and analyze sales tactics that sound too good to be true.

All areas of your practice will be affected by the ICD-10 transition, and physicians should take advantage of all the time they have to prepare, ensuring that the impact is not catastrophic to their practices.

[1]http://www.aapc.com/ICD-10/faq.aspx#howdifferent [2] http://www.who.int/classifications/icd/revision/en/ Korby Miller is the owner of Remedy Billing Solutions, a medical billing company focused on maximizing client revenue and ensuring practice/billing compliance.

WHAT WE DO: Drive patient traffic to your practice through innovative marketing campaigns, proper media placement and cutting edge design.

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the perfect compliment The right partner means t he right patient out come.

by Alan Fi nston P.T., OCS During the course of patient care, the recognition of the need for referral for outpatient physical therapy frequently arises. The nature o f this referral could be f or a condition as c ommon as c hronic low b ack pain, or more involved l ike post s urgical rehabilita tion or a chronic disease process. W hatever the condition or illness, it is important to remember that there are a n umber o f options for outpatient p hysi cal therapy s ervices and t hat qualifications and credentials a re an important f actor in d etermining care.

The American Physical Therapy Association (APTA) has an advanced certification program with special ization areas f or a n umber of a dvanced areas o f study/focus. An APTA certified specialist must have a minimum o f 2,000 hours o f experience i n their clinical practice area a nd d emonstrate advanced knowledge with c oursework and t esting. A PTA certified specialists may be in one of 8 clinical prac tice specializations: Orthopedics, Geriatric, Cardi opulmonar y, N eurological, P ediatric, Sports, The APTA w ebsite has a link to a llow a s earch i n est APTA c ertified s pecialist i n the specific area of medical focus for the prospective patient.

Other criteria f or partnering w ith a given physical therapy office may be of a more practical nature and include i ssues s uch a s “Can t he c linic g et m y patients seen in a timely manner?� continued on next page NOVEMBER/DECEMBER 2012

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THE PERFECT COMPLIMENT

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(continued)

Alan Finston P.T., OCS

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Finall y, it is important to remember that the care office is a reflection of the physician who made the referral.

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Weighing your options :

Outsourcing Your Billing

by Chris Christensen, RMC, CMBSI Medical billing is a n essential function o f any medical practice and greatly impacts the sustainability of a physician's business. The question is whether outsourcing to a medical b illing company is t he right move for your business. The answer is, it depends.

Obviously there a re t rue benefits t o maintaining an in-house billing department. Namely overseeing s taff, access t o reports and p atient f iles as you see fit and t he ability to implement changes to systems. This is all accu rate if you are truly managing .

As a physician you are e xtremely busy t reating p atients.

Managing t he d ay-to-day functions o f an o ffice can be quite c umbersome and t ime consuming. Having a n office manager o r clinical d irector can b e an a sset s o long as they p ossess the skills n ecessary t o oversee t hese f unctions, r emembering t hat you still maintain oversight of their job function .

There are some downfalls to keeping your billing in-house that you should conside r. One important point to ponder is the experience level and ease of access to multiple people with v arious backgrounds t o help with a nswering q uestions and s kills n ecessary t o recoup m onies owed. At a reputable billing compan y, t here w ill b e many employees with varied backgrounds providing a more comprehensive solution t o your billing. Their experience and expertise should not be understated and can definitely i mpact correct initial claims submission and ability to recoup continued on next page

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Outsource Billing:

(continued)

Christine B. Christensen, RMC, CMBSI money even in the face of denials. A good medical billing company can also be a great asset to the physician informing them of the latest medical news in addition to changes in proper coding and documentation policies.

Training and ongoing education can also pose an obstacle with in-house billing. Most physicians do not find it necessary or do not want to spend the money to make sure their billing and coding staff are trained properly and stay up-to-date with the constant changes with government and commercial payers. Some even hire uncertified staff with the belief that billing is easy and is as simple as just entering some codes and sending out claims. I often ask physicians if they would hire just anyone off the street to do their taxes, and of course they wouldn't.

Then why would you not make sure those doing the coding and billing are certified, experienced, fully trained in applying the correct codes and are aggressive and knowledgeable in fighting claim denials? The formula is simple, hire the best and you will see higher revenue. You will also be less likely to come under scrutiny from audits or worse, investigations!

Financially speaking, there are some big differences between in-house billing and outsourcing.

In-house costs are fixed in that they remain the same from month to month regardless of practice revenue. You are responsible for employee taxes, insurance, training, employee turnover, office space, software and the real time investment, management. A medical billing company is usually paid on a percentage basis and the fee for their service fluctuates with your practice revenue. In this case, the billing company is especially motivated to make sure all money is collected as they are paid based on that figure. They carry the burden of training, turnover, taxes, insurance, software maintenance and staying educated with all aspects of billing and coding.

Addressing control, a good medical billing company will provide you access to your patient billing

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“... an office manager or clinical director can be an asset so long as they possess the skills necessary to oversee these functions, remembering that you still maintain oversight of their job function.�

records so that you can manage and oversee all of your practice billing. They should generate detailed reports showing where your money is at all times and the status on collecting monies still outstanding. Their staff should also handle patient balances with care and skill as billing can impact patient retention and referrals.

In a financial example, let's assume it costs a medical office $69,000 a year (include all the fixed costs mentioned above) for the first billing employee and $61,000 a year for each additional employee. If your practice is generating $1,000,000 annually with 3 billing staff, it would cost 16% of total collections to maintain an in-house billing department. If a billing company is charging you 8%, you can see that there is a great discrepancy in the financial value between the two scenarios.

So, do you outsource or keep it in-house? If you are good at managing, keep your staff fully trained and don't mind paying a little more, keeping your billing in-house may be the right solution. If you are losing money, don't have the time or want the headache of managing billing staff and want to spend less, then outsourcing may be the right fit for your organization. If your choice is outsourcing, make sure you do your homework and pick the best company (not necessarily the cheapest one) as no two companies are alike.

Chris Christensen is a valued member of the Remedy Billing Solutions team, a medical billing company in southern Nevada.

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FINANC

E

by Christopher A. Hynes, JD, CFP速 With t he 2010 Tax A ct hanging i n the balance,

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Dying with a Dollar...

protection planning—in particular, long-term care planning—can be integrated into a similar legal and financial structure.

Below is a brief excerpt from my conversation with Jim, a 55 year-old Radiologist from Massachusetts 1/1/13. Of note: his wife Jill is also 55 and has Me: So, how are you doing?

Jim: vated. I feel like this is an opportunity to transfer a

enough to live on should one or both of us encounter a major health issue in retirement—especially that the best financial plan is to die with a dollar left in our names while transferring the entire current know how we account for the risk that we could be spending an additional $130,000 annually—in costs.

Me: Well, generally, there are 3 ways to handle apply to long-term care as well. Based upon the feel confident that you can self-insure the risk.

How do you feel about traditional long-term care insurance?

Jim: For me, I think it would be great to have but, based money wasted that could have gone into my retirement plan or to Jill or the kids that I can never

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Christopher A. Hynes, JD, CFP®

(continued)

recapture. I know I can pay for a Return of Premium Rider on the policy but if I actually use

Me: down for long-term care insurance—not just those with diseases that make them more likely to file a claim and collect on a policy. Clearly, from a morbidity underwriting standpoint, Jill is the very definition of adverse selection—there is a high prob-

essence of long-term care insurance is leverage: you want to pay a relatively small amount of money into an insurance contract that will pay you out a much larger benefit. Here, because of the probing.

-

Jim: Me:

-

expectancy. So, we should be able to obtain life insurance for her at or near standard rates.

Jim: But how does that address my concerns regarding long-term care costs?

Me: highly-rated life insurance carriers who will issue life insurance policies that contain a contractual provision that enables the owner to accelerate the death benefit of the policy during life if the insured

FINANCE

Dying with a Dollar...

Christopher A. Hynes, JD, CFP®

(continued)

can still gain leverage with a carrier even with a textbook case of adverse selection.

Me:

Jim:

during your life as a spousal beneficiary. If prudent, you could decide to accelerate the death benefit

Me: Jim: How much of the death benefit can we get during life? What is the cost?

Me: Well, the cost will be dependent upon how much death benefit we decide makes sense for ance contract. Most of the carriers that we use will

$8,000 monthly. In most cases, that payment is income-tax free.

Jim: Me: inflation protection in the typical life insurance under the rider, it is not a dollar-for-dollar reduction of the death benefit. Instead, the reduction of the death benefit is based upon a net present value calculation that combines an interest rate and the life expectancy of a chronically ill insured.

death benefit during life, the policy will not add to the value of your estate for estate tax purposes and as such, would provide your family with a source of income and estate tax-free cash. In that way, there is a recapture—or rate of return if you will—on the premium dollars you have paid into the policy.

Jim: What if I predecease Jill? Can the kids have access to the accelerated death benefit?

Me:

-

your children could decide to accelerate the death

Jim: English?

catch is that unless the expenses they are paying are considered to be medical expenses that they pay directly to the facility, there could be gift tax implications to them.

Me:

Jim: So, in terms of our planning, we could main-

use during life. How much less will be largely dependent upon your age at the time you trigger

long-term care costs.

you will receive.

Jim: numbers look. In the meantime, how does this fit into my estate plan? Can I have this insurance owned outside of my estate and still have access to benefits?

Me: Exactly.

to both clients and fellow advisors with whom he works regularly. Chris is a Senior Board Member of the Meridian Group, where he helps physicians grow, protect and transfer wealth in the most efficient ways possible. Chris can be reached at his office: 508.751.5350 or by email: at chris@hynesfinancial.com.

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FINANCE

The decade of

Eldercare

by Betty Doll, MBA, CLTC

This is the decade of eldercare. The Conference Board, a global not-for-profit organization specializing in management marketing, predicts that within the next few years, more than 37 percent of U.S. workers will be more concerned with caring for a parent than a child.

Eldercare has a tremendous impact on our workforce and on our family structure. Medical practices may see this more than other employers as family members with health care experience are often the ones expected to care for family members. The effects of long term care and eldercare threaten productivity in the United States. Some family members provide care for loved ones 40 or more hours a week in addition to their regular job responsibilities. Obviously this will have an impact on that worker. They are stressed, resulting in lower productivity and greater absenteeism. Their stress causes them to have health problems of their own leading to increased health claims that can then lead to increased health insurance premiums for the medical practice or other employer. They may take a leave of absence or quit working altogether, resulting in the need to hire and train replacements. These are some of the costs of eldercare that face employers.

Obviously there are also significant costs for the employees who are in a caregiving role.

Taking a leave of absence to care for someone who is terminally ill with a less than six-month life expectancy is a challenge financially, physically, emotionally, and socially. Imagine the challenges of caring for someone with a chronic illness or with dementia where care may be needed for 10-15 years. Multiple sclerosis,

aneurysms, automobile and sporting accidents can affect people at young ages and result in the need for care for even longer periods of time.

There are many costs to caregiving. Clearly there is the economic impact if an employee leaves their job. Not only is there lost income, there are lost social security earnings, lost retirement contributions, lost employee benefits that may include health insurance.

There are additional costs with caregivingeven the day to day expenses of picking up a few groceries or picking up a prescription or having a handyman install grab bars in the bathroom can quickly add up. There is the cost of having someone come in to assist with care when it is no longer possible for the family to handle it all. ity to spend time with their own spouse and children. There is the emotional toll of becoming a caregiver to a person who has always been perceived as strong and healthy. There is the physical cost of the day-to-day caregiving responsibilities for someone who perhaps needs constant care and attention.

Many employers are now offering long-term care insurance to their employees and to the employgives employees the resources to hire additional caregivers that may enable them to continue with their job. It enables them to make sure that funds are available to pay for high-quality care for their loved one and it provides peace of mind while they are at work.

It protects that c o n t in u e d o n nex t p age

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The Decade of Eldercare:

types of long term care

(continued)

Betty Doll, MBA, CLTC

Home care

Home care is generally considered appropriate at the custodial and non-skilled care levels. Skilled care can be provided in the home, however it can be very expensive. Home care could consist of a weekly visit by a homemaker who performs housekeeping chores, a personal care attendant that provides assistance with bathing and dressing, or it may be a daily visit by a home health registered nurse or therapist.

Adult day care -

-

Adult day care is a community-based service that was developed to help keep people out of nursing homes and in their homes. Adult day care facilities offer custodial care during the weekdays (some provide weekend service). This care can be provided to people who need minimal assistance and have moderate impairments. Patients with Alzheimer’s or senile dementia are ideal candidates for this program. Adult day care centers offer a form of support for those who live in their own homes, or even with their children. Adult day care centers offer family members who are providing care the much needed break during the day to continue to live their lives and provide care for their loved ones.

Assisted-care living facilities Assisted-care living facilities,otherwise known as assisted living facilities (or ALF’s), may also be referred to as residential care facilities for the elderly (In California, they are referred to as Residential Care Facilities). These facilities provide non-skilled care for people who need help with their Activities of Daily Living but can also provide a lot of their own care and get through a daily routine with minimal assistance.

Usually, skilled care is not provided in assisted living facilities. An excellent alternative to a nursing home, the residents may live in individual apartments that they can furnish and personalize to make it seem more like home.

Meals are usually provided in a community dining room and there are lots of activities and social events to attend. You can community, or as a stand alone facility that only offers assisted living. There are also small board and care homes that care for anywhere from 3-10 people. These are homes that have been converted to a board and care.

Skilled nursing facilities Skilled nursing facilities are usually comprised of two sepaskilled nursing care that may be covered by Medicare (if the care meets the criteria that Medicare sets forth). The rest of the facility provides non-skilled (or custodial) care. The goal of the “Medicare” section of the skilled nursing facility is to provide services needed to rehabilitate patients so they can return home. However, many times patients are unable to return home and are moved over to the non-skilled or custodial section of the facility. Usually in these cases the patient may not have any support services or family in the community that would allow them to leave the facility.

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FINANCE

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FINANCE

savings vs.

investing.

By: Robert tramont

Have you ever been asked by your advisor if you would prefer to save your money or invest never been asked that exact question. Most advisors may have told you to have a savings and invest the rest of your money. They may say things like “you need to have 3 - 6 months of living expenses in a savings account”. Although this is good advice (as far as keeping 3 -6 months of living expenses liquid) it leads everyone to believe and assume that a savings account or your “savings” is only for immediate availability of funds. This also gives the impression to those who follow this advice that your savings need to be in low interest bearing accounts because “those are the only types of accounts you can save money in and keep it liquid”. This is a very dangerous assumption. If there is one take away from this article it is this: saving your money or investing your money rarely is defined by the interest rate.

People assume that you have to have your savings in a low interest account and therefore equate savings with low interest. Almost all advisors fall into the aforementioned thought process and advise their clients to have this unsafe strategy as a base. Why is it unsafe?

First, we must understand that 3 – 6 months of a higher than 87% of Americans. With that in mind, people who keep a significant amount of

their money in a poorly performing account (for this article we will state 1–2% is poor performing) now need a higher return in their other accounts to give them an acceptable overall return in their portfolio. This now creates a sense of urgency to have their “investments” put into riskier assets in order to make up for low interest in a bank savings, Money Market or Certificate of Deposit. If your advisor is not talking about your overall return in your collective portfolio, it may be time to start researching others. Second, inflation will reduce the “savings” you have in a bank account significantly by bank savings interest rates increasing dramatically anytime soon. Third, there is a temptation by most people to move some of their “savings” into a riskier “investment” when the stock markets are doing well that month or quarter. The temptation is strong for advisors to comply with this since many benefit financially from the movement of the assets from a bank savings or CD into a commission based or fee based plan.

Can you save money and make stock market equivalent returns without the risks of a market drop? Can you have “safe” money, “liquid” money and outstrip inflation with returns in the same account? Yes… simply stated. “Savings” are guaranteed to not lose the principal (original amount) put in, they are safe from market downturns, considerably liquid, and give returns from continued on next page

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FINANCE

SAVINGS VS. INVESTING

(continued)

0.5% to as high as 8% or even higher. That was not a typo… it was 8%, not 0.8%...and not in a hyperinflationary environment. “Investments” are usually in an equity (stock, mutual fund or Real Estate Investment Trust) or a debt instrument (bond). They are all subject to lose some or all of the principal you put in. There are no guarantees. Their returns market, bond market, real estate market or a combination of all three. Commodities were not previously mentioned and some investors and advisors will swear that Gold is the best now, etc… though there is risk still involved, potentially more, with Commodities.

Robert Tramont The current assumption of investors and most advisors is that investments are where the majority of your money should be in order to get higher returns than expected from savings. This model is based on a lack of education and a biased approach. By biased, I am referring to the belief that stocks, bonds, or mutual funds are the only place to receive “good” or acceptable returns. This is risking most of your money to the fluctuations of those markets. If your choice was to have money in savings and investments with your savings making the same or within 1% return of your investments, where would you want to have most of your money? What if your savings were also tax free or tax preferred (lower taxation than most accounts)? What if your savings were protected from lawsuits? All of these can be part of your savings. The question is; is this really how you feel your money should be working for you? Most have answered unequivocally, yes. The next question to your advisor may be “Is my portfolio set up like this?”.

Bob Tramont founded The AMH Group, an advisory firm in Aurora, Ohio. Bob is from northeast Ohio and a graduate of Kent State University. The first part of his life was spent serving in the Air Force Reserve during his college years as a Military Policeåman then finished with a substantial tour in the U. S. Marine Corps as a helicopter pilot flying UH-1 (Hueys) and AH-1 (Cobras).

He retired as a Major from the service of this great nation with 22 total years after tours of duty in Somalia, Liberia and Iraq.

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www.hynesfinancial.com 71 elm street

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direct: 508.751.5350

fax: 508.751.5351

ESTATE AND LONG-TERM CARE PLANNING

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In with the new.

As one of approximately 3,000 attorneys who are also Certified Financial Planners™, Chris Hynes' education, training and experience furnish him with a unique perspective on complex financial structures, issues and products. Since his admission to the Massachusetts Bar in 1995, Chris has provided estate planning, insurance planning, financial and tax counsel to hundreds of individuals, businesses and non-profit entities. call to discuss your options today. 508.751.5350

ON PLANNING

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SE PTE MB E403B R /O CTO B E R MANAGEMENT 20 12 43 401K AND PLAN

LEGAL

The elephant in the room:

10

recommendations on how to properly let go of a medical practice employee

by Neil W. Thomson Esq. Firing any employee can be a difficult undertaking for many employers, and requires skill to do it right. Physicians and office managers are often too talkative, belligerent, or even apologetic when telling an employee that he or she is being "let go." Other times they simply "cave in" if the employee becomes too emotional or threatening, and decide to capitulate under the guise of “giving the employee another chance”.

"The way I look at it," one physician told me, "firing a staff member, particularly from a job she's held for any length of time, is the most traumatic thing next to divorce. She's going to be understandably upset, perhaps bitter, and ready to put the blame on someone else. If the doctor isn't careful, his or her reputation and practice may be the target of a very disgruntled and resentful employee — possibly a lawsuit." c on t i n u e d o n n e x t p a g e

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LEGAL

Elephant in the Room...

Neil W. Thomson, Esq.

(continued)

While there is generally no way to make a dismissal a pleasant experience, an employer can minimize the pain and hostility. Here are 10 tips to make the process a little bit easier:

1

2 3 48

An employee should never be surprised at being fired. If a person's job performance is not satisfactory, advise him or her of the problem, how it can be fixed, and set a reasonable date by which you expect an improvement. If no improvement is seen, a second interview should again address the issue and make clear the consequences of inaction. In each case, document everything in the employee's personnel file, recording the date of the meeting, the substance of your ments. If the desired improvement does not occur after this second discussion, the employee should be terminated without further notice but again documenting the reason for the termination. In addition, do not “candy coat� annual performance reviews. These are often perfect occasions on which to address a problem or a trend before it escalates to a level that requires a specific meeting to address the issue. Again, be certain to document these comments in the employees personnel file.

Don't delay. Once you make the decision to let the person go, get the termination process completed and the employee out quick. Two weeks notice? No. It is more times than not a mistake to have a "lame duck" employee in the office. A depressed or disgruntled employee is bad for everyone's morale — patients included. Better to give the employee one or two week's additional pay in lieu of notice and ask the person to leave immediately.

Prepare in advance. When the day of dismissal arrives, have well thought-out plan about what you want to say to the

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employee. Avoid any discussion of the employee's "attitude." It's subjective and open to debate and almost always assures an argument from the employee.

Rather, focus your comments upon behaviors and actions that were observed and documented.

4 5 6

Don't go into too much detail. If you specify all the ways your employee has failed, you defeat your purpose. What do you accomplish except to inflict pain?

Avoid at all costs, spur-of-the-moment criticisms you may later regret. Stay calm and speak directly on the general actions that the employee failed to rectify or the policies/procedures that were not complied with following the previous meeting(s).

Have a witness. It is strongly recommended that you have someone else in the room for the termination meeting.

Often the presence of another can eliminate the risk of the employee later claiming you said things you didn't actually say.

It also frequently has the effect of keeping the meeting from becoming hostile or aggressive. The witness should sign the summary statement of the meeting to confirm the report of what was said by all persons in attendance at the meeting.

Keep it short. The employee will generally have a sense as to the reason for the meeting. Therefore, get to the point as gently as possible and keep it short, generally not more than 7 to 10 minutes.

Simply indicate that things have not improved since the last conference and that you have no alternative but to terminate employment. Acknowledge the person's capabilities and strong points and let it go at that. Refuse to be sidetracked into reconsidering or providing a second chance.

LEGAL

Elephant in the Room...

7 8

Neil W. Thomson, Esq.

(continued)

Timing. Letting someone go early in the week is preferable to Fridays; early in the day is preferable to the end of the day. In this way the person can immediately begin looking for another job rather than agonize about it overnight or worse, over the long weekend.

Inform staff. Tell other employees of your decision and ask for their support until a replacement is found. Staff members may well be aware of the discharged employee's shortcomings and actually applaud your decision. Do, however, be aware of the personnel relationships that are often formed between employees and if necessary, address the former employees colleagues in private. Such meetings should remain very brief, direct and without disclosing the specific reasons for the termination.

9 10

Reality check. The number of wrongful dismissal cases brought by disgruntled employees has dramatically increased in recent years and many with outcomes that have been extremely costly for employers. When in doubt, consult with your corporate counsel or an employment lawyer in your state to learn the precautions you should take.

Possible reporting requirements. If the reason for the termination of the employee involves violations of federal or state medical regulations, or constitutes a possible crime, you should consult with your corporate counsel or employment lawyer immediately and seek their legal advice of complying with any mandatory reporting requirements.

Inevitably, an employer will need to terminate an employee. By following these 10 steps you can frequently address these unpleasant situations in a more effective manner, thus avoiding employment disputes or lawsuits. Remember, whenever in doubt, consult your corporate counsel or an employment lawyer. An once of prevention is always worth a pound of cure.

Mr. Thomson was born in Madison, Wisconsin. He received a B.S. in Political Science from The Ohio State University in 1979, and his Juris Doctorate from the Capital University in 1985. While pursuing has law degree, Mr. Thomson was the Notes Editor of Law Review and a member of the National Moot Court team.

Mr. Thomson is a member of the Arizona and American Bar Associations, and is a member of the Business, and Litigation Sections of the ABA. Mr. Thomson has been recognized as one of the Best Lawyers in America for business and commercial attorneys from 2001 though 2011 and has long held the prestigious AV® Preeminent™ Peer Review RatingSM from Martindale-Hubbell®..

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LEGAL

becoming an

expert witness

by Jillene Roundy

Experts are needed to evaluate the merit of complaints, write letters of opinion, act as witnesses, and testify in court cases. These experts are needed by both prosecutors and defense attorneys. Although most people think that experts are used only in medical malpractice cases, there is a need for experts in countless areas of knowledge. Experts in forensics, construction, medicine, engineering, chemicals, safety, etc. are needed to help prove or disprove cases.

Many professionals are unaware of the tremendous opportunities that come from doing expert work. It can be both gratifying and rewarding.

Medical professionals regularly enjoy expert work, as they can use their experience and expertise with no traditional office overhead and little to no liability. In addition, they are paid well for the time spent on the case. Case work can often be done without impacting traditional practice hours. There are a multitude of factors to be considered in dealing with the logistics of the legal system and the varying cases. For each case there needs to be an expert to verify findings, opinions, and conclusions. Cases are either strengthened or weakened based on the credibility and character of the expert. Strong ethical experts are needed to keep the legal system in balance and to bring justice and integrity to the judicial system.

Experts are expected to be unbiased, articulate, and honest in their opinions. This is a neccesseity in serving both the public and the profession.

The expert helps to guard the public trust, provide peer review, police colleagues, protect others from frivolous suits, and help right injustices for those who are wronged or abused.

Medical professionals are used to render an

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a second opinion. Often they are pleased to learn that by using those same skills they have an opportunity to cultivate a second revenue stream.

I believe I am qualified to be an expert, where do I start acquiring legal cases? hope that when an attorney is doing a search they will come across the site. Others pay from $150-$1,000.00 annually to join an online directory where they can list their area of expertise and hope to be contacted. There are viable alternatives, and iFind Expert is a reputable example of such.

Case management, in-house counsel, and support staff services are key components to make a successful expert and case. Each valuable service is available at no charge to you. iFind Expert takes care of all your document management and storage, tracks billable hours, invoicing, and payment for services. iFind will send you reminders when reports are due or documents are ready for review. If you are unsure whether or not you are qualified to act as an expert witness, contact the friendly professionals at iFind expert! They will provide the behind the scenes support to ensure you become a qualified, confident, and successful expert in your field. While there are other referring agencies, no other company offers the extensive services and support of iFindExpert!

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LEGAL

demystifying

Internal management agreements & practice group rollups

by Neil W. Thomson Esq. There are two sides to a medical-practice; there is the business side and there is the active physician/patient side. Both sides must be consistently maintained and actively managed in order for the medicalpractice to be a success. Unfortunately the business side of the medical practice is often dismissed as secondary or is otherwise not well crafted. This can result in

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problems that often prove significantly detrimental and sometimes fatal to the medical practice itself. A majority of these problems can often times be avoided with well drafted internal practice management agreements created for the medical practice at the formation. These agreements need not be complex or unduly onerous. Rather, with a minimum investment of time and careful

LEGAL

thought, these agreements can be created cost–effectively and will allow for the orderly maintenance, operation and continuation of the business side of your medical practice.

While the substance of internal management agreements often is the same, the formal names of the agreements may change depending upon the type of entity chosen to house the medical practice. The choice of the entity in which to conduct the medical practice generally consists of a professional corporation (a PC), a professional limited liability company (a PLLC), a limited partnership (a LP), or even a professional limited liability partnership (a PLLC).

The names of the internal practice management agreements for a professional corporation generally consist of bylaws, shareholder agreement, and a buy sell agreement. For the professional limited liability

company the names of the agreements conagreement and a buy sell agreement. For the limited partnership or the professional limited partnership entities, the names of these agreements include a partnership agreement and a buy sell agreement. Not infrequently, many of these agreements may be consolidated or provisions may be contained within one document to keep the number of agreements to a minimum.

“With a small investment of time and focus on these agreements at the start of your practice, you can avoid significant problems and disruption later.� continued on next page

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Internal Management Agreements: However named, the importance of these agreements is providing the basis on which decisions for the business will be made; who will have the authority to make those decisions; setting the limitations of that person or persons authority; determining how ownership in the business entity can be sold or transferred; establishing how the value of the business entity is to be determined for a sale or transfer interest is to be conducted upon an event of termination, death or disability.

A primary focus of these agreements is upon management decisions, in other words, who or what group of partners will be authorized to make decisions on behalf of the business; what are the limits of such authority (monetary limits, substantive or categorical); and what decisions or issues require the approval, whether unanimous or majority, of the physician-partners of the business. Having a wellstructured and conceived system for this decisionmaking process is critical to maintaining viability and stability of the business. It will often avoid disagreements and disputes between the physicianpartners that so frequently prove to be disruptive to the relations and internal operations.

Almost all medical practices will grow and develop over the course of time. The practice will add physician-partners over time and of course, physician-partners will also leave, whether as a result of termination (voluntary or involuntary) or as a result of death or disability. A critical purpose of these internal practice management agreements is to provide the mechanical basis on which a departing physician-partners ownership interest in an entity will be part repurchased, sold or transferred as well as providing the restrictions upon any sale or transfer of such interest. The absence of such agreements upon the event of either a termination or a death of a physician-partner can often times result in difficult negotiations with the departing physician-partner that may frequently be extremely disruptive to the business of the practice itself.

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(continued)

Neil W. Thomson Esq.

Of course, one of the most important aspects of these agreements will be that methodology of how the business is valued for purpose of the repurchase or sale of a physician-partners interest and how that value will be paid to the departing physician-partner. There are numerous valuation methods that can be applied to determine the value of a medical practice. It is critical to establish that method at the outset of the establishment of the practice to avoid disputes and lawsuits over that issue later in time. The mechanics of the payment to the departing partner is equally critical as few medical practices have the financial reserves necessary to “cash out” a departing physician-partner in a successful practice without requiring a cash call or contribution from those remaining.

These agreements may also establish different levels of ownership, such as class A or B stock, so as to allow the practice to admit new physicians as partners and yet establish limits on their voting authority and/or their economic interests until they have fully proven their commitment and value to the practice.

These are just a few of the critical aspects of the internal practice management agreements that will allow the business side of your medical practice to avoid disruption and permit you to focus upon patient care. With a small investment of time and focus on these agreements at the start of your practice, you can avoid operational, financial and emotional distress in the future.

Mr. Thomson was born in Madison, Wisconsin. He received a B.S. in Political Science from The Ohio State University in 1979, and his Juris Doctorate from the Capital University in 1985. While pursuing has law degree, Mr. Thomson was the Notes Editor of Law Review and a member of the National Moot Court team.

Mr. Thomson is a member of the Arizona and American Bar Associations, and is a member of the Business, and Litigation Sections of the ABA. Mr. Thomson has been recognized as one of the Best Lawyers in America for business and commercial attorneys from 2001 though 2011 and has long held the prestigious AV® Preeminent™ Peer Review RatingSM from Martindale-Hubbell®..

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MARKETING

your

reputation

Why It ’s Important & How You Can Us e It to Your Ad vantage Reputation M anagement i s the attempt to i nfluence a nd s hape how your practice is perceived by all interested parties, including your patients, their families, the general public, your employees, potential patients and vendors.

The past f ew y ears have s een a sea change i n the ways t hat a The onset of social media has had a major impact on how people that long ago t hat when a p atient had a n experience (whether good o r bad) w ith a medical practice, h e or s he would share it with f riends and family. If the experience was an e specially bad might contact a lawyer or even a reporter –which would then lead to the general public finding out, as well.

Of c ourse, these days a p erson can post a review of y our tation – f or t he e ntire world to s ee – w ithin mere seconds . a negative r eview a nd y ou are made a ware of i t, y our practice has two options. You c an c hoose t o ignore i t (which is probably combat the negative comments.

If you choose t he s econd approach, y ou c an choose a designated individual (either an in-house person o r an o utside e ntity) social media on your behalf and act to refute any negative comments. This person can post positive pieces in sufficient numbers search r esults or on s ocial media s ites. H e/she c ould a lso join online conversations. For example, the Reputation Manager can respond t o negative p osts about y our practice with comments that they have had only good experiences to report. continued on next page

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MARKETING

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YOUR REPUTATION...

Ron Meritt

(continued)

“Of course, these days a person can post a review of your practice online, and it becomes part of your practice’s reputation – for the entire world to see – within mere seconds.”

Your practice can and should take positive advantage of social media. The first step in reputation management is to monitor references to your practice and its individual doctors. To do this, have your designated Reputation Manager sift through social media on a regular and consistent basis, looking for any references to your practice. This can be done most effectively through social media monitoring, using tools such as Google Analytics and similar processes. They will help give you a “snapshot” of current public opinion of your practice. Armed with this information, you can address any problematic issues which have been revealed.

Reputation Management campaigns can also be conducted to increase the visibility of positive opinions or to decrease the visibility of any negative comments.

There are several things which can happen which could damage the reputation of your practice.

They can include (but are certainly not limited to) the following items: You are sued for malpractice by a patient.

An employee, such as a member of your front office staff, does something which upsets a A patient passes away and your practice is legitimate charge, it can still do irreparable damage to your practice).

Always remember, the actions of each member of your staff reflect – either in a positive or negative way – on your practice.

There are numerous ways your practice can utilize Reputation Management in a proactive manner, helping to engender a positive reputation. Here are just a few suggestions (again, this is by no means a complete listing): Educate the entire staff of your practice about how to deal with patients in a manner which will enhance your reputation.

Along those lines, remind every member of your staff of the old adage that “The customer is always right” – of course, in this case, the customer is your patient.

Remind your entire staff about the importance of treating each patient the way he/she would like to be treated.

One effective way to cultivate a good reputation for your practice is to become known for associations with activities/causes/initiatives which will produce positive “buzz.” A few examples: Submit an op/ed piece to your local paper or a website on a health-related topic.

Submit pieces to print or online medical journals and make sure to publicize the fact that you wrote them.

Sponsor a “fun run” with proceeds going toward a good cause, such as breast cancer awareness.

Donate money to a worthwhile local non-profit,

You receive a professional sanction.

An employee or patient files a sexual harassment or other type of lawsuit.

A doctor or other employee gets in trouble with the law, such as being charged with a DUI. 60

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No matter what you choose to do, make sure you this by developing and distributing news releases upcoming events.

MARKETING

YOUR REPUTATION...

Ron Meritt

(continued)

You should also embrace social media: website.

Set up a Facebook page for your practice, and encourage your patients to “friend� and follow you.

Use Twitter to communicate with your patients and the public at large, providing them with useful information. stay connected and network with other physicians and members of the medical community.

The bottom line is a pretty simple one: The only truly effective way to create a positive reputation for your practice, one which will endure, is through appropriate behavior. tion at a time.

television broadcast production, on-air talent, advertising sales, business marketing and strategic public relations. Ron spent a total of 23 years on television before retiring from broadcasting, and opened PRfect Media in 1994. His keen insight into the workings of journalism and protecting reputations through strategic crisis communications strategies has combined to protect long-term care facilities throughout the United States from media attacks. PRfect Media customizes marketing programs for census development and brand management for long-term care facilities for more than a decade.

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MARKETING

Local Search Engine Optimization & the importance to your practice.

by Keith Clark

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MARKETING

Every business wants to appear at or near the top search results for the major search engines like Google, Bing and Yahoo! The overwhelming majority of click-throughs result from pages that land in the top ten or, at least, on the first page of search results. The higher the search engine listing of your website, the higher the the search game. Recognize that “dominance” plays an important role to the consumers influence. So consider the other “Search” real estate: maps, organic, sponsored, mobile, and the all-important Local Listings.

The objective of local Search Engine Optimization (SEO) is to help your website achieve the highest placement possible in search engine results pages. As the internet continues to grow in both size and importance, it can become even more difficult to get noticed.

What is Local Search?

Local search is simply a search that is intended to find something within a specific geographic area. For example, a user may search for "pediatricians in Las Vegas". Any local-centric business that draws clients from within a specific service area must be concerned about creating an effective local search optimization campaign.

Typically, local online searches result in the completion of a transaction offline, and more and more local searches are being conducted with mobile devices such as smartphones.

Searching Locally engines to look for services and products within their local reach such as restaurants, doctors, lawyers, and lawn care services. As a result, the major search engines now deliver more localized search results into their organic listings. over 79% of U.S. consumers conduct local searches on the internet before making a buying decision offline. As a result, it's become increasingly important that businesses understand what local search is and how it works.

Small and mid-sized businesses need to recognize and take advantage of the fact that people are using search engines to find them locally.

Vegas, do you really care if people in Miami view your website?

How does one improve their local search engine optimization process? Just like standard SEO, creating relevant and compelling content is crucial. Well-written copy for your user and proper local keyword research goes a long way in giving your business a competitive advantage in the SEO battle. Successful local SEO can demand more creativity. c o n t in u e d o n nex t p age

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Local Search Engine Optimization...

The fact that local search results are being listed before organic web results gives your practice a golden opportunity. To take advantage, you now need to pay more attention to local business listings as an essential part of your search engine marketing (while still optimizing for the traditional web listings).

The Importance of Content Today your practice must be strategically engaged on available digital media outlets. Your customer base is more diverse than ever and they like to get their information from a variety of marketing channels and platforms including websites, blogs, and social media. This makes fresh, unique and relevant content critical. Although this can make your job more difficult, it can also create unprecedented marketing opportunities. keeps them engaged. Fresh, relevant, quality, professionally-written and optimized content is also what attracts the attention of the search engines – translating into higher revenues for your business.

Social Media One of the best ways to create a content marketing campaign is with an effective social media program. You make it easy for customers to find your business and to talk about it online. Social media sites will help boost your local search results, your long-term brand awareness and increase sales.

How? Social media lets you communicate directly with your customers, create engaging discussion topics, take your marketing viral, boost your online brand awareness, and helps propel your business to the top of organic local search results. Some engagement examples include using monitoring tools to listen for conversations around important topics that you can service or be an information resource. Establish a keyword list and be notified anytime someone in the geographical area posts a

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(continued)

Keith Clark

question or related comments.

Here are some examples that will help you achieve those goals: Start a Blog. To truly understand the importance and effectiveness of content marketing, start a blog. Write information that your customers want to read instead of dictating to them. Let your visitors leave comments and reviews.

Build a following on Facebook. Half of Facebook users follow a specific brand and more than half of them eventually purchase that brand. “Likes� on Facebook spread brand awareness virally, delivering information to everyone befriended by your followers.

Open a Twitter account. Twitter is a great way to keep in touch with your current customers.

Increasingly, Twitter users follow a specific brand and most will eventually purchase that brand.

Twitter posts should be used to engage your clients by providing them with helpful information about your products and services. Offering special deals to your Twitter followers is a great way to grab their attention.

SEO Practices for Organic Local Search Even without a social media campaign there are many SEO practices that can greatly improve your local search rankings. Here are some basic, simple and effective practices that will help you achieve higher organic search results and improve your click through rate.

Content is King. Carefully crafted quality content establishes you as an authority in your field.

Create useful, information rich sites, microposts experience. The more useful the visitor finds the information, the more likely he/she will pass it on to their friends, followers and connections.

MARKETING

Local Search Engine Optimization...

Customer reviews. Encourage customer reviews.

Consumers love online reviews because they can see what others think about you and your product or service before they make a purchase or decide to use your services. In addition, reviews on social media sites improve your organic search engine rankings and will drive free web traffic.

Keywords. Give serious thought to the keyword What keywords would he/she use to find you? phrases that are four or more words long – are often the most effective keywords. Potential clients close to scheduling an appointment.

Website domain (URL) name. mate how important a good domain name is.

Having your most important keyword in your domain name will give you tremendous advantage over your competitors. (ex.

On name: SantaFePediatrics.com) Page titles. Your website page titles (especially your home page) need to be targeted to the primary terms that you're trying to rank for. For example, if you're a pediatrician, your home page title should target your pediatrician services in your locality.

Manage your local business listings. Nearly every major search engine and Internet Yellow Pages (IYP) offers a free method that allows your practice to claim and manage your local business listing data. This includes the Big Three: Google, Yahoo, and Bing. Take advantage of this tool by working with professionals on claiming, optimizing and managing your local business listings on the such as local medical directories or review sites.

Add all relevant categories that describe your practice offerings that can be easily found when users search for you.

Keith Clark

(continued)

Some top factors if you had sort chronologically: - Physical Address in City of Search

- Proper Category Associations

- Proximity of Address to Centroid

- Domain Authority of Website

- Quantity of Structured Citations (IYPs, Data Aggregators) - City, State in Places Landing Page Title

- Quantity of Native Google Places Reviews (w/text)

Site promotion. Many businesses think that their job is complete as soon as the website is launched. You website needs to be promoted just like any other product or service. Plan it into your business budget accordingly. Discuss this with a digital marketing agency or industry related consultant to find out what marketing mix will work to maximize your exposure and give you the proper return on investment. Each tactic about marketing.

Traffic and next steps.

Most local directory sites have some kind of traffic measurement dashboard providing stats like asked for directions, views of your business, number of reviews,etc. These are good places to start your monthly reporting as to whats working in marketing or advertsing and even tracking offline promotions like coupons or event signups.

Keith Clark, a digital marketing strategist with over 25 years experience related to small businesses and large brand enterprises. As the original founder of Abode Systems, a firm that prides itself on providing innovative resources to maximize exposure at all levels sustainably and within budget.

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Social Media :

A Physicians Specific Approach

by Bob Smith As a physician, it is useful to view social media as an asset and a threat.

The 3 P rimary a pproaches for your S ocial Media Actions:

Done well, i t can very e ffectively leverage and multiply your presence i n your desired market in ways that generate increasing patient f low and cash flow.

Personal (your Humanity)

If i t is done poorly or ignored, i t represents a 24 hour threat t o your market s hare and customer base from competitors and emerging technologies or treatment sources. This keeps your business “at risk”.

The Practical Side: For t he physician, social media is one o f the few sets of resources that can allow you to communicate with your market and be absolutely certain that

Purpose, Function and Achievement: The purpose of social media is to use technology to provide access and a digital p resence t o your customers and your markets.

The function of social media is to provide you with ways to h ave your patients help y ou g et more customers.

Social media is achieved t hrough the use o f platforms (like Facebook, T witter, Blogs, V logs, digital communities, rating and review systems like Yelp, email and texting) through which you establish and sustain an ongoing dialogue and digital relationship with people who matter to you.

This is the place t o be you as an i ndividual. To present your personal side.

Actions: Establish a F acebook presence t hat describes you, your individual traits and your general life. Include pictures of you, the family (as you wish) and a description of things you find interesting (nature, sports, music, hobbies, etc.) This is a fixed presence that has some occasional updates – but is primarily static. The more you update it, the more interaction you will create over time.

Profile descriptions can be as simple and powerful as: “Hi, my name is David. I n my o ffice I am the physician who i s dedicated t o health and wellbeing.

course.”

OR

stay focused.” continued on next page

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Social Media: A Physicians Specific Approach Professional (your Credibility)

Action: Create a Blog as a part of your website. Plan to update it at least every 20 – 30 days. (This is a long time in the digital world.) A Blog post is 300 – 750 words and is usual theme is about something that informs and educates your desired or current patients in ways that serve them and their connection with your profession.

Action: Establish a LinkedIn profile that talks about you as a professional. Feature your education, specialties, success stories.

Use it to inform and educate rather than sell.

Selling in social media is the number one error people make when they try to use it on behalf of their businesses.

Make this about your passion for your craft, your interest in your field, how you want to help people through your business.

Make 30-90 second video vignettes about you and your business. These are often referenced as Vlogs and have a powerful influence on your customer relationship.

The Business (Your Stability) Done well, social media can be an excellent resource for you to perform yield management. When you have a lull in traffic or profit centers, you can utilize social media for social marketing or social selling.

You can make introductory offers or update changes in a real-time fashion.

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Bob Smith

Action: Have a robust and elegant website. You

The Professional use of social media provides you with a basis to establish and enhance your qualities as a professional. It allows you to talk about “why a customer would pick you versus another provider”.

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want it informative, inviting and effective with information, success stories and attractive offers. Use videos to feature different people within the practice (office management, staff and other practitioners) as a way of creating a “personality” and approachability for the business.

You can also use your website to demonstrate your support of community based initiatives or not-for-profit causes that you keep you visible and relevant.

Action: Create a business page on FaceBook, so that

patients can easily find your business. This is a chance to use “key” words that help you attract the kind of patients you want. (Example: if you are a GP and you want to treat more sports related patient needs, then include all the names of the sports you want to attract [football, basketball, soccer, etc.] so that when people search FaceBook for those sports in your area, they find you.

Action: Have a “Dashboard” through which you can

monitor traffic, site feedback, and look for sources of new patient flow and revenue yields based on capacity compared to overall use. This can be accomplished using your internal staff resources, or by hiring a resource to construct a dashboard that reflects the business, the market and your overall digital presence.

MARKETING

Social Media:(continued)

Bob Smith

Action:

Unless you are personally interested in spending 20 hours a week “web surfing” and playing in social media, DELEGATE the function of establishing and sustaining your presence. Have members of your staff post or update things as well as collect reports on things that “mention” you or the practice.

“Use Social Media to inform and educate rather than to sell.”

“Social Media is a waste of time and money unless it is specifically Applied and measured.”

Summary: Social media is a complimentary marketHowever, within 12 months, it can double the efficacy of your advertising.

Because of changes coming down the pike, medical practices will have a substantial increase in the need to market their offerings. Social media is a great enabler in this area because it allows you to be proactive in your market and learn very quickly what does and Above all, know what you want to accomplish with each applied use of social media and have a way to measure traction, impact and returns.

Bob Smith founded MySuccess, Inc. after 12 years in computer industry sales operations, developing successful marketing strategy for hardware and software resellers of big names such as Satellite Software, Wang Laboratories and Data General. Because of that experience, Bob Smith became very interested in the dynamics that occur in Working Relationships, Communication and Performance Strategy the fields of Marketing, Sales and Executive Leadership.

He applied studies from program work at MIT Systems Thinking Lab, along with Organization and Growth Strategy and beyond with MAP (mental Aptitude Patterning) Relationship and Communication tools.

Bob now works with key individuals and teams within companies that want to boost performance through Relationship. He has provided corporate and executive strategy for industry leaders such as Marriot Corporation, Sears, Northwest Airlines, Children's Hospital, Pulte Homes, Staples Inc., GAP Inc. and numerous startups and fast growth companies.

NO V E MB E R /DE CE MB E R

2012

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Strong Tower Real Estate Group 8679 E San Alberto Dr., Ste 100 Scottsdale, AZ 85258 480.719.3313 info@stre.co

CALL 480.719.3313 FOR INQUIRIES.

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