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CONTENTS Volume 1, Issue 3 - WINTER SOLSTICE EDITION 2015
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Welcome
Industry News
Art of . . .
Unexpected Paths to Leadership
Quality Talks
When we set out to do an issue focused on leadership we had no idea it would take us to the top of a mountain and to the pages of an army field manual! In these pages you'll find both expert advise and inspiration to unleash the leader in you.
Julie Wood recaps NCQA's Quality Talks, a half-day conference made up of TED-style talks on a thought-provoking array of topics effecting the healthcare industry today. Speakers ranged from industry experts to patients and family members.
Leadership Nurture of nature, what makes a great leader? Susanne Madden explains what leadership means to her and why the ability to make real connections and to inspire those around you are essential skills for effective leadership.
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Big Impacts
Legal Notes
Pro Tips
Death of Fee-For Service Payments?
The Hybrid Concierge Model Key Issues to Consider
Leadership Skills: Deploying Military Tactics to Create Better Physician Leaders
Call it boutique medicine, personalized healthcare, or direct care, it all falls under the umbrella of concierge medicine and many physicians are embracing the model. Sumita Saxena examines the legal and ethical issues of this rapidly growing practice model.
As a young man Jose Lopez learned to "Improvise, Adapt, and Overcome? in the army. Here he offers lessons learned during his years of service and how to apply them to the challenges of leadership in practice today..
Fee-For-Service is on the way out and Value-Based Purchasing is here to stay. Guest columnist and Verden Group Associate Robert Goff explains what it all means and why now is the time to position your practice for the future.
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Connect
HR Matters
Missed a blog post or tweet? Connect provides a quick recap of what you missed from all our media streams. Didn't know that we blogged, 'booked and tweeted? Join us online!
Thinking of monitoring your staff's communications at work? Before you do, consult this primer on the legal do's and don'ts. Sumita Saxena offers tips and warnings on how to protect your practice without seeming like Big Brother.
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Payer News
Spotlight
What does it mean to be SELF-FUNDED and how does it work? With health insurance premiums steadily rising, more and more employers are taking matters into their own hand and providers are learning that out of disruption comes opportunity.
Think you've got what it takes to be a leader? Dr. Scott Schams has been taking groups of people into the wilderness to be challenged emotionally and physically on the path to discovering their own leader within.
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Frontlines
Overheard
In-depth interviews with Dr. Jill Stoller of BCD Health and Dr. Scott Schams of Allied Pediatricians of Texas uncovers what it takes to be an independent clinically integrated Super Group.
Whether we heard it at the water cooler or on the conference trail, Overheard brings you snippets from interesting conversations on the hottest topics in health care to the just plain funny happenings at the office.
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Events
Gift of Giving
From city to city, coast to coast, we are on the move. Get details on the key events and conferences that we'll be attending this Fall that you don't want to miss. See you there!
It's nice to give (and receive!) cookies and chocolates, but for several years we have been making donations to Heifer International instead. Read on to learn more.
TEAM AND CONTRIBUTORS
Susanne Madden
Scott Hodgson
Jose Lopez
Heidi Hallett
Julie Wood
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Sumita Saxena
Robert Goff
? W ELCOME ? When we set out to do an issue focused on leadership we had no idea it would take us to the top of a mountain and to the pages of an army field manual. As we've compiled these thoughts and insights on leadership from our colleagues, clients and industry leaders we've been fascinated and inspired ? and we hope that you are too. In addition to bringing you perspectives from the field, we continue our Legal Notes series. In this issue, Sumi brings us the ethical and moral issues associated with concierge medicine and we explore what opportunities may exist now that the employer 'self-funded' market appears to be reaching maturity. Julie and I spent an interesting morning in November in Washington, DC, at the National Committee for Quality Assurance's (NCQA) first 'Quality Talks' event. Julie shares the highlights and what we learned about where the consumer health care market is taking us next. Our esteemed colleague, Robert Goff, joins us for the first time on these pages to discuss the 'death of fee for service' payments. But rest assured, it is not all doom and gloom ? with all of this industry change comes remarkable opportunity, especially for our most innovative clients. It's been an exciting year and one that has included seeing the launch of this magazine. We are certain that 2016 will take all of us in directions that we cannot yet anticipate. Wishing a very Happy Yule and prosperous New Year to all and we look forward to bringing you more insights, tips and stories next year.
SUSANNE MADDEN | EDITOR-IN-CHIEF
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VIEW POINT MAGAZINE ONLINE Online at www.VerdenViewpoint.com you'll find expanded content, video, images, tips, interviews and more. Look out for links throughout the magazine or simply click on the link above to explore.
VIDEO Where do things stand with negotiating insurance company contracts in this era of value-based purchasing? Watch this video to find out ? what you learn may surprise you. Susanne Madden, CEO of The Verden Group, has been negotiating with insurers for nearly 20 years. She takes us through the perspective of insurers here.
THE BEST OF . . .
Look For this 'button' throughout the magazine for downloadable PDF versions of articles.
We've selected some of the most popular articles from the Verden Group's blog, Susanne's 'Pearls' published in Physicians Practice magazine, and from past issues of ViewPoint too. Our selected articles are all packaged up as PDFs-To-Go so you can report and share with your colleagues too.
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GRAPHIC VIEW POINT Curious about the images you see in our magazine? You can read more about where these pictures were shot and who took them here.
www.verdenviewpoint.com 5
? INDUSTRY NEW S ?
Julie Wood | Co-Founder, PCS
QUALI TY TALKS A Recap of NCQA's Fir st Annual 'Qualit y Talks' Event
Susanne and I had the pleasure of attending the NCQA?s Quality Talks conference in Washington, DC, last month. A half-day event made up of TED-style talks on an inspiring and thought-provoking array of topics, the stories ranged from personal experiences of patients and families, to industry experts with a genuine passion for quality in healthcare. New technologies and innovative ideas for improvement in all angles of healthcare were shared and explored. From bringing new technology to the forefront, to delivering healthcare to patients in the form of telehealth and pharmacy consultations for patients on polypharmacy ? Quality Talks covered it all. NCQA President, Margaret O?Kane, introduced the day by stating that whatever we do in healthcare it has to be what is right and needed for the patient. Expanding on this point, and taking it one step further, Sachin Jain, MD, MBA, Chief Medical Officer of CareMore Health System, Anthem Inc. said, ?Assume nothing, except that this patient is different from the one before.? Jain?s talk emphasized that we need to keep asking the patients exactly what they want, rather than assuming that we know what it is that patients want. Only then can we respond to the realistic needs of the patient, thereby improving access to, and quality of, care. Juxtaposed with the healthcare provider stories were very personal tales about healthcare systems that failed the patient. Chris Spielman and Donna 6
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Crier brought the patient and family perspective in to focus with their inspiring talks. Chris Spielman?s former wife was diagnosed with breast cancer and died after 10 years of fighting the good fight. He continues to be a major champion for cancer patients and their families, helping to navigate the maze of care to ensure that patients have the best quality of life. Meanwhile Ms. Crier has truly been through the ringer in the healthcare system, having had a liver transplant and many other issues along the way. She explained how healthcare must move towards consumer-driven health and wellness, and that distinguishing good care from bad will mean accounting for the impact patients say their care has on their quality of life.
Retrace Health, Aderinkomi went on to offer a very innovative and interesting perspective on better ways to deliver healthcare to patients. Focusing on the Generation Y population, he went on to explain that many millennials want life to come to them, and if they go somewhere it has to be well worth the journey. Saving costs and reducing their footprint in the world is important to them. ?Time is what people need, and going to the doctor takes a lot of time, so let?s give that time back to patients.? Retrace Health is a company that has no bricks and mortar and no paper. By using tele-health they eliminate 60% of in-person visits. For the remaining 40%, they go to the patient, even delivering simple tests by courier that patients and/or parents can administer and read themselves.
?Silicon Valley gets it. Why doesn?t Andrey Ostrovsky healthcare??asked Andrey Ostrovsky, MD, Founder and CEO of Care at Hand. Ostrovsky examined the need to shift the payment model to a merit based improvement system and emphasized the importance of having digital health as an integral part of healthcare. Believing that technology should be evidence based and peer-reviewed, he pointed to the fact that only 23% of the top digital companies had peer-reviewed data as part of their marketing information. Only by quantifying improvement and making it ?evidence based?can we achieve true quality in healthcare.
Rebecca Onie, Co-Founder and CEO of Health Leads took a different approach, focusing on the social and environmental issues within families. Rebecca believes that a paradigm shift is needed in healthcare to include a patient?s social needs, stating that 80% of health needs are related to these issues and that only 10% of healthcare outcomes are related to medicine. In reality, food, heat and healthier living conditions affect the health of the entire family. Making a change in how patients can get help when they need it, through their primary care provider coordinating with the available community resources, is what can truly make a difference. Health Leads helps PCP?s utilize local current assets and resources and get them to the patients that really need them as a first line treatment.
On hearing the title of Thompson Aderinkomi?s talk ?How to make going to the Doctor less terrible?my first thought was that even needing a talk with this title is discouraging at best. Founder and CEO of 7
WHA T YOU NEED TO K NOW NCQA Update A revised version of the PCMH 2014 Standards were published on November 16th 2015. For practices newly embarking on the Program, these are the Standards that you will receive when you order them from NCQA. For practices in the middle of completing your PCMH Program, please thoroughly review these changes as your submission will be graded based on the current version. Order and download the revised Standards from NCQA here and refer to Appendix 6: Summary of Updates.. There are a number of changes in this version with most being additions to documentation and explanations, but there are a few substantive changes based on the recently published Meaningful Use Stage 2 edits.
Rebecca Onie
Mary Roth McClurg, Pharm.D., M.H.S., spoke about how incorporating a clinical pharmacist into a primary care practice can really help patients and providers with medication reviews for those polypharmacy patients that are most susceptible to dangerous contraindications. The focus of her talk was about the importance of listening to the patients about the medications, supplements and even what diet that they are on. The key to these consultations was to empower the patient for the improvement of self-management through facilitation of the patient?s understanding of the drugs, why exact dosing at certain times of the day is critical, and how to avoid problematic inhibitors that may show up in the form of nutritional supplements. Certainly, a very compelling reason to introduce a position like this into a complex population is that for every dollar spent on a medication another dollar is spent on resolving medication error reactions. UNC?s pharmacy school?s doctorate program has completely revised their curriculum to address this care coordination, changing the focus to working with patients and physicians to improve care delivery for patients with their medications, listening to patients and inspiring health professionals education for quality in outcomes. The next step will be to align payment for this very important piece to the quality of healthcare.
In addition to documentation, explanation and MU edits, NCQA has issued a significant change in the process for Multi-site practices. Previously, multi-site practices submitted their Corporate survey tool and had one year to submit as many sites as possible under that Corporate tool. Now, once a practice has received their Corporate result and submitted their first site under that Corporate survey tool, the 3 year countdown to re-recognition starts based on that first site?s Recognition date. And rather than one year to submit sites under the Corporate Survey, you get 3 years to submit all of your sites BUT that first sites?Recognition date will be the renewal date for all of the sites. To illustrate, if you submit your first set of sites under a Corporate Survey in March of 2016, and your last site in December 2018, and the first set gets Recognition in June 2016 then ALL sites are up for renewal in June of 2019. Are these changes a bad thing? Not at all! NCQA has updated and changed many of their factor explanations to be more descriptive of exactly what they are looking for from practices. This should help considerably with the interpretation of the material. 8
" We are th e h eal th care arch i tects ? l et's get i t ri gh t f or th e pati ents!? - M argaret O?K ane Grace Terrell, MD, President and CEO, Cornerstone Health Care spoke about population health and changing the way patients are being seen. Dr. Terrell re-designed her multi-specialty level 3 NCQA PCMH practice into a PCP and community resource-centered practice with specialty service line clinics surrounding them, with hours 7am to 9pm, 7 days a week and a concierge style practice for their dual eligible Medicare Medicaid patients. Based in North Carolina with a large church-going population they are working on having smart phone tools available at churches to improve screenings, and also managing diabetes with an app for remote management. All of this results in truly managing population health and not just individual patient health. Dr. Terrell utilized a Cherokee saying that translates to, ?no individual can be truly healthy without the whole community being healthy and no community can be truly healthy without each individual being healthy.? Kevin Volpp, MD, PhD, Professor of Medicine and Health Care Management, Perlman School of Medicine and the Wharton School, University of Pennsylvania School of Pharmacy presented ?Motivating the Masses with a Spoon Full of Sugar?.He talked about motivating health systems, plans, providers and patients to do the right thing. Dr. Volpp?s specialty is in behavioral economics and giving people the choices and options in a loss versus gain format using the understanding of irrational behavior to make preventing disease more practical and appealing in everyday life. The takeaways for the day were to focus on the consumer/patient ? what they need, what they say, and how to bring them into their own health care more effectively and efficiently; through tele-health and the effective use of apps for chronic care management, by involving community resources and assets that already exist to improve the health of people on their own terms and with an understanding of who they are. 9
About the photos in this issue Throughout the pages of ViewPoint, you will find pictures of nature taken by our team and our clients. Some are from personal trips, others were taken on business trips and some when we were together as a team. These images remind us of the ever-changing landscape of the health care industry and inspire us to adapt to and grow in the midst of that constant change. For example, watching tidal patterns reminds us to work with the current, not against it, to deliver our most comprehensive business advice to your practice. While some of these images make their way to our publication, many do not. If you'd like to see more of the photography that inspires us, please visit the Graphic Viewpoint section of our website.
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The Ar t of Leader ship Susanne Madden | Founder & CEO of The Verden Group
Leadership means different things to different people. Some people believe you have to be born with it, with certain "leader-like" qualities, while others say it can be nurtured (such as Dr. Scott Schams' view in Take A Hike). Personally, I think you need a bit of both. Being emotionally intelligent and listening to others is key to creating connections, but if you fall short on the delivery, you are likely to viewed as a "well-intentioned manager" but nothing more. If you don't take the time to learn how to make real connections, you're not practicing strong leadership. I believe that in order to lead effectively, you must be able to both connect and inspire people and you must also lead by example. Even less extroverted personalities can make fine leaders if they are able to push themselves to step out in front and lead the pack. When we look to our public leaders today we see very few who embody these qualities: very few, but not none. Over the past two months I have watched with fascination as Justin Trudeau has stepped into his new role as Canada's Prime Minister with dignity, empathy and a real ability to connect. From my perspective, those are the qualities that today's leaders need to bring to the table ? in business, in politics and in our home life. How do you define leadership? You can tell us here on the Verden blog.
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? BIG IMPACTS ?
Robert Goff | CEO | University Physicians Network
Is this the Death of Fee-For-Service Payments?
Of the many things brought to you by the Affordable Care Act (ACA) ? proudly or derisively referred to as ObamaCare ? putting the fee-for-service (FFS) payment system for medical services on a glide path to the scrap heap is worthy of our attention. Not that FFS is going to go out without a fight, but the stars are aligned to usher in value-based payments (VBP), and perhaps even faster than originally projected. For the first time, a major change in the concept of payment for medical care has been endorsed and is being led by a Federal Government initiative. Past efforts, largely by commercial health plans, such as shared savings, PODs and capitation, could never gain traction with the majority of medical care being paid for by Medicare under the FFS model. This time, it is Medicare that is leading the change, and that is where the real dollars are. A single payer controls these dollars ? the government. Under the Act, 30% of payments for traditional Medicare benefits will be tied to alternative payment models, such as accountable care organizations (ACOs), by the end of 2016 and then increasing to 50% by the end of 2018. Hospital payments are being fast tracked with a goal of 85% of payments being paid through the Hospital Value-Based Purchasing Program or the Hospital Readmissions Reduction Program by the end of 2016, rising to 90% two years later. Not to be left out ? and more in the manner of ?riding coattails?than showing originality and creativity ? the major commercial plans have announced a coalition to promote VBP Contracts with a goal of 75% of lives under such by 2020. 12
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payments are reduced. Overtime, the models will move more of the economics from FFS to the earned bonuses, so that while the initial models may provide the comfort of 80-90% of the dollars flowing through a FFS payment, with bonuses potential of 10-20%, the expectation is that FFS dollars will shrink and an increasing part of compensation will be ?at risk?for performance. With all of this in mind, it?s easy to see that FFS is definitely on a path to the scrap heap.
If the writing is on the wall that FFS payments are to become a thing of the past, that writing is in bright, bold spray paint. In truth, we are just getting going with the move to value-based purchasing (VBP). The current payment environment is a hodge-podge of continued FFS, with growing alternative structures being rolled out by government as well as the commercial carriers, all striving to ?align incentives?and ?shift risk.?Only by making the providers of medical services accountable financially for cost of the care they provide, order, refer and arrange, will there be any hope at ?bending the cost curve?, and bringing the rate of the increase in medical costs closer to inflation, rather than the historical rate of more than twice the rate of inflation.
To counteract the fear that these provider groups will sacrifice quality of care for their bonuses, quality measures have to be met before bonuses are paid. Promoters of VBP want to avoid the stigma that HMOs earned under capitation when the economics rewarded depriving patients of care. In the evolving world of VBP, physicians that understand and can shift their thinking from not only providing care one patient at a time, but also managing their patient?s care in an effective and efficient manner, will be successful. The responsibility for patient care will have to extend beyond the walls of the office to advocate for the patient?s needed preventive care, as well as to efficiently navigate through a network of cooperating and collaborative providers who are all aligned to deliver the right care, at the right time and place. Given the rise of patient consumerism, all of this must be provided with sensitivity and respect for the patient.
This push comes after a long drum beat in the public press about the flaws, fallacies and failings of the health care industry to deliver quality of care and affordability. In 2012, The Institute of Medicine reported that the health care system wastes $750 Billon a year in poor quality, fraud, unnecessary services, and inefficiencies. Coupled with the public perception of a system that is unresponsive to the needs of people and absent any hint of being patient-centric, it paints a grim picture of healthcare today. Cue Value-Based Purchasing. These arrangements seek to put the providers at risk to deliver care that meets quality measures, and does so under some financial restraint or goal. There is not enough money to maintain the status quo, therefore let the providers organize, or be organized into structures that can earn them their compensation by reducing overall 'medical spend'.
The time to prepare for this future of payments based on value and performance is now. Proactively look at your own practice and how it functions, and also how it functions as part of a medical community. Assess your own strengths and weakness, as well as the numerous opportunities that are developing in your community. Better still; look to create your own opportunity with like-minded practices. Now is the time to prepare, to maximize opportunity, and to position your practice for the future. Innovating physicians and early adopters are the ones most likely to succeed in the new value-based economy.
The initial models are incentive programs that track the medical spending of provider groups under a FFS payment model. If the costs increase less than a set target, generally how the group is doing in comparison with themselves or the market, additional ?bonus?payments are made to those involved. If costs rise more than the targets, no bonus is given, and perhaps the next year?s FFS 13
? LEGAL NOTES ?
Sumita Saxena, JD | Legal Consultant
THE HYBRI D CONCI ERGE MODEL Key I ssues t o Consider
Concierge medicine, an alternative to traditional, insurance-based medical practices, is an umbrella term for medical practices with a direct financial relationship with patients. These practices are known by a varied and long list of names including concierge healthcare, direct primary care (DPC), direct care, direct practice medicine, retainer-based, membership medicine, cash-only medicine, cash-only practice, boutique medicine, personalized healthcare, hybrid models, and contract carrying healthcare. Concierge medical practices typically charge a monthly or annual fee so that the patient receives additional access and personalized care. The range of access and amenities depends on the physician and the fee charged. For example, the patient may have access to 24-hour physician availability by having the doctor?s phone number and email. Other amenities may include telephone consultations, executive-type physical examinations that last up to three hours in length, and expedited appointments, such as same-day or next-day appointments and no wait time at the office visit. According to the data from Concierge Medicine Today, a leading news organization, patients can also expect longer appointments as more than 70% of concierge and DPC physicians report having 30-60 minute patient visits. Greater access and more personalized 14
care can also mean personal visits in the hospital and sometimes in-home visits, follow-up calls after a specialist referral and/or hospital stay, and customized treatment plans including lifestyle and preventive plans. Contrary to public perception, VIP concierge physicians are not the only ones out there. However, the ones who are VIP offer additional amenities such as luxury robes, shower facilities, personal toiletries, and even cable television and Internet access.
referring patients to specialists that are willing to offer significant discounts, the other type of DPC charges an annual fee for a higher level of service in addition to per-visit fees. As Concierge Medicine Today notes, even though pricing structure and operations are a little different, price transparency, access, affordable rates and the personal level of service provided to each patient is what they have in common.
There are two main types of concierge medical practices ? retainer-based (commonly known as ?concierge?) and direct primary care (DPC). Both of these do not have co-pays, deductibles, or co-insurance fees. Retainer-based concierge practices charge an annual retainer fee for enhanced services. Many of them are hybrid models, meaning that they also accept insurance. According to Concierge Medicine Today over 80% of concierge physicians accept insurance in their practice, while the remaining have cash-only, menu-style healthcare practices. Direct Primary Care (DPC) practices do not accept insurance at all, thus reducing overhead costs, which can account for up to 40% of each medical dollar spent. There are two types of DPCs ? the first typically charges a monthly recurring fee for a defined set of clinical services and avoids unnecessary referrals by
Between 2005 and 2010, the growth of concierge physicians rose five-fold to more than 750 doctors. In early 2013, it was estimated that there were between 5,000 and 5,500 concierge and DPC physicians in the United States. In 2014, it has been estimated that the number of these physicians have grown to as much as 12,000+ in the United States. The four states with a very large lead in the number of concierge physicians in practices, as well as consumers seeking their care, are Florida, California, Pennsylvania, and Virginia. In these areas, the franchise concierge fees are increasing and the independent concierge doctor fees are decreasing due to competition. However, the number of patients seeking concierge medicine far outweigh the number of available physicians, especially in rural areas. According to the data gathered by Concierge Medicine Today, states with high demand but very
Popularity and Growth of Concierge Medicine
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few concierge physicians include Hawaii, Idaho, Iowa, Mississippi, Maine, New Hampshire, South Dakota, North Dakota, Louisiana, and Alaska. The most common specialty for these types of practices is obviously primary care with family medicine a close second. The next top two specialties are cardiology and pediatrics. In 2011, specialists were growing in numbers in concierge medicine, which include general surgery, psychiatry, spine surgery, gynecology, dentistry, addiction medicine, dermatology, oncology, and the cardiology and pediatric specialties already mentioned. Specialists offer the same increased access and patient attention as the primary care concierge doctors and tend to have patients with chronic conditions. The main difference is that the primary care concierge physicians tend to have a patient load of 300-750, whereas the specialists tend to have a patient load of only150-300. Concierge Medicine and the Affordable Care Act
Bet ween 2005 and 2010, t he growt h of concierge physicians rose f ive-f ol d t o more t han 750 doct ors.
Concierge medicine is a service provided by physicians rather than insurance instrument, therefore the majority of patients who use concierge medicine pay for it in addition to health insurance coverage. However, there is a clause in the healthcare law that allows direct primary-care to count as ACA-compliant insurance, as long as it is bundled with a ?wraparound?catastrophic medical policy to cover emergencies. Therefore, the emergence of concierge medicine has encouraged some health insurance plans, such as Cigna, to create employee health plans that incorporate concierge services. In addition, with more than 80% of concierge physicians accepting insurance, many patients use concierge medicine in conjunction with a high-deductible health plan (HDHP). This gives the patient catastrophic coverage that meets ACA minimum coverage requirements with minimal premiums and they are still able to see a concierge physician. With an HDHP, most patients will never meet the high deductible anyway, so they spend their money at the concierge physician where around $135/month is cheaper than a better health plan. However, patients need to be aware that the fees paid to concierge and/or direct primary-care physicians are not recognized by the IRS as HSA expenses and are not eligible tax deductions like other healthcare expenses are. 16
Drawbacks to Concierge Medicine Legal Issues There are some potential legal and ethical issues that concierge physicians and their patients must face. Some states are fighting concierge physicians and saying that they are assuming risk and operating as insurers of medical care without being licensed as insurers. This is a complicated issue as there is a conflict regarding whether it is defined as insurance under state versus federal regulations. Another state issue concierge physicians may face is being viewed as discriminatory. For example, it could violate New Jersey?s insurance code since the ?enhanced?services are only available to plan members who are able to pay the physician?s access fee, which can be viewed as discriminatory. Concierge physicians who also accept insurance could face violating the hold-harmless clause that is in most HMO provider contracts. This clause obligates the physician to look only to the organization, and not its plan enrollees, for payment for services covered by the plan, other than co-pays, coinsurance, or deductibles. These physicians may also have issues with Federal Medicare laws that prohibit charging Medicare recipients more than the ?allowable amount?for participating physicians or the ?limiting charge?for non-participating physicians. Concierge physicians must also be careful with their marketing techniques and make sure that they do not
DI D YOU K NOW? Top 10 fastest growing cities for concierge medicine in 2014: 1. Los Angeles, CA 2. San Francisco, CA 3. New York, NY 4. Palm Beach, FL 5. Baltimore, MD 6. Washington, DC 7. Philadelphia, PA 8. Seattle, WA 9. Chicago, IL 10. San Diego, CA
Top 10 best states to start a concierge practice or DPC in 2013-2014: 1. Utah 2. California 3. Texas 4. Florida 5. Washington State 6. New York 7. Colorado 8. Georgia 9. Tennessee 10. North Carolina * Source: Concierge Medicine Today 2014
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violate the anti-inducement provision of the Health Insurance Portability and Accountability Act (HIPAA), which states in part, ?A person who offers or transfers any remuneration that the person knows or should know is likely to influence the beneficiary?s selection of a particular provider, practitioner or supplier of Medicare or Medicaid payable items or services may be liable??. Therefore, when physicians decide to transition from a traditional practice to a concierge practice and send a notice to their patients, they need to be careful in how they are marketing their new practice.
WHO I S THE CONCI ERGE M EDI CI NE PA TI ENT? Th e f ol l ow i ng peopl e & groups are seek i ng conci erge ph ysi ci ans: I ndi v i dual s: 49% Coupl es w i th out ch i l dren: 23% Fami l i es w i th ch i l dren: 21% Busi ness ow ners and top ex ecuti v es: 4%
Ethical Issues * Source: Concierge Medicine Today 2014
In addition to a few legal concerns, there are some people who feel that there are ethical issues to consider. For example, with the decreasing number of primary care physicians when a physician reduces his/her patient load from 2,500 to 500 by ?going concierge?,that leaves 2,000 patients to find a new traditional primary care doctor. The challenge then becomes finding a new primary care doctor at a time when fewer physicians are accepting commercial, Medicare and Medicaid patients.
medical technology, so if a patient needs certain testing, they will have to get it done elsewhere. However, concierge doctors may negotiate with specialists and labs to secure discounts for patients who would otherwise pay out-of-pocket. Conclusion Any type of healthcare and health insurance-related issue is going to have legal and ethical issues that not everyone will agree on. The bottom line with concierge medicine is that it is growing, presumably due to physicians and patients fed up with the current state of America?s healthcare system and where it could be going due to The Affordable Care Act. In fact, even with the growing number of concierge physicians, the number of patients who are seeking concierge medical care in the past 24 months is far greater than the actual number of primary care and family practice concierge physicians available to service them. Only time will tell how this will pan out, but for now, it looks like this will continue to be a growing trend in healthcare for the foreseeable future.
There is also a concern that minorities, likely due to historically lower income as compared to whites, are not being represented in concierge medicine. In one survey of concierge physicians, the majority reported patient panels with 0%-5% African-American and Hispanic patients. Furthermore, with the doctor?s ability to choose their patients, it is speculated that concierge physicians are ?cherry-picking?the healthiest patients, thus leaving the sicker population to be absorbed by the remaining insurance-participating physicians that are not allowed to do so. Drawbacks for the Patient As mentioned previously, fees paid to these physicians are not tax-deductible like other healthcare expenses. Patients need to consider this when determining if they want to use a concierge physician. In addition, some of the less expensive concierge practices do not have the advanced
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? PRO TIPS ?
Jose Lopez, Senior Consultant at The Verden Group and the author of this article in his first leadership position as Squad Leader, Delta 3-327 INF, 101st Airborne, age 20.
LEADERSHI P SKI LLS Deploying Milit ar y Tact ics To Cr eat e Bet t er Physician Leader s
Never has the expression ?the only constant is change?been more applicable than in today?s rapidly evolving healthcare marketplace. Often, leadership in many medical practices falls to a Managing Partner or Owner, who ends up in that role by default. In the past, fee-for-service payment models were pretty straightforward, devoid of a lot of data and reporting requirements, staff roles were less complex, and patients less demanding resulting in leadership requiring less ?leading?and more ?management?on a day-to-day level. Fast-forward to today and the role of practice leadership has changed considerably. Today?s leaders face growing regulatory demands, more complex insurance plans and contracts, patient satisfaction requirements, quality grades and rankings, consolidations and mergers, ACOs, PCMH, managing millenials! Indeed, the entire model of health care delivery has changed dramatically to a focus on patient-centric care through quality, value, and care coordination. The rate of change in the healthcare marketplace has increased exponentially: In just the past five years alone, 19
we have seen the implementation of meaningful use of Electronic Medical Records, conversion to ICD-10 coding, a systemic shift towards Pay for Performance models, increased Quality Measure reporting requirements, implementation of the Affordable Care Act, and a consumer-driven marketplace that demands increased transparency, access and service. Unlike the previous model of top-down leadership, it is impossible to expect one person to effectively implement and manage all of these changes.
Creating a Culture of Leadership As I began my research for this article, I happened to be celebrating Veteran?s Day and began to reflect upon my own leadership skills developed while serving in the Army (from the age of 18 ? 22 years). I reflected on how those years formed the foundation for my own leadership experiences that I later deployed in a variety of healthcare settings. Most civilians imagine military leadership as the stereotypical image of a Drill Sergeant, barking orders to their subordinates without question in a rigid Chain of Command structure. This image is certainly accurate during Basic Training and situations in combat where life or death decisions require compliance without hesitation. But that Chain of Command is only as strong as the next ?link?in the chain and so the ability of lower ranking servicemen and women to rapidly and effectively fill voids in the Chain is critical, and that starts with empowering them and developing their leadership skills before
they assume their positions. And if there is one phrase I still hear in my sleep at night it?s, ?Improvise, Adapt, and Overcome!? Physicians do not receive extensive leadership training in medical school or residency and often struggle when put into these roles. As with everything in the Army, there is a Field Manual dedicated to the topic, so let?s visit FM 6-22, the Army?s Manual for Leader Development. There are several lessons there that can readily be deployed by today?s healthcare leaders to improve ?conditions on the field.' ?Leaders? Lead!? Leaders use three methods to achieve and improve results: -
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Influencing. Getting people (staff, providers, patients, vendors, etc.) to do what is necessary either through formal reporting relationships or informal interpersonal skills. Operating. By setting an example of conduct, influence others to accomplish missions and to set the stage for future operations. In other words, lead by example. Improving. Capturing and acting on important lessons of ongoing and completed projects. All of which may sound familiar in healthcare settings as a Plan, Do, See, Act (PDSA) cycle (you can read more about PDSA here).
Leadership Attributes & Competencies ?Leaders have a direct responsibility to develop their subordinates; accountability for implementation follows responsibility.? The average age of a considerable percentage of primary care physicians is near retirement age, and due to their experience and ownership stake, many of these physicians are in leadership positions they will soon be leaving. It is imperative that practices develop a succession plan for junior partners and staff to step into the role of leader. If you are a senior partner now how comfortable are you handing the reigns to ?subordinates?? What would happen to them if you left tomorrow? It?s time to develop those skills in them and create a leadership succession plan, even if you are 5 years out from retirement. ?Leaders possess the integrity and willingness to act in the absence of orders, when existing orders, doctrine or their own experience no longer fit the situation, or when unforeseen opportunities or threats arise.?
Empower your staff beyond their existing roles to meet and exceed challenges that arise. Providing leadership training is an exercise in futility if there are no outlets for staff to utilize those skills. Identify and assign ?Champion?roles to staff, which can be as simple as a Receptionist being in charge of a patient feedback program, to a Provider being in charge of developing an ancillary service or program for Asthma, Diabetes, etc. ?Leaders rely on effective teams to perform tasks, achieve objectives, and accomplish missions.? With the emergence of patient-centered care, team effectiveness has never been more important to practices. There are three qualities that measure good teamwork: identity, cohesion, and climate. Team identity develops through a shared understanding of what the team exists to do and what the team values. Cohesion is the unity or togetherness across team members that forms mutual trust, cooperation, and confidence. Teamwork increases when teams operate in a positive, engaging, and emotionally safe environment. A safe environment occurs when team members feel they can be open and are not threatened by unwarranted criticism. Teamwork
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is first introduced in the military by the use of the ?Buddy system?where two individuals are assigned to look out for each other in every aspect of their performance. By fostering teamwork amongst your staff, not only are results improved by having a second set of eyes on things but it also breaks down information silos and reduces the tendency for finger-pointing. ?Leaders Provide, accept, and act upon candid assessment and feedback.? Expect, and promote learning from, mistakes! Utilize the Plan-Do-Study-Act (PDSA) cycle for quality improvement and measurement, and provide counseling, coaching, and mentoring to your staff based upon 360-degree feedback and measurable deliverables. Five minutes of coaching may translate into hours of saved time down the road. Recognize and reward good performance. Schedule and implement regular formal performance feedback and make informal feedback part of your day-to-day communication style. ?Leaders communicate a clear vision.' Uncertainty, fear, and gossip are the enemies of your practice culture. Communicate openly and transparently and record/commemorate the decisions made in your meetings for accountability. Have an open door policy to get input from staff. Be as transparent as possible with decisions and managing change. Allow for input not only on operational issues but with more strategic planning as well. Have Fun! There?s nothing more depressing than walking into a workplace devoid of fun. Create an environment that encourages learning and the implementation of new ideas. Develop and use interpersonal skills to be able to relate to a wide variety of staff and patients. By fostering teamwork, cohesion, and cooperation you develop team unity, known in the military as Esprit de Corps. Just as the military has evolved from the stereotypical image of a leader barking orders at robotic subordinates to a system where lower ranking servicemen and women are empowered to fill voids in leadership, medical practices must evolve from top-down leadership models into a culture of teamwork, shared empowerment and succession planning. With the challenges posed by rapidly evolving delivery of health care, the military mantra of ?Improvise, Adapt, and Overcome?has never been more relevant to healthcare leaders.
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Look i ng f or more? Ch eck out FM 6-22, w h i ch contai ns 188 pages of l eadersh i p dev el opment i deas, tool s, and resources.
- CONNECTTVG BLOG
TVG MEDIA STREAMS
HIPAA Legal Updates ? Breach Reporting Requirements
Susanne was "feeling pumped" in Austin, Texas recently. Find out why and what she loves most about her work with The Verden Group here.
There might be some confusion regarding the breach reporting requirements mandated by HIPAA and further enforced by the HITECH Act. Sumita Saxena walks you through what you need to know here.
Missed the NCQA Quality Talks event? Susanne was there, tweeting all the best nuggets of wisdom under the hashtag #QualityTalks. Don't miss out on her next batch of live tweets by following us here.
CMS issues Final Rules for Stage 2 and Proposed Rules for Stage 3 On October 6, 2015, the Centers for Medicare and Medicaid Services and the Office of the National Coordinator released the final rules for modifications to Stage 2 and 2015 reporting requirements, as well as proposed rules for the third stage of the Meaningful Use incentive program. Stage 3 is set to begin as an optional requirement for physicians and hospitals in 2017 and a requirement in 2018. Jose Lopez takes a closer look at the new rules and reaction in the industry here.
We share industry news and commentary, informative blog posts and articles from Physicians Practice and more. Stay connected and link with us here.
For more healthcare news and views be sure to visit & bookmark our online articles section: www.theverdengroup.com/ category/ articles/
Connect with all our social streams here: www.theverdengroup.com/ connect/ verden-media/
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Welcome to our third issue of ViewPoint magazine! Each issue will deliver our take on the latest news and developments from the health care industry, tips and success stories from our clients, blog recaps and reports from the conference trail. This third issue brings even more content to VerdenViewPoint.com to compliment what is in these pages. View videos, listen to audio clips and get inspired by stories about what other practitioners are doing.
Want to stay connected and be the first to know all the latest news? Visit www.theverdengroup.com and click on CONNECT at the top of any page on our site. With just one click you're connected to all of The Verden Group's social media feeds. LinkedIn, facebook, and twitter plus a whole lot more. The TVG team will keep you up to date on events, conferences and training sessions that your practice needs to know about.
Policy Search is the only search tool available that allows you to look up commercial healthcare insurance company policies, easily and immediately. No more searching insurance company websites for medical policies. No more chasing reps to get answers. Know how an insurer?s competitors are covering services and use that information to forge policy change. Get what you need, when you need it. INSTANTLY.
www.TheVer denGr oup.com The Verden Group is an innovative consulting firm focused on shaping the landscape of advocacy by empowering medical practices to navigate through the increasingly complex business of healthcare, and to advocate on their own behalf with insurers and regulators. The Verden Group delivers expert services and advice to meet needs across your practice. From contract management to social media management, start ups to super groups, PMCH to research studies, we are your Partner In Practice. To learn more about our services visit www.theverdengroup.com Subscribe to ViewPoint to stay on top of all our news and views on the business of health care. Using a smart phone or tablet? Just scan the QR code to subscribe now, or visit www.TheVerdenGroup.com 24
? HR MATTERS ?
Sumita Saxena, JD | Legal Consultant
LEGAL & ETHI CAL CONSI DERATI ONS Monit or ing Em ployees?Use of Com put er Syst em s
Legal and Ethical Considerations of Monitoring Employees?Use of Computer Systems Technology now makes it possible for employers to keep track of virtually all workplace communications by any employee on the phone and in cyberspace. And many employers take advantage of these tracking devices: A survey of more than 700 companies by the Society for Human Resource Management (SHRM) found that almost three-quarters of the companies surveyed monitor their workers' use of the Internet and check employee email, and more than half review employee phone calls. According to a study by the American Management Association, businesses offering financial services ? such as banks, brokerage houses, insurance firms, and real estate companies ? are most likely to monitor employee communications. Employers have a legitimate interest in keeping track of how their employees spend their work hours. After all, no one wants workers surfing X-rated websites, sending offensive email, or calling in bets on the ponies on the company's dime. And employers may want to take steps to make sure employees are not giving trade secrets to competitors, engaging in illegal conduct at work, or using company-owned communications equipment to harass their coworkers. 25
Employers are allowed to monitor their employees' communications, within reasonable limits. But employers must make sure that their monitoring does not violate their workers' privacy rights. And, on a practical level, employers must decide how much monitoring is necessary to serve their legitimate interests without making their employees feel unduly scrutinized. The Law of Monitoring Generally, the law allows you to monitor an employee's communications in the workplace, with a few important exceptions. Here are the rules: Phone Calls Employers may monitor employee conversations with clients or customers for quality control. Some states require employers to inform the parties to the call ? either by announcement or by signal (such as a beeping noise during the call) ? that someone is listening in. However, federal law allows employers to monitor work calls unannounced. An exception is made for personal calls. Under federal law, once an employer realizes that a call is personal, the employer must immediately stop monitoring the call. However, if an employee has been warned not to make personal calls from particular phones, an employer might have more monitoring leeway. Email Messages Employers generally have the right to read employee email messages, unless company policy assures workers that their email messages will remain private. If the company takes steps to protect the privacy of email (by providing a system that allows messages to be designated "confidential" or creating private passwords known only to the employee, for example), a worker might have a stronger expectation of privacy in the messages covered by these rules. For the most part, however, courts have upheld employers' rights to read employee email, particularly if they have a compelling reason to do so such as investigating a harassment claim or possible theft of trade secrets. Internet Use Employers may keep track of the internet sites visited by their workers. Some employers install devices that block access to certain sites (sites with pornographic images, for 26
example) or limit the time workers may spend on sites that are not specified as work related. The Ethics of Monitoring Employers should also be aware of the potential pitfalls of monitoring. You could create a morale problem and hurt employee performance if your workers feel a distrustful Big Brother is lurking over their shoulders. You could inadvertently learn about people's religion, sexual orientation, political views and medical problems, creating potential privacy dilemmas or even opening your firm up to discrimination lawsuits. And you could run afoul of the National Labor Relations Board if you discipline employees for making negative comments about you online. A year ago, it issued guidelines affirming employees' right to discuss and seek to improve their working conditions, following a number of cases involving social media. Employers should consider the difference between monitoring and surveillance. It isn't controversial or obtrusive to monitor events on a company's computer system to ensure proper use and protect the company's assets and reputation. But surveillance, defined as tracking an individual's activities, has "a creepy factor" that can cause pushback from employees. Avoid such
trouble by engaging only in focused surveillance of a person if you have well-founded suspicions of policy or legal violations and have the documented agreement of top managers and your attorney. General monitoring for electronic abuses, with employees' full knowledge, is a necessary practice. It's a fact of business life that legal and regulatory risks exist. Employees can put your business at risk accidentally or intentionally ? you need to mitigate those risks and keep misdeeds from turning into expensive crises or lawsuits. Tips for Staying Within the Law Employers currently have a lot of leeway in monitoring their employees' communications. However, the law in this field is evolving rapidly, as technological change and increasing concerns about privacy pressure legislators and courts to take action. If you decide to monitor employees, consider these tips: Adopt a policy. Tell your workers that they will be monitored, and under what circumstances. If you indicate that you will respect the privacy of personal phone calls or email messages, make sure that you live up to your promise. The safest course is to ask employees to sign a consent form, as part of their first-day
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paperwork, acknowledging that they understand and agree to the company's monitoring policies. Monitor only for legitimate reasons. You will be on safest legal ground ? and waste less time and money ? if you monitor only for sound, business-related reasons. If you have a reasonable suspicion that a particular employee is engaging in unauthorized use of your equipment, that would certainly qualify as legitimate cause for monitoring. Equally sound reasons include keeping track of productivity or monitoring the quality of customer service and patient care. Be reasonable. Employees will not perform their best work if they are in constant fear of eavesdropping. Overreaching monitoring ? or unnecessarily Draconian policies about personal use of communications equipment ? will only result in employee resentment and attrition. It is
reasonable to prohibit workers from spending hours on the phone wooing a lover or catching up on gossip with an old friend, but it is unreasonable to prohibit brief personal calls of the "I'll be home late," or "where shall we meet tonight?" variety. Conclusion The reality is employers, in this day and age, need to reserve the right to monitor their employees?use of computer systems while at work. This should be documented in clear written policies that all employees read, understand and acknowledge. On balance, though, employers should also be mindful not to tip the scales and go too far in their quest to protect the workplace. Employers should take into account ethical considerations of employees? privacy and limit their actions to monitoring (which serves a legitimate purpose), and not surveillance. With clear policies in place you?ll avoid the risk of turning in to Big Brother prying into the personal lives of your employees.
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-PAYER NEW S -
Susanne Madden, MBA
SELF FUNDED EMPLOYERS: Out of Disruption Comes Opportunity
The self-funded market, historically the domain of very large employers, has been steadily growing over the last decade and now includes employers of all sizes. Self-funded health care is an arrangement whereby an employer provides health benefits to employees using its own funds, rather than purchasing fully insured plans where the employer contracts an insurance company to cover the employees and dependents. Over the last several years insurance premiums have become more and more expensive and employers facing double-digit increases year over year have decided to take matters into their own hands and control costs through employer-sponsored health care and self-funded insurance instruments.
So what does it mean to be ?self-funded?anyway? In self-funded health care, the employer assumes the direct risk for payment of all the claims for benefits, instead of paying insurers to take the risk by purchasing premiums that have been based on expected cost of care. In order to mitigate some of the financial risk, many purchase ?stop loss?insurance from an insurance carrier. These policies typically provide for risk retention limitations both on a specific claim and aggregate claims basis. Given the high cost of certain procedures, such as say, heart surgery, one big claim could seriously impact an employer?s bottom line, so this type of insurance is a critical 29
deductibles, resulting in practices having to chase after patients for large bills once the claims submitted have been processed.
component. The stop loss policy runs solely between the employer and the stop loss carrier and creates no direct liability to those individuals covered under the plan. This feature provides the critical distinction between fully insured plans (subject to State law insurance regulations) and self funded health plans that, under the provisions of Section 514 of ERISA, are exempt from state insurance regulations.
How big is the self-funded market? It is estimated that the average self-funded plan covers 300-400 employees and that 59% of companies within the U.S. self-fund part of their healthcare plan. To further breakdown the numbers, 26% of employers with 100 to 499 employees and 82% of employers with 500+ employees are utilizing self-funded plans. However, there are also many smaller companies utilizing this option and demand is so strong that United Healthcare began offering it to companies with as few as 10 employees this year (its previous cut-off was 100 employees). And for many insurers, the percentage of their business now focused on self-funded plans is very high. For example, 82% of Cigna?s commercial members are enrolled in self-funded plans!
And this is of major significance. Because self-funded plans are NOT subject to state insurance regulations, it means that Employers are pretty much off the hook when it comes to things like Prompt Pay laws and mandatory coverage of certain benefits. They are also free to design benefit packages as they see fit, creating a wide variation between patients with the same plan through the same insurer.
Here?s how it works. Employers contract with insurance companies primarily for them to act as third party administrators (or TPAs). That means that the Employer decides what?s covered and what?s ?carved out?of the benefits, and then utilizes an insurer?s existing set of policies and procedures, claims processing and customer service infrastructures. Their employees enjoy the use of the insurance company?s provider network and are able to access care through that network. However, on the practice side there is little transparency in terms of which patients are under self-funded plans and which are under fully insured plans, because each patient will have an insurance card that reads the same way (for example, United Healthcare Options PPO plan). What is different for each patient is the deductible, copay, cost share and coverage, and physicians often only discover what those parameters are AFTER services have been rendered and claims have been processed. This can be problematic, as the old rule of collecting copays has been replaced by much larger
One of the biggest advantages for employers in these plans is the transparency of claims data. Self-funded employers who contract a TPA receive a monthly report detailing medical claims and pharmacy costs. Knowing this information becomes instrumental in controlling costs by shifting buying patterns. And this data is what has been a major driver in the push to ?tier?providers based on quality, cost and efficiency. That is, employers have a vested interested in eliminating high-cost providers from their offered networks
Th e Sel f -I nsured M ark et i n 2015
26%of employers with 100 to 499 employees
82%of employers with 500+ employees *Source: U.S. Department of Health and Human Services
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and ensuring that employees ONLY have access to those providers that demonstrate high value.
Tiering and Benefit Design With this push from Employers (amongst others) to tier providers based on performance, insurers have responded by identifying those that are least expensive (e.g. those that are not on negotiated rates and/or those that routinely bill lower-paying codes and rarely refer to high-cost facilities). If you have not yet looked yourself up in an insurer?s provider directory, do so. You will see how you ?score?and into which tiers you fall. You should also see which tiers you may be excluded from. This is important because as this type of insurance continues to grow, providers are essentially being hand-picked by employers to deliver care. If you fail to meet certain standards, you may be denied access to a percentage of your patient population and that can cost your business plenty.
Positioning your Practice for Viability In order to ensure that you do not get tiered out of employer-sponsored plans, it is important that you understand how your practice contributes to costs and what it can do to remain viable and relevant to insurers plans. Annually, Payers send out profile information to their participating providers that explains details about your ?score? and a list of the patient claims that were referenced in order to arrive at that score. Review that data carefully, compare it to your own records and challenge them on any data that does not match up. The Payers are relying on claims data for this; you have more ?data-rich? records and can therefore challenge the score by providing additional information (e.g. a patient with pharyngitis that was managed differently to the protocols may be because that person is also asthmatic. The Payer may not have the asthma diagnosis, resulting in a negative score). Determine how your cost efficiency is being calculated. Are you referring patients to the most
Pr o v i d i n g o u r Cl i en t s w i t h Ex ecu t i v e Su m m ar i es o n Pay er Po l i cy Ch an g es Get the latest insights regarding your group' s specialties & learn about the biggest impacts from your Payers. w w w .Th ePo l i cy A u t h o r i t y .co m
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expensive hospital in town? Do you refer patients to an expensive specialist group (i.e. a group with a negotiated contract that is well above standard rates)? And so on. Determining this may help in your ability to negotiate some shared cost savings. Working in conjunction with Payers to deliberately alter your referral patterns to help better control costs for them may mean an opportunity to receive a portion of those savings too.
certain plan (or have been deliberately excluded from one) and your patients are going to have to go elsewhere, find out who those patients?employers are first before you let them go. You may find that you take care of several of their employees (or employees families) and that creates an opportunity for you to pitch that employer on providing services directly to them without having to run it through the Payer. Any claims that don?t get processed through a Payer result in a cost savings to the employer as there is no administrative fee on those claims. If you are in primary care, this may be pretty easy to do. Pediatricians can make estimations about how much care may cost per year based on a child?s age and the average number of sick visits per patient at the practice. It?s a pretty low risk proposition to create a set fee for the year ? in return you may get paid upfront (better cash
Cut Out The Middlemen Altogether Let?s say all of this is highly distasteful to you and you would rather leave medicine than have to collaborate with Payers and meet targets that you consider harmful to practice of good medicine. If that?s you, then your opportunity may lie in direct care whereby you cut out the middleman (the Payer) altogether. If you don?t participate in a
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flow), there will be no denials for any services (full payment for services rendered) and very little administrative costs to bear (no claims to file and chase). It doesn?t stop at primary care. Employers are looking for bundled-case-rates for common surgeries. If they can utilize a local physician to perform that at a competitive rate, why pay extra to go through an insurer? Physicians can explore these offerings directly with employers or through companies that connect self-funded employers to physicians best suited to providing necessary care, at a pre-negotiated amount. The service is considered an add-on benefit to employees?existing insurance coverage. While these third party companies act as the ?broker?for these services, it can be a good way to start a direct-care practice model. With more and more employers becoming self-funded to keep healthcare affordable and to derive the best value from the healthcare dollars spent, many are interested in alternatives that will service their employees faster, smarter, and better than ever before. Payers continue to creak along with their clunky claims and policies infrastructure and are not nearly as expedient as a savvy practice with the ability to deliver excellent care. This makes the market ripe for disruption by physicians who are innovative enough to see where the market is going and to take back healthcare for themselves.
Interested in Self-Funding Your Practice? You?ll find more information here.
Want to read more about Direct Care? Read an article by Susanne in Physicians Practice magazine here.
Ready to make the move to Direct Care? Turn to page 14 of this issue to read Sumita Saxena's advice on some of the key issues to consider.
Want th i s arti cl e 'to-go'? Dow nl oad a PDF v ersi on of i t f rom th e V i ew Poi nt si te h ere. 33
Bison, Yellowstone, photo by Dr. Scott Schams
?SPOTLIGHT?
?
ON DR. SCOTT SCHAMS Interviewed by Heidi Hallett | Director of Communications
We asked Dr. Scott Schams to share one of his passions with us - heading ?off the grid?and into the wilds! He shares how taking groups on wilderness adventure hikes has taught him how the lessons of self-discovery and leadership learned on the trail make you stronger and more prepared for the challenges of running a busy practice.
opportunity to enjoy the simplicity and find a peace that you?ve never known before. In addition to the hikes, we also give a lot of talks to men?s groups and children?s groups. We do about 34 treks a year, as well as consulting to other adventure groups in the country. We are licensed outfitters ? liability protection is a must even though we?ve never had a major problem in that regard. That?s very fortunate considering we get into some potential scary situations at times. We had a run in with a grizzly bear on one hike so I can tell you all about bears, firsthand. Our group leaders get bear training, and several of us are OSHA certified on predator attacks so we?re ready and able to handle just about anything that nature throws our way. Despite finding ourselves in some difficult situations, we?ve only had a couple of scrapes, one laceration and an ankle sprain.
Dr. Schams, when we spoke about APT you mentioned your love of hiking and heading in to the mountains. Can you tell us a bit more about your adventures and how those experiences have shaped your approach to leadership? I love this. I love to backpack and hike. I?ve lead 51 hikes so far. I?m a member of the Back Country Men?s Ministry, a licensed outfitters group that was founded in 1989 and went on to become a non-profit organization in 2006. The aim of our group is to teach people to become leaders, and we primarily do this from a faith-based perspective. We work with church groups, men?s groups, boy scouts, other adventure based groups, and students. The trail is a great teacher. The mountain will humble you in ways that nothing else can. For these guys and these kids ? we take boys and girls ? it?s a bonding experience and an
The nice thing about the mountains and the wilderness is that you can figure out what?s important. And what?s not. Many people do these hikes in their late 30s when they?re having a personal or professional crisis. I?ve been doing this for 20-odd years, and we?ve all bonded very closely. It?s an opportunity to get away from 34
Grand Thetons, photo by Dr. Scott Schams
everything, just to be alone in the wilderness, with good friends and alone with God. When you strip everything else away, you can kind of figure out what life is all about.
yourself through pain??and I say it reminds me of what life is all about so when I come into a really tough situation I?m mentally prepared for whatever civilization can throw at me. Believe me, when I have a bad day at the practice, all I have to do is think back to some of those worst days on the trail and I can always say, ?Yup, today is not that bad.? It?s an amazing thing, really.
You?ll find yourself in situations where you?re being challenged to the nth degree. Your physical, emotional, spiritual, and psychological self is being tested. You find that you?re able to do things you never thought you?d be able to do. It stretches you and teaches you to prepare for challenges in life on and off the hiking trail. You?re intentionally putting yourself into situations where you know you?re going to have to overcome some discomfort or fear. Sometimes the weather is gorgeous, other times it can be very cold. Sometimes it?s snowy, you?re wet, and you may have to deal with wildlife that doesn?t want you to be there. There?s also the fatigue factor, and dehydration. There?s a lot to overcome but when you do, that?s when those life-changing moments happen.
What have these hikes taught you about leadership? I?m a John Maxwell team member. I coach and speak for his team, particularly to medical students. John says, ?Leadership is influence: Nothing more and nothing less.?If you can influence people in a positive way, they will follow. I may be the leader on these hikes but the thing I always remember is it?s not all about me. It?s not about myself. That?s the essence of leadership and that really comes to the forefront on these hikes. We have to work together to overcome challenges on the trail, and off.
My wife says, ?Why do you do this? Why do you put 35
? FRONTLINES ?
Heidi Hallett | Director of Communications
A TALE OF TWO PHYSI CI AN GROUPS: BCD Healt h Par t ner s & Allied Pediat r icians of Texas
In this edition of Frontlines we interviewed two physician CEOs who have worked hard to band practices together to form independent clinically integrated 'Super Groups': Dr. Scott Schams of Allied Pediatricians of Texas in College Station and Dr. Jill Stoller of BCD Health Partners in New Jersey are at different stages of evolution with their organizations; one just setting out on the journey and another facing new challenges four years down the path.
Click here to read the full interviews and find out why Dr. Schams feels that servanthood is the key to leadership, and why financial transparency is one of the main tenets for Dr. Stoller?s group. 36
Yellowstone, photo by Dr. Scott Schams
We asked them about their vision, their goals and the successes and challenges they?ve faced along the way. Both Schams and Stoller generously shared their experiences and advice on everything from recruiting new members, staffing solutions, the importance of pooling resources and knowledge, as well as the need for more and better patient education. From the importance of NCQA recognition, to the opportunities and challenges of the Affordable Care Act, both physicians had many valuable insights to impart.
Read th e i nterv i ew s and l i sten to sni ppets onl i ne h ere at V erdenV i ew Poi nt.com
Yellowstone, photo by Dr. Scott Schams
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OVERHEARD at The Verden Group
"Find somebody good, pay them enough, encourage them to move up and give them the tools to do that" - Jill Stoller, MD, CEO of BCD Health Partners talking to Heidi Hallett about the importance of staff and development. Listen to her comment and read the full interview here
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2016 OP USER CONFERENCE
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January 29-30, Las Vegas, NV
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For more information on all the upcoming events and conferences visit: www.TheVerdenGroup.com 38
THE GIFT OF GIVING "At this time of year The Verden Group would like to thank our clients and subscribers for their business and express our gratitude to them. While it's nice to give (and receive!) cookies and chocolates, for several years we have honored our relationships by making donations in your names instead. There are so many charities and too many people in need, due to war, poverty and climate change. We have chosen to continue our support of Heifer International, an organization with a stellar reputation and one that does not simply give, they empower the recipients of donations by allowing families to turn hunger and poverty into hope and prosperity. Heifer brings sustainable agriculture and commerce to areas with a long history of poverty. The donated animals provide partners with both food and reliable income, as agricultural products such as milk, eggs and honey can be traded or sold at market, which in turn brings new opportunities for building schools, creating agricultural cooperatives, forming community savings and funding small businesses. We believe in sustainability and building small business, and so again this year we have made a big donation on your behalf. Thank you and we wish you all a happy and prosperous new year." - The Teams at Verden, ViewPoint and PCS (Please view the gifts that we donated this year here. )
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VIEW POINT ViewPoint is a seasonal publication, distributed digitally Š The Verden Group 2015 Editor-In-Chief: Susanne Madden | Editorial, Design and Production Manager: Heidi Hallett | Cover Design: Scott Hodgson Contributors: Susanne Madden, Julie Wood, Jose Lopez, Robert, Goff, Heidi Hallett, Sumita Saxena, Photography by: Susanne Madden, Heidi Hallett, Joseph Madden, Dr. Scott Schams www.Ver denViewPoint .com 40