For many of us, email has become a primary means of building relationships, conducting business, and keeping in touch.  It is very effective in doing so, and while it isn’t a full replacement for phone and face-to-face interaction, it does provide a very efficient means by which to communicate.

In business, email has another important benefit; it provides a document trail that can be used to record activity and conversation, creating a transcript of all that is said (and not said) via electronic format.  Along with other benefits, the efficiency of use and ability to document in real time provides some obvious appeal to those who communicate with clients on a regular basis.

Enter physicians, dentists, physical therapists, and other healthcare providers that interact with clients (i.e., patients) on a daily basis.  While drawbacks exist in the use of email as a means of communicating with patients, we are finding that patients like it and doctors are on the verge of getting reimbursed for it; both important drivers for the regular use of email in the near term.  There will be many pitfalls to avoid for the physician and patient alike, but we will soon be seeing more and more use of email between provider and patients in the years to come.

This article in Modern Medicine explains in detail the key benefits associated with the use of email between physicians and patients, and speaks to the trends that are currently underway in this important area of medical practice.

If you haven’t yet begun using e-mail to communicate with patients, there are plenty of reasons to start. First is the increasingly loud patient clamor for e-mail, as indicated in one survey after another. The latest is a Harris Interactive/Wall Street Journal poll in which three out of four respondents said they should be able to schedule medical appointments via e-mail or the Internet, and e-mail their doctors as part of their overall medical care—at no extra charge.

Ironically, that proviso is precisely what has discouraged many time-pressed doctors from giving their patients e-mail access. But as patient demand rises, the “no extra charge” barrier is slowly but surely coming down.

Late last year, Aetna and Cigna HealthCare announced that they would dramatically expand programs that reimburse physicians for “virtual visits.” Until recently, only a handful of health plans paid doctors for this service, and the news has sparked speculation that other insurers will soon follow. Not surprisingly, the number of physicians who communicate with patients electronically is also on the rise—going from 19 percent in 2003 to 31 percent in 2007, according to a Manhattan Research survey of more than 1,300 doctors. Among physicians who did not yet use a secure online messaging service, one in four said they intended to start in the next 12 months.

Albert Fuchs is a primary care physician and business owner.  After realizing that he couldn’t keep up with the pace of his busy practice, his answer wasn’t to simply hire additional staff, but rather to drop the least profitable of his insurance contracts…then another…and another…and another. 

Dr. Fuchs kept dropping insurance contracts until he had none left, leaving him with a practice free from the rules imposed upon him by insurance companies, and a practice that provides great care and excellent service. 

This won’t work for all medical practices, but this innovative approach to the issue of excessive volume has contributed to a practice that is likely more profitable than if approached by hiring to keep up with the pace of unprofitable contracts.  This solution has also provided him with the resources to provide regular free clinics to serve those that can’t afford his services.

Read this article by Dr. Fuchs in today’s LA Times to hear how and why he did it.

Every politician and his Aunt Martha has a scheme to overhaul American healthcare. But not one of them will solve this problem: Most doctors are awful at serving their patients. The typical hair salon pays more attention to customer service than the typical doctor.

Why? Even the best medical schools give short shrift to practice management. So a doctor can emerge as a skilled diagnostician without a clue how to run a business that serves consumers. In fact, many physicians find it distasteful to think of medicine as a business at all. They feel that it’s their mission to serve as many patients as possible rather than to provide the best care possible. Most significant, today’s doctors are preoccupied with the bureaucracy of insurance companies, so much so that they’ve lost the simple logic of the doughnut shop model.

I’ve been reading more in the press about the use of remote technologies used by physicians to communicate and monitor patients.  The technology exists, so using it for this purpose makes perfect sense.  I’ve even learned of some companies building this type of technology into their core business models which I believe to be a very exciting development in medical care (more on that in a future post).

In this post from Peter Lucash at the Medical Practice Business Blog, Peter reports on the use of wireless networks and video communication for just this purpose, and draws a very good parallel to the introduction of a now standard piece of office technology to the development of improved communications between physicians and patients in the 1990’s: the fax machine.

Wireless networks have the ability to carry voice, data and video. The latter becomes particularly interesting when we realize that a camera can be brought to the patient, regardless of where they are. This very portability is what makes this technology so powerful. In rural parts of Japan, nurse practitioners are using cell phones to transmit fetal monitor tracings to Ob’s at the nearest hospital (in one case, 200 miles away) for review and guidance before moving a patient several hours. AT&T offers a service dubbed “AT&T Video Share” where users can take and send live video from their mobile device – allowing another mobile phone user to see exactly what they are seeing.

Free market enterprise is daily finding more of a home in the healthcare industry.  Of recent note are moves by Microsoft and Google to become big players in the personal health record (PHR) market, but it’s not just the big guns that are bringing consumer-friendly tools into the heart of medical practice operations.

The Massachusetts eHealth Collaborative blog posted recently about an innovative approach to the online scheduling of physician and dentist appointments using a tool very similar to the type commonly used to make restaurant reservations online.

The market won’t stand still. While a bunch of us are futzing around with patient portals, PHRs, patient kiosks, and other tools to add convenience to health care delivery, along comes ZocDoc (http://www.zocdoc.com/) which allows online scheduling of physician and dentist appointments for participating providers. Physicians pay for the service and it’s free to patients.

Online scheduling has been around on the web for awhile. Booking tickets, for example, for everything from movies to airplanes. And www.opentable.com allows free restaurant reservation booking in a number of cities. Like opentable, Zocdoc also allows patients to review their physicians on the site.

Finding the right staff is difficult.  Finding the right physicians can be even harder.  But what if your staffing need isn’t permanent, you’re just testing the waters in a new setting, or you want to bring in new staff for a short period? 

Locum tenens can be a good alternative in the private practice setting, and is used widely worldwide, creating a $1.6 billion industry in the United States.  This newswire from Vista Staffing Solutions comments on some of the benefits of locum tenens placements, and references some of the practice and assignment preferences of locum tenens physicians.

Locum tenens may extend the medical careers of physicians and help them avoid burn-out, according to a survey commissioned in January 2008 by VISTA Staffing Solutions. Physicians surveyed indicated that locum tenens would be most attractive to physicians considering semi-retirement, those making a professional transition from one position to another, and residents completing training who want to try out diverse geographic settings and practice types before settling down.

Locum tenens - Latin for “one holding a place” - is the industry term for physicians who fill temporary assignments, covering for a colleague during medical or military leave, for example, or staffing a healthcare facility while that facility recruits a permanent physician. The practice is worldwide, and a $1.6 billion industry in the US alone, according to Staffing Industry Analysts. Interestingly, however, 69% of survey respondents said they had no personal experience working as or hiring locum tenens physicians.

Here is a great post from a physician who asks the very valid question: Why don’t we pay more for better service in the healthcare? 

Whether defined by more experienced physicians, better bedside manner, or increased time spent trying to figure out exactly what’s wrong, better quality doesn’t affect the bottom line in a medical practice - physicians get paid the same even though they’re acting different.  This poses a natural barrier to incentive which doesn’t favor improved care in the U.S.

The solution isn’t simple though.  In a system that already lacks for enough to go around (money AND physicians), how do you pay better physicians more and still subsidize those in need…

How we pay physicians creates problems.  We have a totally irrational payment structure, which discourages thinking and encourages doing.  We have a payment structure which drives physicians towards speed and away from careful consideration.

Unless we recognize the importance of the payment system and revamp that system, we will continue to get what we pay for - quick, incomplete visits - too many procedures - unwillingness of physicians to communicate with emails and phone calls.  And just remember not to blame the physicians.  They are making economically rational decisions.  If you design payment as Medicare has, you will reap the weak seeds that you have sown.

The iPhone is a great invention.  My brother-in-law, Preston was one of the earliest adopters of the device, and I spent most of my Thanksgiving and Christmas holiday draining his iPhone battery while watching YouTube videos.  I have a Treo 700wx, and still prefer it to the iPhone in some ways (especially in regard to networking with our server), but the iPhone does have a huge advantage over other smartphones in that the internet really is the internet.  Not scaled back, just smaller and more mobile.

In this post from the Independent Urologist, we are introduced to a great use of the iPhone to improve the efficiency of private practice through mobile e-Prescribing.  I just love to see technology in action…

…I was in the OR today and forgot my Rx pads. I did several cases on patients, all of whom had different pharmacies and I had have to call in some scripts for them. Now with hold times and phone trees and formulary related call backs etc, calling in prescriptions to pharmacies can be a royal pain and not something that I relish. Instead, I asked to borrow my friend Mike’s i-Phone. With it, I logged onto my e-RX network, located my patients’ profiles, selected the meds and doses from drop down menus, selected their pharmacies, hit approve all and voila’, done.

RN Central has identified 20 ways in which Wal-Mart will affect healthcare throughout the US (…and I thought 7 ways was a lot).  Wal-Mart has had a significant impact on a few other industries (retail, pharmaceuticals, to name a couple) so why would we expect their impact on healthcare through retail health clinics to be any different?

Big-box behemoth Wal-Mart has ventured into the healthcare realm, offering low-cost, walk-in clinics in more and more of its stores every day. Although Wal-Mart medicine may not sound like a great idea at first, these clinics can bring good changes to the health care industry, like insurance-free care, eased emergency rooms, and more widespread treatments. Of course, the plan is not without its drawbacks, creating a “Wal-Mart effect” on small practitioners, as well as a race to the bottom. Here, we’ll take a good look at some of the implications you might not have thought about.

I love to hear about ways that innovation and technology make things possible that once were not.  In fact, I scour the internet learning from others who do this very thing in healthcare, leading to newfound improvements in care, diagnostics, and efficiencies.

Here is an example of a small practice that really gets it.  So much of the technology that already exists will help practices keep the doors open and wheels turning, and I love to see it in action.  This isn’t a crazy example of the latest and greatest EMR saving a hospital organization millions of dollars in efficiency and reduced waste - just a small practice that is using many of the available technologies and services in order to keep things going on a snow day in New York State.

Despite global warming, the weather brought snow today to Suffolk County Long Island, where I have my urology practice. Fortunately I had a slow day in the office and was not really disrupted much by the snow. My biller however, was unable to get into the office. No biggy. Here’s what we did:

From strategic planning to financial analysis to marketing plans, there’s a lot to know about how to position and operate a successful medical practice.  Because of the vast, yet specialized scope of services that business consulting is used for in private practice medical clinics, we believe the due diligence process to be extremely important to identifying a consulting firm that will provide medical practices with the most appropriate consulting services available.  We’ve found the following criteria useful in evaluating the expertise and resources available from business consultants in this area, and we recommend that they be used if you are considering such services:

1. Always request a non-disclosure agreement (NDA).  NDA’s should outline the way in which information you share with the consultant may be used, as well as what is prohibited.  Medical practice consultants are exposed to some of the most intimate details of financial structure, marketing strategy, and referral networks, and this information must always remain confidential.  NDA’s aren’t difficult to produce, and if a consultant doesn’t have one, or doesn’t want to use one, this is a red flag.

2. “Try before you buy.”  Medical practice consultants should have a plethora of knowledge in many areas of business and private practice, and it shouldn’t hurt to give some helpful information away for free.  I personally like to make sure that clients not only get a feel for the core competency of our services, but that they get a feel for our personality and way of doing business as well.  Good client-consultant relationships are very close and require a good working relationship, so if you aren’t 100% comfortable with your consultant or consulting firm, you probably aren’t going to have a great experience.

3. Check references.  Always, always, always check references.  As stated above, there is a lot to know in the world of medical practice business consulting, and knowing what you’re getting upfront is difficult unless you really do your homework.  Checking in with references provided by the consultant is a good way to do this.  Also know that consultants will naturally guide you toward those clients that have had an especially good experience with the consulting firm, so it is also prudent to set some of the criteria yourself.  Asking a consultant for references in a certain geographic location, or that have received a specific area of consulting service (e.g., marketing strategy, brand development, financial projections, business planning, startup, etc.) is a good way to lessen the selection bias of the consultant.

4. Know the deliverables.  Understanding the expectations are key to finding value in the services provided by a medical practice business consultant.  Even the best consultants that provide services that weren’t contracted for or that provided unclear value come away with disappointed clients.  In the proposal or statement of work provided by the consulting firm, make sure you understand EXACTLY what will be provided, how the process will work, and all of the fees associated with the project.  If you like all of the above and it is delivered by the consultant, chances are you’ll be a satisfied client.

5. Understand the fee structure.  Medical practice business consultants are generally paid based on the time required to provide their service.  As the scope of consulting projects can vary drastically, so can the fees charged to a client.  A good consultant will be able communicate how fees are determined very quickly and very clearly to a potential client.  It is typical for there to be a range of hourly fees associated with varying level of expertise required (e.g., legal and financial consulting will commonly dictate higher fees than projects that are more general in nature, such as marketing strategy or competition analysis), and fees will naturally be higher the more “hands-off” the client wishes to be during the project.  Projects that require more data mining, research, concept development, and copywriting by the medical practice consulting firm will be more expensive than those in which the consultant is acting in more of an advisory role.

The criteria outlined above applies not only to medical practice consultants, but also to consultants specializing in dental practices, physical therapy clinics, optometry practices, and many other allied healthcare disciplines.  Unfortunately, some of the smaller healthcare markets including small to medium sized medical practices sometimes lack the geographical availability of specialty consulting, and practices often employ the services of general business consultants.  While in some circumstances this can work out well, the specialty nature of the medical profession often benefits most from the business expertise provided by specialty consulting firms, and always requires a high level of due diligence to find the right fit.

_______________________________________________

Vantage Clinical Solutions is a private practice consulting, management, and financing firm that specializes in small to medium-sized medical practices nationwide.