Private Practice Is Challenging, But Even More Rewarding

Lea Chatham September 30th, 2014

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Tweet this Kareo storyBy Scott E. Rupp

It’s often said that independent physicians enjoy the flexibility that comes from being on their own, the owner of their own business, and the driver of their destinies.Tweet this Kareo story

This flexibility helps them define the culture of their practices and have the final say about the direction of the practice, including patient volume, the hiring of staff, and implementing new technologies to better manage day-to-day operations.


Employment trend not all it seems
Even as the trend seems to be toward employed physicians, especially among those who are under 40, many doctors remain steadfast in their desire to maintain their entrepreneurial spirit and are building practices based on their own personal and professional goals.

In regard to operating an independent practice, there are certainly pros and cons. Ultimately, it’s up to the individual physician to decide what he or she wants out of a career and from their lives. For those entering the field, there’s much to consider—do you go for the comfort and stability of employment and give up the autonomy that comes with independent practice?

The challenge of independent practice is clear. According to Medical Economics, “Growing regulatory pressures, privacy rules, the burdens of billing and collections, steep investments to incorporate electronic health record (EHR) systems, and onerous requirements of data collection are all difficult to manage on one’s own. These forces, coupled with declining revenues, are causing more doctors in small practices to consider employment over independence.”

However, the pros of private practice still outweigh the lure of a steady paycheck for many providers. An example of this can be found among orthopedic surgeons, a population that seem to be among the employment holdouts, at least according to the American Academy of Orthopaedic Surgeons. Census data from 2010 suggests that more than 40% of orthopedic surgeons are still in private practice and 20% of those physicians are in solo practitioners. Only 8% of those surveyed reported being employed by hospitals.

According to respondents of this particular survey, a major advantage listed of maintaining a private practice is the autonomy the physicians claim over their careers and their professional lives. “They can make decisions based on care instead of hospital policy, and they can change processes more quickly because they are smaller than hospitals.”

Of course, physicians in small practices must continue to adapt, change, grow, and evolve with the times—probably more aggressively than their hospital-employed counterparts. Luckily, for those willing to take the risk, there are more and better options to help them meet the challenges as well.

Independent impulse really remains strong
The impulse to remain independent is still strong among a significant number of doctors in practice today, reports Medical Economics. Based on the results of a 2012 survey of more than 5,000 physicians, conducted by The Doctors Company, 56% of respondents said they were unlikely to change practice models in the coming few years.

Flexibility and autonomy don’t end with being the boss of a business; the concepts have deeper roots than that. Work life balance is important, of course, but so is patient care. Many solo practitioners say they have a stronger bond with their patients than those who work in health systems or hospital-owned practices. From a patient perspective, receiving care at a large practice means they’re likely not seeing the same physician every time they seek an examination, and there’s a good chance that their doctor (or doctors) do not know them personally nor are they likely to be highly involved in all aspects of their care. In many cases, small practice physicians not only know their patients, but they also get to know their families and their patient’s stories beyond their health.

Independence offers flexibility, options, and higher satisfaction
For those leading independent practices, they also are able to engage in all areas of the business they run and become more well-rounded. For providers who have a passion for the business side of care or like to have a say in decisions, they get everything they want.  They have a voice in everything from HR and marketing to managing finances, IT, contract negotiation, revenue cycle management, and facility management.

For a doctor who wants the independence but doesn’t want to manage the day-to-day, it is actually easier for a small practice to outsource many billing and office tasks affordably. There is less bureaucracy and decisions can be made more quickly. A nimble practice like this can shift to outsourced tasks or take back tasks much more easily. This is part of the flexibility that is so appealing.

Finally, according to a 2014 survey conducted by Medscape, self-employed doctors are somewhat more satisfied with their situation than are employed doctors. Additionally, about 70% of physicians who left employment in favor of self-employment are happier now. Only 9% who went to self-employment are unhappier now. According to the study, in contrast, less than half (49%) of physicians who left self-employment for employment are happier now, and a quarter (25%) are unhappier now. All in all, those responses seem indicative of a sentiment towards independence.

“I am so lucky,” says Michelle Meyer-Ban, RNC, MSN, WHNP-BC, a board certified Women’s Health Nurse Practitioner who went out on her own. “It has only been five years, and I have grown to this point, which is just amazing. The practice model and the technology fit with and support my professional and personal goals. And I would just reiterate that this endeavor is totally possible for anyone. You can go into private practice and create a thriving practice with the right technology that lets you keep costs low and be efficient.”

To learn more about how you can successfully step out on your own, check out the recording of the recent webinar, Taking the Leap: Best Practices to Start Your Own Medical Practice.

About the Author

SRuppScott E. Rupp is a writer and an award-winning journalist focused on healthcare technology. He also works as a public relations executive, and has spent time working in house with a major electronic health record/practice management vendor. In addition to writing for a variety of publications, Scott also offers his insights on healthcare technology and its leaders on his site, Electronic Health Reporter.


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The Great Healthcare Payment Switch: Fee-for-Service to Pay-for-Performance

Lea Chatham September 25th, 2014

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Tweet this Kareo storyBy Charles Settles

Everyone agrees the United States’ healthcare system needs improvement, but nobody can agree on how that should happen. Transitioning from a fee-for-service payment model to a pay-for-performance model is one of the more popular solutions being touted as a potential fix. It could improve service for everyone—or make it worse.


As far as the United States’ government is concerned, the debate is over.
Fee-for-service in healthcare is out, and performance-based compensation is in. Tweet this Kareo story
Incentive programs have been designed and deployed, and new acronyms such as HVBP and PQRS have entered the medical lexicon. Billions of dollars in incentives have been paid to providers and care organizations to encourage them to adopt electronic health records (EHR) software. This technology gives regulators and payers access to an ocean of patient data, which will presumably help improve population health modeling, and ultimately treatment outcomes—if the hype is to be believed.

‘Big Data’ has already transformed sales, marketing, logistics, and innumerable other industries—why not healthcare? Normalizing healthcare data is not without challenges though. Many providers refer to the same procedures with different names. For example, a ‘heart attack’ could be referred to as a myocardial infarction, MI, or just simply as the layperson’s aforementioned ‘heart attack’. A person reading notes with those terms would identify them all as the same condition, but a machine reading those notes would identify three separate conditions. This is one of the biggest problems with data-driven medicine: subjectivity. Disparate terminology isn’t technically subjectivity, but the root problem is that freethinking, and most importantly—unique—humans will have varied habits, speech patterns, subjective opinions, and other nuances that objective machines struggle to decipher, let alone match.

Reconciling disparate terminology for the machines’ benefit is one of the reasons behind adopting new codes sets, such as ICD-10, that turn physicians’ narratives or superbills into machine-readable diagnoses and progress notes. If the idea of health 2.0/3.0 is going to be realized, this is something that must happen. Natural language processing software has made great strides, but it would still be a struggle finding regulators, lawyers, or patients willing to have a machine fully interpret a doctor’s note. It will always be necessary to have a trained human to interpret and perform medical procedures—in some capacity—barring science-fiction levels of advancement in artificial intelligence.

While population health modeling and data-backed treatment protocols are all seen as positive outcomes of such standardized systems, physicians can sometimes end up feeling like glorified data entry specialists at best, or as one physician said, off the record, “barcode machines” at worst. The same physician went so far as to say that having clinicians collect the data being provided to payers and CMS is “akin to having a condemned man dig his own grave.”

Hyperbole aside, the most cited problem with American healthcare is the high cost of treatment. The only data important to the bottom line in a fee-for-service, non data-driven payment model is the number of procedures performed. In a performance-based system, instead of doing more procedures to earn more money, physicians must instead improve treatment outcomes.

Starting this transition now gives providers the ability to not only get used to the coming changes, but also influence the metrics by which their performance will be measured. If the story is in the data, it benefits organizations to capture as much data as possible, and analyze that data to discover trends in their own patient outcomes.

The elephant in the room, of course, is whether or not outcome-determined compensation will negatively affect the amount, variety, and quality of care available. Exceptions will likely be made to encourage clinical trials, but where will the line be drawn elsewhere, if at all? If any sort of approval, arbitration, allocation, or negotiation process is necessary, data will likely be the determining factor. Being able to demonstrate outcome ‘improvement’ in any treatment-attributable, measurable way will be necessary for proactive providers and organizations.

In short, anyone holding out on electronic health records, data analysis, or other technologies because of supposed complexity or expense is rapidly running out of time to get in front of new mandates. If expense is an issue, Meaningful Use Incentive Program eligible providers have only until Oct. 3, 2014 to take advantage of over $23,000 in incentive payments, and only until next year to avoid a one percent penalty in Medicare reimbursements. Even non-eligible providers have reasons to learn more about data analysis in healthcare—even if they’re only monetary.

About the Author

charles settleCharles Settles is a product analyst at TechnologyAdvice. He covers topics related to healthcare IT and gamification. Connect with him on LinkedIn.




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4 ICD-10 Changes on the Horizon for Mental Health

Lea Chatham September 23rd, 2014

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ICD-10 Resource CenterBy Lisa A. Eramo

Although mental health providers may use the DSM V for documentation and diagnostic purposes (it came out earlier this year in anticipation of ICD-10-CM), they must continue to translate DSM codes back to ICD-9-CM before billing. This will change as of October 1, 2015 when DMS V codes must map to ICD-10-CM, which includes several notable changes. Chandra Stephenson, CPC, CPC-H, CPCO, CPMA, CCS, CPC-I, CANPC, CEMC, CFPC, CGSC, CIMC, COSC, Indianapolis-based consultant and member of the American Academy of Professional Coders National Advisory Board discusses four important changes.

  1. Mental and behavioral disorders due to psychoactive substance use (F10-F19). Although ICD-9-CM doesn’t distinguish between use, abuse and dependence, ICD-10-CM does. Tweet this Kareo story
    Many of the codes in this section also specify complications such as mood disorders, delusions, delirium, perceptual disturbances, and more.The ICD-10-CM guidelines have also been expanded to include a hierarchy for reporting purposes. Providers can only submit one code per substance (e.g., alcohol, opioid, cannabis, etc.). This hierarchy states the following:
    - If the patient uses and abuses the same substance, assign only the code for abuse.
    - If the patient abuses and is dependent the same substance, assign only the code for the dependence.
    - If the patient uses, abuses, and is dependent the same substance, assign only the code for the dependence.
    - If the patient uses and is dependent on the same substance, assign only the code for the dependence.Mental health providers must clearly document the association of the psychoactive substance with the patient’s mental or behavioral disorder.
  2. Pain disorders related to psychological factors (F45.4-). The ICD-10-CM guidelines have been expanded to include information related to codes F45.41 (pain disorder exclusively related to psychological factors) and F45.42 (pain disorder with related psychological factors). Although these two codes seem very similar, providers should note the following:
    - Code F45.41 denotes purely psychological pain that is not supported by any medical condition.
    - Code F45.42 denotes a legitimate medical pain with a psychological component. When reporting this code, providers should also report the associated acute or chronic pain (G89.-). Note that pain NOS is reported with R52.
  3. Attention deficit hyperactive disorder (ADHD) (F90.-). ICD-10-CM has been expanded to include the specific type of ADHD (i.e., predominantly inattentive, predominantly hyperactive, or combined). This code expansion, like many others, will be important in terms of research and treatment.
  4. Anorexia. ICD-10-CM includes separate codes for anorexia nervosa, unspecified (F50.00), anorexia nervosa, restricting type (F50.01), and anorexia nervosa, binge eating/purging type (F50.02). In ICD-9-CM, anorexia nervosa only had one code (307.1).

Strategies for Success
Mental health providers should review all of ICD-10-CM Chapter 5 (mental, behavioral, and neurodevelopmental disorders) to ensure compliant coding. As with many specialties, mental health diagnoses have expanded and/or include revised code descriptions. Specificity is the key to success. Tweet this Kareo story

For more tools and resources, download the free ICD-10 for Mental Health eBook or visit the ICD-10 Resource Center.

About the Author

Lisa A. EramoLisa A. Eramo is a freelance writer/editor specializing in health information management, medical coding, and healthcare regulatory topics. She began her healthcare career as a referral specialist for a well-known cancer center. Lisa went on to work for several years at a healthcare publishing company. She regularly contributes to healthcare publications, websites, and blogs, including the AHIMA Journal and AHIMA Advantage. Her focus areas are medical coding, and ICD-10 in particular, clinical documentation improvement, and healthcare quality/efficiency.

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6 Reasons Email Makes for Great Patient Marketing

Lea Chatham September 18th, 2014

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Tweet this Kareo StoryBy Cheryl Bisera

Email. It’s that pile of daily correspondence that seems to haunt you with an ever-growing list of people and information you have to respond to in an already-busy day. But, have you ever considered email as a means of marketing? If your practice isn’t using email for patient marketing, you’re missing an opportunity to communicate in a friendly, informative way that builds patient loyalty and can contribute to increased revenue.


As a medical practice it’s important that your correspondence with patients via email is not “salesy”, but provides valuable and relevant health information. Tweet this Kareo story
In choosing to communicate regularly with patients via email about relevant health topics, services your practice provides, and what’s new in and about your practice, you are actually marketing your practice in the best, most credible way.

Here’s why patients should hear from your practice regularly via email:

  1. Email is a low-cost, time-efficient platform to communicate with many patients at once.
  2. There’s no better way to inform patients of changes within your practice. It gives you the opportunity to frame those changes the way you want. For example, when adding a Physician Assistant, you can ward off concerns about access to the physician by sharing the skills and training the new hire brings in a celebratory introduction email.
  3. When you stay current with patients on hot topics that are already on their minds (i.e., vaccinations, latest news on cancer screenings, etc.) you deepen their trust in both your credibility and authentic care for your patients.
  4. Showing patients that your practice is active and evolving builds credibility and confidence to stay with your practice. For example, you can announce new equipment, new training, lines of service, or involvement in community events.
  5. Your patients can help you make better practice decisions. By using email surveys you can find out what services they would utilize, if they’d follow you to a new location, and answers to other important questions that affect your success. Patients may also have great ideas. They may say something in a survey they would not have the nerve to say in person.

All of the above can deepen patient loyalty and reduce attrition, remind patients of your services—which can provoke new appointments by existing patients—and encourage patients to refer others to you by forwarding your informative emails to friends and family.

Now that you know why your practice should be emailing patients regularly, you’re probably wondering how to go about doing so the right way. Below are tips for getting started and reminders for those of you who already engage patients this way.

  1. Permission is crucial. You absolutely MUST gather email addresses directly from patients and give them the opportunity to indicate permission to send emails and an understanding that they are not mandatory. Be prepared to show proof should a random sample audit be provoked by a high number of unsubscribes.
  2. Don’t be a spammer. Frequency and content need to be appropriate. Sending sales and marketing emails is not appropriate, but informing patients of a new product or service line is okay. Keep these three things in mind: don’t mention a product or service every time, stick to the facts, and quote sources of any data or statistics.
  3. Knowledge is power, not only when you have it but when you give it. By providing free, credible, and relevant information you will strengthen your brand and become a trusted source of useful information in your field of expertise.
  4. Choose an email service or marketing application, such as Constant Contact or Demandforce. For a monthly fee you can easily send out professional looking emails. These tools will also provide reports and manage your email list by letting people directly unsubscribe or subscribe to your emails.
  5. Consider hiring a professional or assign someone who understands your practice, specialty, and how to write and brand your practice with a consistent “voice”. Whatever is sent in an email is coming “from the practice” so having practice leaders or a medical director approve them is a good idea.

You’ve got the basics, now engage patients through email. You’ll strengthen your practice-patient relationships and boost loyalty, visits, and referrals! And increased appointments and referrals means a boost to practice revenue!

About the Author

Cheryl Bisera photoCheryl Bisera is a consultant, author and speaker with extensive experience in marketing and business promotion that spans more than ten years in which she worked with professionals to strengthen their position in the marketplace. She is the founder of Cheryl Bisera Consulting, a California-based image development and marketing company that focuses on the healthcare industry. Cheryl has spoken for regional medical management organizations, conducted customer-service workshops, and written numerous articles for publications such as KevinMD, Physician Magazine, and the Journal of Medical Practice Management.

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Expanding Access to Care through Telemedicine

Lea Chatham September 16th, 2014

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Tweet this Kareo storyBy Lisa Eramo

When MedPeds, a family medicine practice of eight providers in the D.C. suburb of Laurel, MD, decided to venture into the world of telemedicine, it wasn’t a completely novel idea. The practice, which was named winner of the 2013 Ambulatory HIMSS Davies Award of Excellence for its use of health information technology to improve patient care, had implemented an EHR nearly a decade ago and had also served as a beta site for a patient portal in 2006.

Seth Eaton, MD, adolescent and internal medicine specialist at MedPeds, says the benefits of telemedicine seemed obvious—that is, being able to increase access to patient care and help patients overcome the barriers that may prevent them from being able to physically come to the office. These barriers could include distance, health or physical limitations, lack of transportation, and a variety of other reasons. Telemedicine—the use of electronic and telecommunication technologies to enhance patient care—helps physicians and patients because it fills the gap and enables direct communication without necessitating the need to be in the same room, he explains.

“I see it as a way to expand access to primary care,” says Eaton. This increased access is critical not only for both rural and urban providers but also for patients who continue to enter the healthcare marketplace due to the Affordable Care Act, he adds. The supply of providers must be able to accommodate the increased demand from patients flooding the marketplace.

According to the Deloitte Center for Health Solutions 2013 Survey of U.S. Physicians, 18% of primary care physicians use telemedicine for follow-up or diagnostic visits. Tweet this Kareo story
Rural primary care physicians have also been using the technology to obtain specialty consults in real time. Telemedicine may be particularly beneficial for orthopedic practices or any surgical specialty that requires follow-up visits, says Eaton. With telemedicine, a physician or physician assistant could see a patient postoperatively while the patient recovers from an injury or surgery at home. Not only is this more convenient for patients, but it’s also more efficient for providers who typically aren’t reimbursement separately for these visits after a surgery, he adds.

At MedPeds, patients currently have access to one telemedicine slot per week. This ‘virtual visit’ is typically reserved for urgent issues and follow-up visits. Eaton says he eventually hopes to expand the number of telemedicine slots so that every patient will have the option to either physically come to the office for a face-to-face visit or meet with their provider during a virtual encounter.

“The major benefit that I see for our practice is that if we can hire a nurse practitioner who could essentially work behind a monitor, we could generate visits that don’t require additional staff such as medical assistants,” says Eaton. “This would also add so much access for our patients.”

The New England Journal of Medicine reported in May 2013 that physicians in many specialties are starting to embrace telemedicine as a way to “expand their practice, reach new patients, and potentially improve the care of patients who have historically had poor access to medical services—especially specialty services.” The article, titled “Telemedicine: Changing the Landscape of Rural Physician Practice,” cites various examples of how providers, including a pediatric critical care physician, a psychiatrist, a neurologist who performs telestroke consultations, an OB/GYN, and a family medicine physician, are using the technology to improve care.

Cardiologists and electro-physiologists have embraced telemedicine because it allows them to monitor patients remotely, says Rhonda Bray, RN, BSN, founder and CEO of Rhythm Management Group, a Washington D.C.-based company that provides remote monitoring for patients with a pacemaker or implanted defibrillator. With remote cardiac monitoring, a machine collects data wirelessly and then transmits it to an EHR, or a company such as Rhythm Management Group sends the information to the provider within 24 hours. Bray says her company is in the process of interfacing with various EHR vendors so providers can automatically view the data.

Nearly one million Americans currently use remote cardiac monitoring, according to the American Telemedicine Association. Bray says physicians like the technology because it allows them to intervene more quickly. “If a patient has a new onset of a heart rhythm disturbance or their battery is wearing down or if the wires are failing, we can catch that early and alert the physician,” she says.

Patients like the technology as well because they’re able to stay at home while being monitored 24/7. “These devices are so sophisticated now that they’re on auto pilot. They self-adjust. There’s really no good clinical reason to bring patients in [to the office] every six months,” says Bray.

In addition to enhancing the access to and quality care patient care, telemedicine also enhances patient satisfaction because it gives patients options in terms of how and where they can receive care, says Eaton. Although patients in the Laurel community are slowly embracing the concept of virtual care, Eaton says he hopes they will take advantage of it more frequently over time just as they have gradually accepted the practice’s portal technology.

How to get started with telemedicine
If you’re thinking about offering telemedicine in your practice, consider the following tips:

  • Shop around for a vendor. Eaton says there are an overwhelming number of vendors that offer telemedicine technology, some of which are more geared toward hospitals rather than physician practices. Many vendors charge a monthly fee for an unlimited number of visits. The American Telemedicine Association provides a helpful telemedicine buyer’s guide that practices can use to find a vendor that’s suitable for their particular specialty.
  • Look into reimbursement limitations. According to the American Telehealth Association, almost every state Medicaid plan covers at least some type of telehealth services; however, this coverage varies greatly by state. Medicare covers telehealth only in certain circumstances, such as remote radiology, pathology, and some cardiology. It also covers videoconferencing for beneficiaries living in rural areas. Private insurance coverage for telehealth service also varies by state. Eaton says there is a state mandate in Maryland that requires all insurers to cover telemedicine in all instances. “We’ve never had a single denial,” he adds.
  • Consider legal issues. The National Telehealth Policy Resource Center outlines several legal implications for telehealth that providers must address.
  • Identify a physician champion. As with any technology implementation, practices that succeed are those who identify a physician champion who can help other providers learn how to use the telemedicine technology and incorporate it into their workflow.

Find out more about how the demand for healthcare services will be changing in the coming years on this infographic, Healthcare Demand is Growing: Are You Ready?

Are you using telemedicine or considering it? Share your thoughts in the comments.

About the Author

Lisa A. EramoLisa A. Eramo is a freelance writer/editor specializing in health information management, medical coding, and healthcare regulatory topics. She began her healthcare career as a referral specialist for a well-known cancer center. Lisa went on to work for several years at a healthcare publishing company. She regularly contributes to healthcare publications, websites, and blogs, including the AHIMA Journal and AHIMA Advantage. Her focus areas are medical coding, and ICD-10 in particular, clinical documentation improvement, and healthcare quality/efficiency.

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Free Webinar: Should You Start Your Own Medical Practice?

Lea Chatham September 11th, 2014

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Register NowTaking the Leap: Best Practices to Start Your Own Medical Practice
Wednesday, September 17, 2014
1:00 PM Eastern, 10:00 AM Pacific



Are you ready to take the leap and step out on your own? Whether you are a newly minted physician or looking to leave a group practice, how do you know if going it alone is the right choice? In this webinar, startup practice expert Audrey Christie McLaughlin will walk you through a step-by-step process to help you decide if opening your own medical practice is the right choice.

During this free event, Audrey will offer practical recommendations on:

  1. How to decide if you should open your medical practice
  2. The initial steps to take prior to leaving your current position
  3. Business models, budgets, timelines, marketing and staffing considerations

Find out everything you need to know to decide if independence is right for you and how to start a new practice successfully.Tweet this Kareo story

Register Now

About the Speaker

Audrey MAudrey “Christie” McLaughlin empowers physicians to grow their practices and better the lives of the patients they serve. Audrey is the CEO of McLaughlin Sales Group LLC, creator of the series Customer Service from the HEART, and creator of, a sales and consulting firm that specializes in the business of medicine. Audrey has more than 12 years of experience in helping physicians and hospitals provide the best medical care while growing revenue and keeping costs down. She is an expert, entrepreneur, author, speaker, and is active volunteer in her community.

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6 Common EHR Implementation Challenges and How to Avoid Them

Lea Chatham September 10th, 2014

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Download this guide on successfully implementing an EHRBy Lisa Eramo

The adoption of EHRs in physician practices is definitely on the rise thanks to Meaningful Use incentives. According to the data from the Office of the National Coordinator (ONC), office-based provider adoption of basic EHRs has increased from 17% in 2008 to 40% in 2012.

And although the number continues to grow, actual implementation of EHR technology continues to challenge many practices. Tweet this Kareo story
Only 12% of the 1,442  respondents who completed the Physicians Practice 2014 Annual Technology Survey sponsored by Kareo reported that EHR implementation was ‘smooth sailing.’ Slightly more than 10% characterized the transition as ‘traumatizing.’

Mary P. Griskewicz, MS, FHIMSS, senior director, healthcare information systems at the Healthcare Information and Management Systems Society (HIMSS), says practices can encounter a variety of setbacks during—and even after—implementation, and they need to know how to address those challenges efficiently and effectively in order to achieve success. She provides insight into these challenges as well as advice for how to overcome them.

  1. The EHR implementation is breaking your budget. According to, various studies indicate that the cost of purchasing and installing an EHR ranges from $15,000 to $70,000 per provider, depending on whether the practice uses an on-site or Web-based EHR. These costs include hardware, software, implementation assistance, training, and ongoing network fees. The cost of an EHR is the number one reason why practices haven’t purchased one yet, according to the Technology Survey. Griskewicz says practices—particularly solo practitioners and smaller groups for whom these costs are especially high—should contact their Regional Extension Center (REC) to identify ways in which they can work with vendors in an economical way. Practices may find that it’s more economical to partner with the same vendor that provides their practice management software because it’s more seamless from an interoperability standpoint. There are also several free and open source EHR products available on the market that physicians can explore to determine whether they meet the needs of the practice. Essentially, there are options for everyone, and physicians shouldn’t let cost be a deterrent.
  2. The EHR just doesn’t fit into the workflow. Some practices may find that even after a careful implementation, the EHR just doesn’t provide the flexibility or customization that the practice needs. This is the worst scenario in which physicians find themselves because they’ve already invested in the technology and are unable to use it effectively. The 2014 HIMSS Physician Community EHR Usability Pain Point Survey identifies several deficiencies related to clinical data review, documentation, clinical decision support, and more. The best way to avoid this problem is to ensure that each potential vendor provides an in-depth demonstration regarding features and functions. All staff members should be able to ‘test drive’ the software and provide input.
  3. EHR training is difficult and time consuming. Although vendors should be able to provide thorough training for all employees, practices that succeed with EHR implementation are those that identify super-users who really take the time to get to know the EHR and who can serve as a resource for physicians and others, says Griskewicz. Also be sure that your EHR vendor specifies the type and duration of training that employees will receive. This includes training on any software updates or patches. The vendor should also provide an active support line that users can call when they have questions. Again, the vendor should outline all of these details, she adds.
  4. Physicians resist using the EHR. Some physicians simply won’t want to use the technology either because they don’t believe in its efficacy, they feel that it will decrease productivity, or perhaps they are even intimidated by it. Practices must identify a physician champion who can encourage others to adopt the technology and feel more comfortable using it, says Griskewicz, adding that a peer-to-peer approach works best.
  5. Your chosen vendor hasn’t—or doesn’t intend—to meet Meaningful Use Stage 2 requirements. Griskewicz says some practices are frustrated because the certified vendor they chose to meet Stage 1 requirements either isn’t going to meet the more detailed Stage 2 requirements or will be delayed in doing so. Only 40% of respondents stated their vendor was ready for Stage 2, according to the Annual Technology Survey. If practices intend to continue the attestation process, they may need to find a new vendor entirely. For those that choose to ‘wait it out’ with their vendor, keep in mind that time is money, and the longer that practices must wait on their vendor to update software to meet the new requirements, the fewer incentives they’ll receive. Griskewicz says one way to avoid this is to vet your vendor thoroughly to ensure that it intends to invest the time and money to accommodate ever-changing requirements. RECs may be able to help physicians switch vendors in a cost efficient way and help them choose a vendor that meets the needs of the practice.
  6. The practice falls behind in meeting Meaningful Use requirements. There’s no doubt that it’s challenging to keep up with the requirements to comply with Meaningful Use. Even practices whose vendors are ready for Meaningful Use requirements sometimes fall behind because they don’t have the internal processes in place to ensure success. Practices that miss deadlines will unfortunately be subject to penalties. The best way to avoid this is to appoint someone within the practice whose responsibility it is to oversee requirements, deadlines, and ongoing communication with your vendor.

Networking is often the best way to resolve EHR challenges and identify best practices. Many EHR vendors provide user groups, and practices should take advantage of the opportunity to network with other providers and ask questions. Oftentimes, practices face the same challenges and can benefit from best practices and lessons learned, says Griskewicz.

For more strategies to help you successfully implement your EHR, download this guide.

About the Author

Lisa A. EramoLisa A. Eramo is a freelance writer/editor specializing in health information management, medical coding, and healthcare regulatory topics. She began her healthcare career as a referral specialist for a well-known cancer center. Lisa went on to work for several years at a healthcare publishing company. She regularly contributes to healthcare publications, websites, and blogs, including the AHIMA Journal and AHIMA Advantage. Her focus areas are medical coding, and ICD-10 in particular, clinical documentation improvement, and healthcare quality/efficiency.

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Kareo September Newsletter Focuses on Staying Independent and Competitive

Lea Chatham September 9th, 2014

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The September edition of the Kareo Getting Paid Newsletter highlights the steps for launching a new practice and staying competitive with emerging retail clinics. The newsletter also provides a chance to discover upcoming events, news, and resources from Kareo. Plus, you’ll learn about how to register for our upcoming free educational webinar, Taking the Leap: Best Practices for Starting Your Own Medical Practice, presented by Audrey McLaughlin, RN. Read all this and more now!Tweet this Kareo story

September Kareo Getting Paid Newsletter


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The 5 First Steps to Start a New Medical Practice

Lea Chatham September 8th, 2014

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Tweet this Kareo storyBy Audrey Christie McLaughlin, RN

So you’ve decided to open a practice? Now what?

Once you have determined that starting your own new medical practice IS for you, then it’s time to dive in. Sure, you could wait until the timing is perfect, but much like anything else you do in life, there really is no perfect time. You just make up your mind, and go for it.

Here are the first five steps you should take to get started with your new medical practice. Tweet this Kareo story

  1. Hash out a budget and timeline. Starting a practice costs money. In order to spend your money judiciously, you must know what things cost. Your budget document will be a very fluid document. You may choose to have multiple scenarios included in the same document or have multiple budgets outlining different scenarios. You could look at it as plan A, B, and C.The budgetary step will involve some research on your part. Sure you can delegate this to practice start-up specialist, but it will still be more of a collaborative effort. Don’t forget to add the cost of a consultant and marketing for the first year.
  2. Secure tax, legal, and practice start-up advisors. Don’t look at this as a luxury. Taxes are no joke, and the right tax professional and legal advisor can make the difference in choosing and setting up the type of entity that is most beneficial to you financially.Practice start-up advisors can help you finalize your budget, allow you to continue practicing in your current position, train and hire your staff, set up and plan your marketing and prevent you from making common start-up mistakes.
  3. Business Entity Formation and obtain an EIN. Your tax and legal advisors will assist you in securing this information.
  4. Begin insurance credentialing. Yes begin insurance credentialing even if you don’t have a practice location selected. This process is long, and even though it can be a pain to change your address later with the payers, not getting paid for rendering services when you open will hurt worse. You can use your home address temporarily or secure a temporary address.
  5. Location selection. Begin researching options for location and building choices. Determine a timeline for any construction and installation etc.

From step five, we could go on thru step 105. This list is just a starting point. For a more detailed overview of the steps involved in starting a new medical practice, join me for my free webinar, Taking the Leap: Best Practices to Start Your Own Practice on September 17.

About the Author

Audrey MAudrey “Christie” McLaughlin empowers physicians to grow their practices and better the lives of the patients they serve. Audrey is the CEO of McLaughlin Sales Group LLC, creator of the series Customer Service from the HEART, and creator of, a sales and consulting firm that specializes in the business of medicine. Audrey has more than 12 years of experience in helping physicians and hospitals provide the best medical care while growing revenue and keeping costs down. She is an expert, entrepreneur, author, speaker, and is active volunteer in her community.

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6 Steps to Position Your Practice to Accept Urgent Care Patients

Lea Chatham September 8th, 2014

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Tweet This Kareo StoryBy Nathaniel Arana

Noticed a drop in the number of patients coming to you for simple consultations or same-day care—flu vaccines, minor infections, or a sprain? Retail clinics may be to blame.


Retail clinics like those offered by Walgreens, CVS/Caremark, and Walmart have emerged as a solution for patients who need to be seen quickly for relatively minor injuries or illnesses but who can’t get an immediate appointment with their primary care physician (PCP).

It’s a skyrocketing business. A recent study shows that the number of patients using retail clinics for preventive services, screenings, and chronic visits jumped from 4% in 2007 to 17% in 2013. With the backing of multibillion dollar corporations, retail clinics could very well transform the way healthcare is delivered in the United States.

The reason patients turn to these clinics is straightforward: It’s much more convenient. Patients can get a same-day appointment or walk in without one. They are seen quickly—most often in less than 30 minutes. As a general rule, patients trust their PCPs more than retail physicians, and would prefer to see them for urgent care. But the hassle of waiting days or weeks for an appointment makes retail clinics the easier option, especially for patients who aren’t feeling well.

In order for PCPs to regain their patients, they must set up their practices to provide urgent care. The following are relatively simple operational changes that PCPs can make to avoid losing patients—and revenue—to retail clinics.

  1. Make time in your schedule to accommodate same-day appointments. Designate one to three 10-minute time slots for urgent-care appointments. To accommodate patients’ schedules, it is best to spread these throughout the day (9 a.m., 12 p.m. and 3 p.m., for example).
  2. Have your urgent-care patients seen quickly. Most urgent-care visits take less than five minutes. Many of these visits can even be handled by a nurse practitioner or physician assistant if you have one on staff. It is important that these patients don’t wait longer than 30 minutes. Remember, you are competing against retail clinics that offer convenience.
  3. Manage your schedule strategically. If your office typically runs late, set your urgent-care time slots for times of the day when you are least likely to be behind schedule (for example, the first appointment of the day or immediately after lunch).
  4. Market aggressively. Don’t assume that your patients know you offer urgent-care services or that they can book same-day appointments. Post a sign in your waiting room and train your front-office staff to inform patients that you offer urgent-care services. Make a handout with a list of conditions that can be treated. Communicate to your patients that they can typically be seen within 30 minutes. Make sure this information is on your website and posted to your social channels (i.e., Facebook).
  5. Provide 24/7 Online Appointment Scheduling. The benefit of online scheduling is two-fold. First, patients can schedule an appointment with you at 9 pm in the evening for first thing tomorrow morning, which adds another level of accessibility and convenience. Second, if you use a service like ZocDoc you may be able to reach more patients looking for an urgent-care appointment and grow your practice. According to ZocDoc about 85% of the patients who schedule appointment with local physicians through their service are new patients.
  6. Offer to accept cash. For patients without insurance, create a reasonable cash-pay rate that is similar to retail clinics in your area—the typical range is $90 to $125. Communicate to your patients that they can see you, a trusted provider, for a similar rate that they would pay at a retail clinic.

Although retail medicine can help fill a gap, it’s bad medicine to have them replace primary care practices altogether. Tweet this Kareo story
Given their success in offering urgent care, retail clinics have now begun to offer treatment for chronic conditions such as diabetes and hypertension. But for the most effective treatment, chronic conditions require continuity of care, and retail clinics tend to have high turnover among providers. This is just another reason why it is important for PCPs to retain their patients and find ways to meet their changing needs.

It’s not only good business, but also good medicine to accommodate your patients’ urgent-care needs.

Share your thoughts about the impact of retail clinics and solutions for PCPs in the comments below.

About the Author

nathaniel_headshotNathaniel Arana is nationally recognized healthcare business consultant. A physicians’ advocate, he has helped numerous practices become more profitable by allowing his clients to focus on patient care. You can e-mail Nathaniel at or visit his website at



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