February is Black History Month, and to celebrate, Fast Layne Solutions would like to pay tribute to some of the key African-American pioneers in the field of medicine.
Dr. James McCune Smith (1813 – 1865) was the very first African American to hold a medical degree. He was the valedictorian of his graduating class in medical school at the University of Glasgow in Scotland. After completing his degree and then an internship in Paris, he returned to the US, where he had a long and successful career that included being the first Black man to run a pharmacy in the United States; publishing articles in respected medical journals; and conducting extensive research, especially in the area of refuting racist theories about the connections between race and intelligence. He accomplished all this despite the many obstacles 19th-century America put in his path: he was refused admission to medical schools in the US due to his race, and was never accepted by the American Medical Association or even local medical groups. He was even once refused passage on a ship to return to America due to his race. Smith was an ardent abolitionist, and died just before the ratification of the 13th Amendment abolishing slavery.
Dr. Helen Octavia Dickens (1909 – 2001) was the first African-American woman to be admitted to the American College of Surgeons. She completed her medical degree at the University of Illinois College of Medicine in 1934. In 1942, she passed the boards to become the first Black woman to become a board-certified Ob/gyn in Philadelphia. She served as Director of Obstetrics and Gynecology at the Mercy Douglass Hospital in Philadelphia for almost 20 years, and did extensive research into the areas of teen pregnancy and sexually transmitted diseases, using the results to educate young women. As a doctor who faced the double challenge of overcoming both racism and sexism in her personal and professional lives, she was a true pioneer in both medicine and the fight for equality.
Dr. Robert Fulton Boyd (1855 – 1912) was the first president of the National Medical Association, an organization he and others founded in response to the racial segregation of medical facilities and schools and of other medical associations. Born into slavery, he went on to become a superlatively qualified healer, earning a degree not only in medicine but dentistry, on top of a Master of Arts degree. In 1893, he was appointed professor of gynecology and clinical medicine at Meharry College in Nashville.
Mary Mahoney (1845 – 1926) was the first African American woman to be awarded a nursing degree in 1879. She was also among the first Black women to be admitted to the American Nurses Association (ANA). She was a co-founder of the National Association of Colored Graduate Nurses (NACGN), which made significant contributions in the area of ending racial discrimination policies in their field. (The NACGN later merged with the ANA.) She was a civil rights pioneer in other ways, too: she was among the first Black women to register to vote in Boston after Suffrage. She was honored with induction into both the ANA’s and the National Women’s Hall of Fame.
Despite the great strides made by these and other brave African American pioneers in the field of medicine, to this day, Black medical professionals face challenges unknown to their white counterparts. Sociologist Adia Harvey Wingfield of Washington University has studied this subject extensively and her work shows we still have a long way to go. That’s doubly true for African American women working in medicine. Wingfield reported cases of Black female doctors regularly being called “miss” by people who assumed they must be nurses or orderlies. And the “new economy,” with its emphasis on contract work, has presented even more challenges, as Black medical professionals are disproportionately pushed into such arrangements, limiting both job security and upward mobility.
Every February, Black History Month provides us with myriad inspirational stories telling us how far we have come as a society, along with new milestones showing that we continue to make incremental improvements. But it also a sobering reminder that we still have miles to travel before we arrive at that “not too distant tomorrow [when] the radiant stars of love and brotherhood will shine over our great nation with all their scintillating beauty.” But we will get there. Dr. Martin Luther King never doubted that vision of his, and he never abandoned hope. Nor should we.
We often hear about so-called ‘food deserts,’ areas where it is difficult to impossible to purchase healthy, nutritious foods. But did you know there are also healthcare deserts? These sections of both rural and urban America have a shortage of doctors and healthcare facilities, and the impacts are deadly. And the effects disproportionately fall on minority communities. For example, on Chicago’s South Side, the death rate from diabetes is twice that of other neighborhoods in the same city. The result, when compounded by other factors such as poverty and poor access to nutrition, is that America has a huge life expectancy disparity, and it’s getting worse, not better. In fact, the gap is now 20 years when comparing the wealthiest zip codes to the poorest.
Fast Layne Solutions is dedicated to fighting this trend by helping doctors in these areas to become more financially viable and to thrive in these environments, even as we also develop plans to help these communities in other ways. Today’s blog is an introduction to how our solutions can help, and next month's installment will reveal exciting news about how we plan to do so while keeping jobs in the community.
First of all, why is it so hard for independent doctors to thrive in these communities? Mainly it’s a question of economics. It is extremely expensive to be an independent doctor these days. Quite aside from the fact that new doctors are starting their careers hundreds of thousands of dollars in debt, it is also financially burdensome to practice in the current regulatory and competitive environment.
This month and next, we are going to be looking at the journey of a fictional doctor, Dr. Janelle Smith, a young endocrinologist determined to make a difference in her South Side neighborhood, but who’s struggling to overcome the obstacles facing so many independent doctors, especially in the more economically-challenged areas of America’s cities.
Dr. Smith has just finished medical school and residency and is now ready to dedicate her life to fight diabetes among the area’s poorer residents. Dr. Smith is already in debt from medical school. She owes $200,000 in student loans. But she’s determined to help fight the diabetes epidemic that is cutting so many lives short in her neighborhood. So she raises some money and opens her clinic. She plans to stay viable by serving a wide range of patients: those who have private insurance, a few who are self-pay, some Medicare, and a very large portion of Medicaid patients. She also hopes to do a free clinic session every Saturday for four hours. She hires a biller, a receptionist, an office manager, and a physician’s assistant.
Once she is up and running, she quickly builds a large patient base. Yet she’s not thriving, and her cash flow is terrible, with her average accounts receivable days at around 75. Reimbursements are slow, expenses are high. Her biller spends all day fighting the insurance companies over rejected claims. She’s paying over 3% on credit card transactions for co-pays and self-pays. Her staff seems to spend endless hours on mundane, unproductive tasks like setting up appointments and doing reminders by phone, calling insurance companies for verifications, reworking the hundreds of claims that get kicked back from insurance for seemingly pointless reasons, dealing with write-offs over unexpected denials, going through mountains of paperwork for patient forms that the receptionist must then manually enter…...the list is endless. And Dr. Smith herself has no life. If she isn’t seeing patients, she’s catching up on charting in her tortuously cumbersome EHR (that she can barely afford). And it’s not like she has a choice: as a doctor taking Medicare, she has to start reporting her MIPS performance by her second year, and her state Medicaid program also has reporting requirements. She MUST use an EHR.
Dr. Smith is getting by, but she’s frustrated. She thinks of the stereotypes she grew up with: rich doctors driving Mercedes, taking off Wednesday afternoons, living in mansions. Not that she became a doctor for those reasons: if she had, she could have taken a cushy job with one of the large hospital systems. But still, it would be nice not to feel that her practice and her own financial situation was a month-to-month crisis waiting to happen.
One evening, after yet another 14 hour day, she gets a phone call. It’s a recruiter from the large hospital system in town. He’s familiar with her work, knows her impressive education and residency history. He throws out a number. A number that would mean no more stressing out about student loan payments. No more worrying about making payroll next month.
And no more independence. And no more serving the community she grew up in. In fact, no more living or practicing in her old neighborhood at all. To avoid an excessive commute, she’d have to move to the north side of town. And it means working as an employee for a corporate provider. No more being her own boss. No more serving the South Side.
Is this really what it comes down to? A choice between doing what’s right and barely scraping by on the one hand versus giving up her independence and her dream of serving the community where she grew up on the other?
Absolutely not. She’s facing a false choice, because, like so many doctors in America, she simply does not know that there are solutions to all her problems. Tune in next week and we’ll see how Dr. Smith can turn her practice around and live her dream of serving the South Side as a thriving, independent doctor.
This month's blog is by our guest-blogger Ken Vaughan of Record Storage Systems, a Charlotte-based company specializing in helping doctors securely store their vital paper records. We’ve partnered with Record Storage Systems to help doctors manage their records storage and scanning in a secure, cost-efficient, and convenient way.
Although in recent years Electronic Health Record (EHR) systems have begun to replace paper documents, many medical practices still find themselves drowning in a sea of paper. Even without paper charting, doctors’ offices produce a lot of paper, and they still have to contend with years, sometimes even decades, of pre-EHR paper charts. So what should a modern medical practice do to strike the right balance between responsible, safe, and efficient document management and affordable, common-sense storage?
Generally, practices should make decisions as to the disposition of paper files based on state and federal record retention guidelines and compliance regulations, as well as how much access will be needed in the future. For documents that are routinely accessed and/or distributed, scanning is the preferred solution, since it allows for multi-user access and the ability to electronically route information via automated workflows. Record Storage Systems offers a scan-on-demand service that allows practices to access their records without removing the physical document from our document storage facility. This enables practices to enjoy timely, convenient electronic record retrieval. By storing offsite, and taking advantage of scan-on-demand, practices can enjoy secure hard-copy storage with quick access to records while reclaiming valuable space in their offices for revenue-producing activities.
But can’t practices just store their own documents? Sure, if they’re fans of high risk and huge HIPAA fines! Doctors’ offices and self-storage facilities don’t have full-service security monitoring. Self-storage units are particularly risky, since you have no idea what is being stored nearby (e.g. hazardous/flammable materials), security is lax, and there is no disaster relief plan in place. Other risks of storing your own documents include potential liability from having employees moving heavy boxes, occupation of valuable staff time and storage space that could be dedicated to revenue-producing activities, and potentially huge HIPAA fines in the event of document misplacement or theft.
Meanwhile, a professional records storage provider like Record Storage Systems has everything you need to ensure your peace of mind: a highly-secured, climate-controlled environment with full fire protection on site. The facility floors, walls, and ceiling are equipped with 6-inch precast ribbed concrete reinforced with rebar steel. The site is inspected twice a year with ultrasound technology for the detection of wet spots/leaks. There is a fully documented disaster relief and recovery plan in place. And if you ever need access to your files, our staff can retrieve the relevant files quickly to ensure you always have access.
When deciding whether to scan records or store them offsite in a secure facility, consider how often they will need to be accessed. If most of the documents are archived medical records or files that the practice will rarely reference in the future, the most cost-effective option is to securely store the hard copy files offsite and retrieve them occasionally when needed, either through scan-on-demand or physical delivery. For documents requiring regular access and retrieval, document scanning and electronic document management software will offer long-term conveniences and cost-saving benefits. Going paperless requires planning and consulting. Record Storage Systems works to identify challenges in your current practice processes and find opportunities for increased efficiency and streamlined workflows. No matter what your paperless goals are for 2020, we can work with you to find a customized solution that fits your needs.
And of course a medical practice isn’t just about medicine and medical records: practices are like other businesses, with paper-intensive business processes such as human resources and customer service. By implementing a record management system like Fast Layne Solutions’ iDocsNow, a practice can use a day-forward approach to ensure that such processes convert from paper to electronic storage daily, continually pushing out all documents to a safe, secured, HIPAA-compliant cloud storage platform. iDocsNow can also be used to store old charts to which you need regular access or, for whatever reason, that you choose not to store physically.
For practices not already on an EHR (or for those who are on overpriced and/or user-unfriendly EHRs), we encourage practice administrators to consider a cloud-based, tablet-optimized EHR like Fast Layne Solutions’ EMRx to move away from paper charting entirely. This reduces errors, helps cut down on insurance rejections, and improves patient outcomes. It also requires less personnel to handle and support paper files and to organize countless documents. And EMRx requires no physical storage space, or even a server, since it is cloud-based, meaning it also has zero maintenance costs. In addition, switching over to electronic medical records provides a practice with more safety and security for their patients' confidential data, thus reducing the risk of HIPAA violations, all while increasing staff efficiency and driving profitability.
If you would like to discuss how Record Storage Systems and Fast Layne Solutions can partner with you to help your practice get out of the paper business, please visit our website or drop us a line.