In honor of this month's Juneteenth holiday and in recognition of the challenges facing the African American community that we’re seeing highlighted through the Black Lives Matter protests, Fast Layne Solutions CEO Christopher Hughey connected with a hospice administrator and nurse this past week to talk about what it means to be a healthcare leader of color. This blog article is based on that conversation.
Due to the contentious nature of these topics, our interviewee, whom we will call Pam, has asked to remain anonymous. She is a middle-aged African American healthcare leader based in the South.
Pam is many things: nurse, healthcare leader and administrator, mother.
She is also African American.
What went through your mind when I added that last fact and how do you think it impacts those other labels that describe Pam? Many people these days want us to ignore race. They tell us it shouldn’t matter, so we should simply disregard it. For them, that is how we will end racism: just pretend race isn’t even a thing and all will be well! So let’s examine how being Black in America in 2020 changes how Pam has to manage her life and then re-ask that question at the end.
Being a nurse v being a Black nurse:
One day, in her role as a nurse, Pam (a highly qualified medical professional) and her colleague (her White assistant) arrived at a home to visit an ailing, elderly patient in hospice care. The patient’s wife answered the door in a panic as her husband had just lost control of his bowels and the result was a very unpleasant mess. The wife was also quite distressed as she was uncertain how to administer her husband’s anti-anxiety medication and needed a nurse to help her with it. Upon seeing a Black woman and a White woman at her door, she immediately handed towels and a bath basin to Pam and the medication to her White assistant.
Does 'White privilege' mean that that White assistant has never had struggles in her own life? That becoming a nurse's assistant was easy for her? That she faces no personal challenges of her own? No. Of course not. All people face struggles in life. But what White privilege does mean is that her skin color doesn’t add to those struggles. And it means people don’t draw on centuries of stereotypes and oppression and shove cleaning supplies in her hands when she walks in the room based on the automatic assumption that she must be the ‘help’.
Being a healthcare leader and administrator v being a Black healthcare leader and administrator:
Being a healthcare administrator and leading a team of providers and staff are two challenging responsibilities for anyone. But when you add in the African American experience, it can become more than just challenging. At times, it can become next to impossible, especially in an age when we are seeing dog-whistled approval of racist attitudes coming from the highest levels of our country’s leadership. This has impacted Pam’s life directly. She supervises a staff of almost four dozen people in an area of the country already not known for its racial tolerance. Of late, the climate of tension has made her job even more difficult, with some staff openly disrespecting her. And it is impossible to gloss over the impact America’s political toxicity is having on this aspect of her life: she has noticed, for example, that such behavior is measurably worse the day after a televised ‘Make America Great Again’ rally. But as a business leader, she can’t mandate people’s politics or attitudes, and she also faces the constant stress of walking the line between maintaining control of her organization and being cast as the ‘angry Black woman.’
None of these are challenges faced by White healthcare leaders and administrators.
Being a mother v being a Black mother:
One day recently, Pam, a Black mother of biracial adult children, noticed that her son’s car had a malfunctioning taillight as he was pulling out of her driveway. She had a moment of panic and stopped him before he could leave, insisting he take her car instead. When she recounted this story to her White friend, whom she has known for decades and who has an adult son roughly the same age as Pam’s, her friend was puzzled that Pam would be so adamant about her son switching cars. After all, a non-working taillight isn’t such a danger to vehicle safety, and even if he got a ticket for it, it would be a minor offense. Pam had to explain to her friend that none of those everyday considerations was going through her mind when she panicked and made her son change cars. This wasn’t about such mundane factors as vehicle maintenance or insurance costs or ticket court dates. No, when Pam saw that darkened taillight, what she had to picture was her gentle giant of a son being shot to death because a nervous cop approaching a car occupied by a large, dark-skinned male panicked when he saw that man reach for his license. She had to picture herself identifying his body while listening to the police explain how her son’s death was his own fault for acting ‘suspiciously,’ how a wallet can look like a gun in the heat of the moment. She had to imagine White social media explaining to her that none of this would have happened had he simply maintained his car properly (because apparently we have capital punishment for burnt-out bulbs if you’re Black). Her White friend was aghast at all this. It had never occurred to her to fear such outcomes from something so trivial as a broken taillight.
Being a mother is hard for every woman. And being a mom isn’t made easy by being White. But it also isn’t made harder, either. And it doesn’t include the grim task of teaching your children how to behave ‘just so’ to avoid ending up dead after even minor encounters with law enforcement, encounters that would be at most a mild annoyance to the majority of White people.
The purpose of this article isn’t to solve racism. We don’t have those answers for you.
So we’ll just close by first asking that same question again:
How do you think race impacts Pam’s roles in life?
And we’ll add another on which to end:
After reading about Pam's experiences, do you think America can solve racism by simply ignoring the role of race in our society?
Postscript: Another thing to consider when asking if race matters is this: we were originally going to use Pam's real name and the name of her town. But after reading the draft, she asked that we make her contribution anonymous, and understandably so. If racism is 'over' in America, why does an African American healthcare administrator have to fear for her job (and potentially even her safety) for simply discussing actual events from her life with the CEO of a small company? Again, we don't have the answers. But we do feel it's time for everyone of every race in America to start asking themselves these questions.
Today’s Guest Blogger is Danny Mensh of InsureSTAT, a national leader in disability insurance for physicians. Danny is a 23-year veteran of the insurance business. He is based in Winston-Salem, NC.
As a national leader in disability insurance solutions for doctors, my company, InsureSTAT, offers unique products to supplement existing coverages or to enhance overall program values. Why is that important to you as a physician?
We know that the typical practice will provide a group Long-Term Disability Insurance platform that typically maxes out at 60% of income up to $10,000 (or in some cases $15,000) per month. With employer-paid status, the group benefits would become taxable as ordinary income, creating a hole that needs to be filled with individual protection. If you don’t think that gap exists, ask yourself this: if you currently make $250,000 a year and you became disabled, could you live on a pre-tax income of $108,000 a year? How about $72,000 a year? Probably not.
You may be tempted to stop reading at this point and say, “Look, I am only 40 years old and I’m in great shape. This doesn’t worry me.” Think again: from age 35 onwards, your career-long risk of suffering a long-term disability is 38%, and that disability period will average 82 months. So before you dismiss the risk, ask yourself what your life would be like if you had to spend the next seven years living on $72,000 a year pre-tax. And if you own or are a key contributor in a private practice, ask yourself what that means to the viability of the practice itself and to the jobs that depend on it.
Enter LifeStyle Value Guard built, backed by Lloyd’s of London, the largest insurance carrier in the world. This is an individually-owned disability insurance policy that works differently than a traditional disability policy. It pays monthly benefits to age 65/67. Rather than the “low and slow” approach, these policies will pay large lump sums every 6 months for up to 24 months on top of any existing individual and group disability insurance. In other words, the higher income earner who is capped at 60% or below now has a way to more fully insure income in the event of a disability.
Here's an example of how the policy works. Suppose a doctor earns $500,000. S/he may have $15,000 per month of group disability insurance and another $10-15,000 per month of tax-free individual protection. With LifeStyle Value Guard (LVG) this individual can secure a plan that would pay $250,000 if disabled after 6 months, with additional $250,000 sum paid if still disabled at 12, 18 and 24 months. This policy will have paid $1,000,000 over 24 months TAX FREE to help the surgeon continue to fund 529 plans, fund retirement, pay off other debt, etc.
One of the significant keys here is that there is no reduction in traditional benefits. In fact, the Issue and Participation rules that govern the group LTD and individual disability insurance market don’t apply here. So a practice can pull its top earners and provide this type of coverage as an executive perk or offer it on a voluntary basis. To top it all off, in many situations, we can design these programs to be issued without any medical review at all! Yes, these plans, with minimal participation, can be offered on a guaranteed-issue basis. Keep in mind that we also have access to a proprietary group Long-Term Disability insurance platform built by a major insurance carrier and offered through a group Trust for medical practices, so we can leverage the lowest possible cost for group plans and individual lump sum protections, all without medical review.
For a new practice or one that has grown over time, we can design employer-pay options for physician and admin groups at certain levels with lower lump sums available on a voluntary basis for other employees. Typically, with only three or more employer-paid lives, we can get all plans issued without medical review.
Where can one secure an individually-owned policies with specialty occupation language to protect medical duties, pay large lump sums, allow the individual to maintain all existing coverage and get the plans issued without medical exams? For practices with an older, established partner group with younger physicians, physician’s assistants, nurse practitioners, etc., the cost for traditional disability insurance or getting all individuals insured via medical review can be tricky. With LifeStyle Value Guard and its flexibility and guaranteed-issue availability, we can often find solutions for a wide range of ages, health histories, varying levels of individual coverage already in place, etc.
If you’d like to learn more about protecting yourself and your practice, just click here to email us or click here to submit an information request online.
Today's blog is a Guest Blog by Charlotte dentist Dr. Charles Payet. Since 1999, Dr. Payet has been the sole dentist & owner of Smiles by Payet Dentistry at the corner of Park Rd. & Abbey Place in Charlotte. He earned a dual B.A. in Biology & German at UNC Chapel Hill in 1994 and his DDS at the UNC Chapel Hill School of Dentistry in 1998. He and his wife, Fara (who runs the office most capably) met in Charlotte in 2005 and married here in 2006. They have 2 daughters, 2 dogs, and live in south Charlotte. You can follow Dr. Payet and his practice on Twitter and Facebook.
Dentist-ing in the Age of Covid-19
Let’s see…what day is today? Monday? Friday? Sat-wed-sun-day? Oh hell, it doesn’t matter, because without getting to work on patients, they all blend together. Not because of alcohol, but as a dentist, who doesn’t bear the responsibility for the business side of my practice, I don’t have a way to tell the difference. My wife handles all that stuff. Normally it’s a great division of labor, but not so much at the moment.
We closed our office just after lunchtime on Monday, March 16th. I’d followed the news from Italy closely over that weekend and could see what was coming to the US. It was a hard decision, because as a small business, neither our employees nor we get paid if we aren’t working. No patients = no revenue, so how would we pay the rent, our office and equipment loans, and accounts payable already incurred the previous month? What would our employees do? What could we do for them? There was (and even now still is) so much uncertainty surrounding the supplemental unemployment insurance for them, the loan possibilities for the office, etc. Would our mortgage lender let us defer payments? Online applications frequently crashed; my wife was on hold for hours trying to reach our lenders and vendors about deferments and extending/increasing lines of credit, only to be suddenly cut off.
We’re still waiting for the $10,000 EIDL loan to arrive to our account. The Paycheck Protection Program though? Well, we decided to wait on applying for that, as we didn’t want to be forced to hire our team back, if we still don’t know when we can open. As of Thursday, April 17th, that fund has been fully used up, and Congress is in recess, so no one knows what will happen next for small businesses like ours, which hadn’t yet applied for, or received, any money.
I’ve seen 5-6 patients in the last month, and it’s frustrating. I love dentistry and helping people, but I can’t do that now. Like many dentists, I’m moderately Type A and thrive on the pressure of a full schedule of patients. I’m a general dentist, but with more than 1,800 hours of advanced training since graduation, I provide a variety of advanced surgical and prosthetic services, along with fillings, check-ups, cleanings, etc. At the moment, because we are unable to source adequate PPE for our team, and because of the unknowns surrounding COVID-19 transmission, we’re limited to life-threatening emergencies and writing prescriptions.
Relatively speaking, we have no right to complain about our situation. Thanks to my wife’s financial savvy, our personal financial situation is solid, even if we stay shut down for 5-6 months. We live in a beautiful home in a beautiful neighborhood, we’re all healthy, we have plenty of ways to entertain ourselves. This includes our newly adopted American English Coonhound, Hershey, whose youthful energy keeps us moving. We are admittedly privileged. Because of that, we’ve doubled our charitable donations to both local and national non-profits, focusing on groups that support those most in need.
One of the most frustrating feelings right now though, is the feeling of being useless and unable to help our physician colleagues. We dentists often get irritated by people calling us “not a real doctor.” After all, we do have to study most of the same basic medical subjects for the first 2 years of dental school. It doesn’t diverge greatly from medical school until year 3, when we begin caring for patients and start our rotations. But in following so many physicians on Twitter, and having joined a few COVID-19 related FB groups, I’ve realized just how little we do know of medicine. The terminology, diagnostic criteria, etc. are all radically different, especially when colleagues talk to each other. We all have to use layman’s language when speaking with patients, but when physicians talk among themselves, it’s all Greek to me. And even though I wish I could go volunteer at a hospital, I realize how useless I’d be. There’s not much worse for any type of doctor than the feeling of being useless and helpless.
So I do what I (and my family) can do: we stay home so we don’t get sick and burden the doctors and nurses of Charlotte’s hospitals even more. I do try to help counter misinformation online, but I get so frustrated by the ignorance that I lose my cool. That doesn’t help anyone.
So we play games, read books, read too much on Twitter & Facebook, walk our dogs and exercise, and try to maintain a semblance of normal sleep.
At least the setting and rising of the sun makes it easy to tell when one day ends and another day begins. Even if I still don’t know what day it is.
One of the biggest issues in our healthcare system is the disconnect between cost visibility and care delivery. Doctors are typically trained to deliver the best care they possibly can for the indicated diagnosis, as well they should be. But they rarely have at hand the information necessary to determine if that course of treatment will be financially feasible for the patient. If there are no alternatives and the patient needs the indicated treatment to live, then it's a moot point. But in many cases, there are indeed alternatives, so arming doctors with better insights into the cost of treatment for that particular patient can mean the difference between that patient getting the care they need and not getting that care due to financial constraints.
Take medications. When you as a doctor prescribe a drug, you normally have absolutely no idea how much it will cost that particular patient. With all the differences in plans and programs and copay assistance policies, who can know? It could be free for Joe Smith, your 1 o'clock patient, and cost $500 a week for Jane Jones, your 2 o'clock. And while hopefully Jane would call the office and explore alternatives if that's the case, she may very well not; she may simply not take that medication and hope for the best, which can be a deadly strategy.
That's all about to change. Later this year, we're releasing a new feature that will tell you the doctor right there on the screen in your EHR what the medication you're about to prescribe will cost for that particular patient based on their profile. It will even suggest alternatives in case the pricing is not feasible for the patient. It will take into account not only that patient's particular insurance plan, but also membership in programs like GoodRx.
Think back in your career about how many times you've experienced or heard of cases of patients dying or suffering because they neglected to take the medications they were prescribed. In many of these tragic cases, the cause is simply failure to adhere to the treatment protocol. But in many others, the cause is financial: the patient simply couldn't afford the prescribed pharmaceutical(s). This new feature won't solve all our problems: there will still be cases where there are no affordable alternatives for the patient. But it is an important new tool for doctors to reduce non-adherence and to help more patients get better faster.
This is yet another game-changer from EMRx, not just for doctors but for their patients. Contact us today and let us schedule a demo to show you the future of EMR.
As I work closely with many healthcare professionals, I am hearing all the latest and greatest (and usually false) rumors about Covid-19.
The latest one is of special importance to independent healthcare providers, many of whom are turning to telehealth sessions during shutdowns to help enforce social distancing. There is a rumor going around, especially on social media, that the government has essentially suspended all HIPAA privacy rules and is allowing all forms of communication for telehealth sessions. This is simply untrue. To read the full, official statement, please click here (link to HHS.gov article).
In a nutshell, it says this: yes, as of this past week, the government will be temporarily suspending enforcement and fines for some non-compliant platforms, but not all of them, including FB Live, Twitch, and other public platforms.
However, we are advising clients, prospects, and all providers we know to be careful about employing non-compliant platforms, even in light of the new, temporary waivers. We have four main reasons for issuing this advice:
1) Privacy rules are in place to protect patients, and our ethical duty to do that does not end just because we (temporarily) cannot be fined for failing to do so. Applications like Facebook Messenger, consumer-edition Skype, and FaceTime are not subject to BAAs and you (and by extension your patients) are therefore not protected in case of breach. Indeed, the HHS statement underscores your responsibility as a provider to protect your patients' privacy even in the temporary absence of enforcement. And you must be cautious of even HIPAA-compliant teleconferencing applications that are not telehealth-specific, as the security nightmare with Zoom has shown us.
2) From an operational point of view, consumer applications like FaceTime are not optimal, since they are not integrated into a practice's workflows and have no functionality to help with things like scheduling. A robust telehealth platform like EMRx's, by contrast, is simply another feature in an overall patient portal that allows you and your patients to manage the entire interaction, from setting the appointment to holding the secure, HIPAA-compliant telehealth session, to having the patients pay their co-pay/fees, to following up with messaging/labs/notes/prescribing (as applicable). Burnout among healthcare professionals was already high before this crisis; let's not make it even worse by forcing staff to jump through extra hoops by using applications that sit entirely outside their workflows.
However, we understand that in the middle of a crisis, practices that do not already have an EMR with telehealth may not have the time and resources to make that switch. That's why we also offer a standalone telehealth application that is true telemedicine, not simply a video chat tool. Our platform- and vendor-agnostic Blum Telehealth is the first Bluetooth-enabled telemedicine app, allowing physicians to monitor vital signs such as temperature and blood pressure, and even to look into patients' eyes and ears.
3) From a best-practice point of view, we do not recommend that practices get in the habit of using non-compliant platforms. Sooner or later (and quite likely sooner), HHS will rescind the enforcement waiver. So we recommend asking yourself this: were you aware of the HHS article above? Possibly. Also quite likely you were not, given how chaotic everything has been. So will you be equally unaware when the rescission of the waivers is published? HIPAA fines range anywhere from $100 to $50,000 per violation. That's a lot of long-term downside risk to save very little money in the short term.
4) We all need to start thinking about the "New Normal." Practices of almost every kind are under tremendous financial strain thanks to this crisis. And let's face it, with all the rules, regulations, bureaucracy, paperwork, bad technology, and the constant insurance company push-back on claims, it was already a challenge to be an independent provider to begin with. For example, on average, the insurance companies make practices resubmit one out of every three claims at least once, with an average re-work/re-submission cost of $25 a claim. We are projecting those rejection rates to climb in the months to come as insurance companies scramble to cut their losses from Covid-19 coverage. (That's a polite way of saying they are going to try and claw back as much as possible from you, the healthcare providers.) We broach this in the context of these temporary enforcement waivers because we are concerned that the waivers represent a bad opportunity for many independent practices to delay making the changes they already needed to make to stay financially viable in the long term. Practices that fail to adapt to the New Normal, practices that were already under pressure to begin with, are going to struggle to stay afloat if they do not act now.
In summary, please be careful about the decisions you make regarding telehealth, and be sure to consider those decisions in the larger context of your practice's long-term health. Reach out to us today and we can get you up and running on a safe, fully compliant teleheatlh platform at a reasonable cost and in a very short time frame. And if you need the standalone application, we are pleased to offer that free of charge until September 13, 2020, or the end of the pandemic, whichever comes first. (For other ways we are helping out with the Covid Pandemic, please see our official response statement.)
In closing, a heartfelt thank-you to everyone in the medical and mental health community. Your dedication during this dark time for our country is an inspiration and gives us all hope. Please stay safe!
Covid-19, the deadly and highly contagious disease caused by the novel coronavirus that was first reported late last year, has already tested our country’s healthcare delivery system, and it is almost certainly not even close to peaking yet as of this writing. Here at Fast Layne Solutions, we are, as always, focused on how to help small- to medium-sized independent medical practices, so this blog post outlines our response, including our advice and the steps we intend to take to help our clients and our country. It will be updated as events unfold and as we add more measures.
Let’s start with social distancing. It is absolutely vital that we minimize human-to-human contact to stem the spread of the virus. For any medical procedure that does not require in-person consultation, we strongly recommend e-visits, aka telehealth. If your office is not already equipped to do telehealth visits, please contact us. For the duration of the Covid-19 pandemic, we are waiving much of the implementation cost for our clients and, for qualifying practices, will amortize the rest over one year. We can get practices set up on telehealth extremely quickly and we have two versions: one is embedded into the patient portal that we provide with our EMRx and Revenue Cycle Management offering (see iClaim below), while the other is a standalone app that is Bluetooth-enabled and vendor/platform-agnostic and can be rolled out in a matter of days. In either case, with just a few clicks, you can be seeing a patient anywhere in a secure, HIPAA-compliant environment. (Because Apple will not sign a BAA, FaceTime, for example, is not compliant. Do not make that risky and potentially expensive mistake. Please see our statement on the HIPAA telehealth enforcement waivers for more information.) In the embedded version, in the same portal where you hold the telehealth session, your patients can make appointments and even pay for their visits, as well as message your office, review their records, and check lab results.
Another way your office can facilitate social distancing is to get rid of the old practice of having patients arrive early to fill out paperwork. Using our portal, patients fill in their paperwork online in advance, and your office staff see it as highlighted entries ready for them to check and confirm before making them permanent entries into the patients’ records. As noted above, that same portal can also minimize face-to-face interactions by facilitating online payments, scheduling, records and results retrievals, and messaging.
Now we need to discuss an unpleasant topic, doctors and practice administrators. The insurance companies have waived certain co-pays related directly to testing, but this will not impact any other costs to patients, including actual treatment. Independent doctors already struggle with denials, claim rejections, and outstanding patient debt even at the best of times. During this crisis, those problems will only grow. So let’s look at how we can use technology to minimize the impact on your practice so that you can continue serving your patients:
Technology has an important role to play in this crisis, and we are ready to help you implement it quickly and efficiently to minimize negative outcomes for both you and your patients. And to help even more, we will be offering all the basic features of our standalone telehealth app free of charge until the pandemic is over or until September 13 2020, whichever comes first.
To further assist doctors and their patients at this difficult time, Fast Layne Solutions is also offering a monthly 5% rebate to any of our clients who are in a position to offer medical care to uninsured patients, in order to help them defray those costs. This offer remains in effect until the pandemic is declared over in the United States.
For the duration of the crisis, we will also be donating 5% of our clients’ monthly invoices to the Center for Disaster Philanthropy’s Covid-19 Response Fund. We will also be earmarking 5% of all 2020 corporate profits for Covid-19 relief.
We want to close by thanking our tireless and brave healthcare workers who will be on the front line in the battle against Covid-19. You are our heroes and America’s best hope.
Last week, we talked about the challenges facing a fictional doctor, Dr. Janelle Smith, a young endocrinologist trying to serve the South Side of Chicago as an independent practitioner. When we left off, she was facing an impossible choice: stay in her private practice but barely scrape by, or join a large hospital and let go of her dream to serve her community. But it's a false choice, because all those problems we described actually have solutions.
Let’s take her EHR. Her total annual costs, including maintenance, updates, and training, for her current system exceed $25,000 for the practice. And that’s just what she pays to her provider. What she’s not capturing in that figure is the value of the time wasted by her and her PA due to how complicated and user-unfriendly her system is. So she sits down and runs the numbers: she and her PA are averaging 10 minutes per patient encounter and they see 40 patients a day. To her horror, she realizes that almost an entire headcount is dedicated just to charting. But a tablet-optimized, Cloud-based EHR like NextGen’s EMRx costs a fraction of that, and because it was designed by doctors, it’s intended to get doctors through the charting process as quickly as possible, in an average of just two minutes per encounter. Her first year savings alone are going to be almost $10,000 just for the software, and it leads to productivity gains equating to getting ⅔ of a new headcount for free. She almost has enough to add a second PA and expand her practice. And she’s just getting started.
Now let’s look at her overhead. She has a staff of five, including herself. Of those, three produce no revenue whatsoever and are not involved in providing care to her patients. They spend their days in purely administrative tasks, as noted above. But how much of that work is even necessary? Very little of it. With a full-feature practice and revenue cycle management suite, claims are generated automatically based on the integrated EHR, and reviewed by experts who handle claims for many offices, getting her practice out of the billing and claims business. (Any self-pay bills can be printed with a push of a button.) And because those claims are scrubbed by the advanced iClaim claims management system, the rejection rate is under 2%, and the payments hit Dr. Smith’s account within just a few days, thanks to the separate clearinghouse the system uses.
Patients can now fill out their paperwork in advance through the patient portal. They can also submit their medical records requests there, make appointments, and even pay their bills. And all benefits verifications are now automated and executed with the push of a single button when the patient checks in. And denials? A thing of the past thanks to a rigorous and automated verification system.
So the work of three staff who had been working 45-50 hours a week can now be done by two staff members working 40 hours a week. Now Dr. Smith has a receptionist/admin working no overtime and a far less stressed-out office manager working a normal schedule. Including overhead, salaries, and overtime, she is saving over $50,000 a year. That’s the rest of the money she needs to add that second PA or a nurse practitioner!
She also implements ChoicePay, cutting her credit card transaction fees to 1.79%, saving her money, allowing her to take payments online, and giving her a fully HIPAA-compliant merchant services solution that is seamlessly integrated with her billing system.
Her overall financial situation starts to improve dramatically as her AR days fall and she all but eliminates write-offs and bad patient debt caused by denials. Cash flow is excellent, with payments coming in within days of service provision. She’s no longer worried about making payroll. Her staff of five is now three healthcare providers, all of whom are caring for patients and generating revenue. She’s thriving. She’s able to dedicate more hours to her free clinic. She’s no longer living month to month; on the contrary, she’s making bold plans to expand to a second location.
As you look back through this scenario and consider the impact on the South Side, you can see the obvious benefits in terms of keeping quality care in the area and helping a local practice thrive. But you might have one concern. What about that biller? Yes, the practice still employs five people, but that biller is out of a job, and that isn’t good for the community. That’s why Fast Layne Solutions is proud to announce an initiative to create jobs in the communities we serve by training and equipping claims handlers in those neighborhoods. For example, we are committed to adding one new job for every five providers we serve on the South Side of Chicago. Note we’re saying providers, not clients, here. So a single office with, say, three doctors, one physician’s assistant, and one nurse practitioner would lead to a new job on the South Side. We will provide the training and the equipment, and the claims handlers can not only work from home, but also set their own hours, since we require only that a certain number of claims be processed within a given week. Think about what that means for, say, a single mother. Single mothers in economically vulnerable neighborhoods often struggle to find sustainable employment because working outside the home simply doesn’t pay once you account for childcare. But if you have a job that can be done from anywhere and at any time of day, you have the flexibility to earn a good living while still caring for your children.
The term “win/win” is thrown around a lot, but that’s truly what this is. We are giving practices the tools they need not just to survive but thrive in a challenging environment, while also creating new jobs in the community, jobs that involve highly valued, transferable skills.
Want to learn more? Email us today and let’s set up a free, no-obligation practice analysis. If we can’t prove that we’ll save you more than we will charge you, we just won’t ask for your business. It really is that simple.
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.