What are the top challenges facing small- to medium-sized, independent physicians as they fight to maintain their independence and compete with the large, corporate providers? Over coming weeks, we are going to look at the top 10 challenges, so please join us for this informative series and tune back in every Tuesday!
First of all, why should independent physicians even try to maintain their freedom? Isn’t the corporate takeover of our healthcare system inevitable? In 2018, employed physicians outnumbered independent physicians for the first time ever, according to Medical Economics. Many independent physicians are despairing that selling out is just a question of when, not if. That’s especially true in the era of Obamacare and MACRA, when the increased rules and regulations are making it more and more challenging for physicians to operate confidently and profitably while complying with all the Byzantine rules.
But it’s a fight worth fighting! Studies show patients of small- to medium-sized independent physicians fare better. Medscape recently highlighted several studies that bear this out. Smaller practices have “ambulatory care-sensitive admission rates fully 33% lower” and lower overall costs for care for diabetes, for example.
So we need to win this battle for our patients. But how? Let’s look at the biggest issues the independent doctors face.
1) High insurance claim rejection rates. On average, 34% of all insurance claims submitted to the insurance companies are initially rejected. Many are eventually paid out, but only after resubmitting, often multiple times. When you consider that each reworked claim adds an average of $25 in cost to the practice, you can see how this is one of the biggest burdens for small providers. But isn’t that just how the game is played? You submit, they reject, you resubmit? Many practices, even smaller ones, have entire headcounts dedicated to nothing but fighting this battle. But they don’t have to! In fact, it makes no sense to. Doing your own claims, especially if you are doing them manually, makes zero financial sense for providers with under 25 staff. The math simply doesn’t add up. Using a resource like Fast Layne Solutions solves this in two ways: it brings advanced Revenue Cycle Management technology to bear on the problem (thus slashing that rejection rate to under 2%) and brings economies of scale to bear to cut your claims management costs by on average 60%.
2) Slow reimbursements. Even when you do get paid, it is often taking far too long. The solution: use a provider that has an independent clearinghouse connected to all insurance companies and that gets your claims paid the first time. That’s why our doctors get paid in days, not months.
3) Clunky, user-unfriendly, slow, overpriced EMR/EHR systems. It is the shame of our industry. Talk to any doctor pretty much anywhere in the United States and they will tell you the same story: I HATE MY EMR! There is even a popular parody account on Twitter dedicated entirely to how awful the leading EHR system in the US is perceived to be by the doctors and other healthcare professionals forced to use it. And to add insult to injury, these systems are incredibly expensive. And on top of all that, most are PC- or laptop-based, which interferes with the doctor-patient interaction. And many are so complicated that even a smaller practice often has to have a full-time IT headcount to maintain their systems. The solution: EMRx, a Cloud-based (read “zero maintenance and no IT staff needed”), software-as-a-service EMR designed by doctors, for doctors, and currently used by thousands of doctors nationwide. EMRx is tablet-optimized, meaning you can maintain eye contact with the patient. It is so user-friendly that our average documentation time per patient encounter is just two minutes for general practitioners, somewhat greater for certain specialists. (And yes, everyone always thinks that’s a lie….right until they see the demo.) And because it is software-as-a-service, the start-up costs are far more reasonable, there is zero maintenance for you, you have access to award-winning support, and the ongoing costs are reasonable. Also, you aren’t stuck in multi-year contracts.
Tune in next week for challenges 4 to 7!
Today’s guest blogger is a Registered Nurse and hospice administrator who shares with us her personal experiences and observations of a life in healthcare from her front-line perspective. We welcome guest bloggers who can share insights regarding the many facets and aspects of healthcare: tech, administration, policy, and patient outcomes, among others. Interested in contributing? Please send your credentials and a brief content pitch to us at email@example.com, using GUEST BLOGGER in the subject line.
What Do Nurses Eat?
What do nurses eat? Well, the old adage is that “nurses eat their young.” Not literally of course; I’m not talking about a nurse cannibalizing their biological children. I’m talking about the abuse a new nurse sometimes faces when he or she enters the workplace. It’s a surprising hurdle that a lot of nurses must deal with: bullying, hazing, and conflict in the workplace. The types of bullying can manifest in different types of forms, such as unwillingness to help a coworker, verbal abuse, mocking, gossip, exclusion, and, in extreme cases, even physical abuse.
I find it so unusual that even though nursing is a profession that is committed to helping, caring, healing, and loving others, it's also very consistent with such bullying tactics like hazing. Nursing is regarded as one of the most trusted professions; however, in this career we are subjected to high pressure, stress, and extreme emotions, which could lead to a boiling point that may precipitate aggression towards each other.
Does that still stand as true today as when I started out? Unfortunately, I believe it does, and I see it happen often in my own career. It often happens when new nurses are insecure and unable to defend themselves. Suddenly, they find themselves in this new, big, scary world and in a new role straight out of nursing school.
Believe me, we all know that nursing school is no joke, and some nursing school instructors can be vicious. I wonder if such experiences make new nurses accustomed to this treatment as a result of nursing school and clinicals. Is it possible that being bullied, humiliated, and harassed is familiar and it just carries on into the workplace with them? Is this a rite of passage, akin to hazing in sororities and fraternities?
The bigger questions are why it is necessary and when does this end? Does it end when a person has been a nurse a certain number of years? Does it start over and over when a person goes into a new job, regardless of how many years s/he has actually been a nurse?
I witnessed one of the first instances of bullying of nurses while attending nursing school. There was in our class one student who was particularly bright, beautiful, and organized (let’s just say she was perfect). Honestly, she rather intimidated the rest of us and would consistently stand to speak anytime she had a question or to answer a question. She was the kind of girl that we all detest: her always perfect notes were pristine, she always made A’s. When it was her turn to speak, she would stand, poised as Princess Diana, and in the most articulate voice you can imagine, would answer or ask a question.
One day after a very grueling test, we were all literally in tears because we were sure that we had failed it. Suddenly, this young lady stood up to ask a question. That’s when it happened: another student blurted out to her, “would you please just sit your ass down?!”
The entire room burst into laughter. Even the instructor laughed out loud and openly. Very slowly she sat down. I saw tears run down her face. That was the very first instance that I can recall that I witnessed nurse bullying and this poor girl wasn’t even officially a nurse yet. It was so blatant that I was actually shocked. The instructor did nothing, giving absolutely no reprimand to the student who blurted out. Through the instructor’s silence, the bullying student’s behavior was condoned and somewhat rewarded. For the remainder of the term, the bullying student was regarded as the leader of the class.
I often wonder about that young lady today. I wonder what her nursing career has been like since we graduated. I wonder: does she still display her intelligence boldly? Does she still stand while being extremely poised in all her interactions with people, or did she shrink and become quiet and reserved? I think and wonder about her frequently, and I feel very sad that on that day when everybody burst into laughter, I joined in the chorus. I succumbed to the peer pressure to laugh and ridicule a fellow future nurse who was just trying to make her way, just as I was.
For years, this culture of bullying has been widely tolerated among nurses; however, there has been increased public attention brought to this problem. As a nurse leader, I am very watchful of bullying behavior by senior nurses towards new staff, making it clear to them that it is not accepted as part of the culture of our workplace. I think about the new employees and especially the nurses that come under my leadership and strive to cultivate a new adage: “nurses protect and treasure their young.”
My name is Freda Beaty. I’m originally from Winston-Salem, NC, but currently live in Greenville, SC. I am a Registered Nurse and I am the Administrator for a hospice company. During my free time, I am a jewelry designer and self-proclaimed photographer. You can reach me at firstname.lastname@example.org.