amednews: Leasing practice to hospital can be a viable business plan :: June 13, 2011 ... American Medical News

amednews: Leasing practice to hospital can be a viable business plan :: June 13, 2011 ... American Medical News

4 Quick Ways to Start Marketing Your Practice

So, you are convinced that you need to ramp up the marketing efforts of your physician office.  But you  still feel swamped, and the practice manager will not be thrilled to have another thing added to the to-do list.  What's a doctor to do?  Call for a consult?  Give up?  Keep doing what isn't working?  How about a few baby steps forward in your practices marketing efforts.  These are 4 quick, easy and relatively painless ideas:

1. Make marketing a priority. Find a few marketing activities that take less than 30 minutes of time, such as Twittering, writing a blog post or following up with networking contacts at other clinics. Then, commit to doing these activities first thing in the morning before you do anything else.
   
2. Create a marketing calendar for the practice. Block out set times every month when you'll only focus on marketing, just as you might block out specific times for call, meetings or patient appointments. Then, be sure to keep these "appointments." Display your marketing calendar prominently so you can't "forget" you're committed to marketing.
3. Review your marketing calendar monthly. Each month, schedule one hour to review your marketing calendar and plan for any upcoming events. If you plan to speak at a patient support group, plan out what practice marketing materials you will need to create before that date. If your clinic publishes a monthly e-newsletter, plan out when you'll write it. Any tasks you commit to should be added to your to-do list so you don't forget.
   
4. Consider hiring an assistant or free intern from a local college (Marketing Majors may need internships). If you or your office staff still doesn't have time to market the practice, consider hiring an assistant to do some of it. Try out a Websites like Elance.com to find qualified professionals cheap and easy.  Consider trying virtual assistants, designers, writers, consultants and other professionals to help you manage your practice.
   

When you market your medical business on a regular basis, it becomes a habit.  Once it's a habit, you know your clinic is on track to be strong, growing and able to best serve the patients over the long-term. 


Note:  The thoughts and opinions on Training Wheels are my own, unless otherwise referenced, and are to be food for thought.  If contemplating business changes, these blog posts are not a substitute for consulting your lawyer or accountant. I'll bet you already figured that out, didn't you? 

Why Make Time to Market A Practice

One common problem independent physician offices have today is the belief that they too busy to market the practice. There is the new EHR system.  Staffing and billing is a nightmare.  The senior partner is retiring.  Marketing?  You have to be kidding! 


These practices may have, at some time, created a marketing plan, but maybe not.  They may have believed a shingle, a business card and some old friends or colleagues would be enough to attract new patients.  They may have a fairly stable group of referrals for now.  They may have passed all business and marketing responsibilities to their office manager who feels that there isn't enough time for marketing activities on top of all the other minutia of running a practice today.  They are just plain, frantically, busy.
So what happens? Well often, doctors just stop marketing and focus their attention on patients and day to day issues. After all, they have all the patients they can handle.  Their med school buddies will keep referring to the clinic.  They have a good reputation in the community.  They don't have to market the practice anymore, right?                                


Wrong!                      

That may be true for a few weeks several years ago, but sooner or later those patients will die, move away or change insurance plans.  Those referring colleagues may have their practices bought by a health system that discourages them from sending your office patients.  The hospital may build a clinic across the way and have a large successful marketing and advertising plan.  If you've just stopped marketing your practice, the office may suddenly realize you don't have any new patients, and it may be too late to impact that trend.

Marketing may not seem like a necessity when you have plenty of folks in the waiting room and your are booked out for six weeks.  But without steady marketing efforts, you won't be able to attract new patients to keep your practice healthy, stable and competitive in today's health care market.

Keeping abreast of your practice's marketing efforts requires planning, so my next post will have a few suggestions for marketing your services even when the office is extremely busy.


Note:  The thoughts and opinions on Training Wheels are my own, unless otherwise referenced, and are to be food for thought.  If contemplating business changes, these blog posts are not a substitute for consulting your lawyer or accountant. I'll bet you already figured that out, didn't you?  

Is Your Practice Selling to a Health System? A few considerations...before you cash the check

Oops!  There goes one.  Oops!  There goes another one!  We hear about it every week.  Shrinking Medicare and private payer reimbursements,  increasing regulatory demands, and high cost technology are just a few of the reasons that many physicians are crying "Uncle" and actively looking to sell their practices.  As quickly as they can, many are relinquishing the freedom of being their own boss and are becoming employees of a hospital or health system.

Of course, for some docs, selling to a hospital system may make a lot of sense.  You may be overworked, under capitalized or ready to soon retire.  There may be a problem with billing, taking call or, dare we say it, you just want to take care of patients and HATE the business side of medicine.  Regardless of the reason, you, your accountant and your attorney need to evaluate several issues before making the big decision. And, if you decide to take the plunge, be careful to make sure that you have an “out” if the deal isn't all both parties expect..

Due diligence review (discover your own dirty laundry)

Don't even think about entering into discussion about the sale of your practice until you've conducted an internal due diligence review.  This allows you to be certain the the practice is in the condition to be sold. 


Make sure you identify billing and coding problems, contractual arrangements, or legal issues including potential litigation. Take a look at leases, employment contracts, service agreements, and other contractual arrangements should be current and meet present regulatory requirements. Finally, the review should also include a verification of accurate and complete medical records (and it doesn't matter how much you hate documenting!) and a billing audit.


If there are any problems, fix them before beginning negotiations.  

Personal and professional areas to think about

This may be a little too touchy-feely for some, but you must consider your own personal practice philosophies and professional goals:

• How does selling your practice and becoming an employee fit with who you are as a physician? 
• What if the arrangements don’t work out?  Will you be back looking for work after only a few years? 
• Do you expect to practice beyond the initial employment contact agreement?  
• How hospital employment fits with your career goals?  
• Can you go from being a boss to being the worker?  Selling the practice you built can be a traumatic for some doctors, and more than one clinician used to "doing it my way" may find the transition to being an employee difficult at best.

Pick the right buyer
When making the decision to join a health system, remember that what works for a large, corporate hospital may not work an individual practice. These are some questions you should ask:

• What is the hospital’s strategic plan?  
• Will it support your specialty’s growth after the ink is dry on the contract?   
• What is the health system's physician employment model? Some hospitals may already have other clinics formed and in place to employ physicians. 
• Does your practice has unique features that the buyer will want to preserve?   If it does, the hospital might be willing to establish a new model for your practice.
• What about its current technology?   An electronic medical record (EMR) system that meets the needs of the system's employed FP and IM doctors may be mind-numbing for your specialty practice.

The final step: the purchase agreement 
If your group recently put a substantial investment into technology (EMR, equipment, computers), you may want to make sure to be reimbursed or that you can continue to use it after the sale, and that the existing license agreements can be assigned to the hospital. What about the transfer of  medical records? 

Is your medical practice a corporate entity?  If it is, you may be able to handle the sale as a stock purchase, and simply transfer all your stock to the hospital system.  However, its important to remember that most corporate health care entities will only want to purchase the assets, and a stock purchase transfers liabilities as well. 

What should be in an asset purchase agreement?
 Legal experts say that the asset purchase agreement should address the following issues: 

1. The purchase price and terms
2. The handling of technology issues (EMR, compatibility, etc)
3. The transfer of medical records, and disengagement if the arrangement doesn’t work out
4.  Should include a mechanism to disengage from the arrangement, and should address your ability to reacquire your assets and return to private practice
5. It should dovetail with employment agreement and restrictive covenant provisions. The provisions should also clearly spell out when and how the unwind option can be exercised.

The employment agreement
So now you have gone as far as reviewing the hospital employee agreement.  This agreement sets the stage for your practice's arrangement with the health system and should address issues such as term and termination, compensation, and dispute resolution processes.  The agreement should also include an adjustment mechanism if performance targets set by the hospital system aren't met.  


Most hospital employment agreements will have a term of not more than 5-years, and  3-year terms are fairly typical. However, the typical employment agreement can allow for early termination by the hospital, the doctor, or both. If the agreement can be terminated “for cause,” make sure the grounds for cause are spelled out clearly and are as objective as possible. Also, if the agreement can be terminated prior to the end of the term without cause, adequate notice should be required to permit you to make new practice arrangements.  Be sure you have a lawyer review your contract and these terms very carefully.  

Watch for more:  What do do after the contract is signed


Note:  The thoughts and opinions on Training Wheels are my own, unless otherwise referenced, and are to be food for thought.  If contemplating business changes, these blog posts are not a substitute for consulting your lawyer or accountant. I"ll bet you already figured that out, didn't you?  

Options for Practices Regarding Accountable Care Organizations

These days physicians, medical practices and health systems around the country are debating requirements of becoming an Accountable Care Organization (ACO), and are often wondering where their organizations can accomplish the task. Health care consultants and other experts point out that this is a critical time to develop strategic plans, implement some operational initiatives and update a business' direction.  So while the issue is important to discuss and consider for many groups, it's also critical to take look at all the options in this time of ongoing health care reform.


We're all aware that to survive every doctor must deliver cost-effective care to patients.  Consequently even large systems have been scrambling to update their electronic medical records beginning to try and implement a stronger clinical integration.  However, it's important to have a clear framework for practice changes and and both a mid-range and a long-term plan.


Recent articles on health care trends and the transformation of the health care industry suggests other options to ACOs will emerge as well  They include the following: low-cost leader, niche clinical service provider, research/innovation institute, island, virtual health organization, and vantage integrated provider.  Understanding these opportunities and niches, can help practices to put down a  plan to outline goals, make action plans, and decide the resources necessary to achieve them.


Below are descriptions of these other potential roles:


1. Low-Cost Provider

• Very selective scope of services
• Based on low cost and patient convenience
• Care is provided in low cost settings
• Minimal administration
• High patient volume with reduced cost per patient
• Will build volume via contracts and "word of mouth"
• Little to no investment in aggressive marketing
• Operational standardization and efficiency are maximized
•  Mid-level providers used to reduce the number of MDs and RNs providing care

2. Niched Provider

• Narrow array of services
• Standardized, efficient operations
• Practice identity based on clinical expertise and ongoing innovation
• Structured means of developing and managing patient referrals
• Targets patient base due to  market size, usage patterns, value sought and decision criteria used to select care
• Thorough understanding of competitors
•  Proactive in establishing and managing new strategic relationships 
• Able to recruit and retain a clinical team with area respect

3. Research/Innovation Institute

• Focused on bench and translational research
• Can implement services and products more quickly and cost-effectively than competitors  
• Targets patients specific to the services and products being developed
• Can anticipate multiple trend to identify new services and products
• Open innovation network attractive to physicians, scientists, and others
• Strong relationships with public and private funding sources
• Minimal bureaucracy

4. Island

• A sole provider in an area.
• May be any size.
• Able to protect practice from competitors
• Strong relationship with local community
• Strong outreach strategies and resources
• Services meet the majority of the needs patients and is supplemented with patient transfer agreements, tele-medicine, and coverage agreements for needed specialists
• Ability to limit out-migration by patients via meeting their needs (access, clinical skills, service)
• Financially stable
•  Creative in recruitment and retention of clinical staff

5. Virtual Health Organization

• Contracts to support other providers.
• Does not own or operate a care delivery site.
• Delivers health care resources
• Strong marketing and sales capability 
• Large, geographically dispersed network of resources available 
• Strong network management  
• Strong IT and telecommunications resources compatible with a diverse array of providers

6. Vantage Integrated Strategy

• ACO "plus"
• Provider, payer, or other party that assembles and coordinates a network or system that consists of providers, finance and other strategic alliances.
• Strong IT and telecommunications resources compatible with a diverse array of providers
•  Access to capital
•  Legal skills to form network relationships and manage within the regulatory guidelines
• Understanding of the businesses and the management strength necessary to integrate the operations and cultures of diverse members of the network

It may seem that a "wait and see" attitude may be best until all of these aspects are determined, but doing so is risky as other more proactive providers will carve out their position and limit another practice's options. However, it's also risky to just select a path because it seems to be your only option, or because it's what everyone else in your market is doing!


Take some time, read more than one opinion and continue to map out re strategies for practice growth and success.


Note:  The thoughts and opinions on Training Wheels are my own, unless otherwise referenced, and are to be food for thought.  If contemplating business changes, these blog posts are not a substitute for consulting your lawyer or accountant. I"ll bet you already figured that out, didn't you?  

Can Social Media Start Patient/Clinician Communication?

It’s no surprise to anyone that patients are turning to the Internet for information about their health.  Consequently, it’s more important each passing day for health professionals to understand that Facebook, Google, health news and patient online support groups will not replace the medical community. The Web is merely a tool that allows for more open conversation between providers and patients.   However, because of this broad use of the Internet, clinicians need to use social media and the broader Internet to help educate the patient.  Through the Web doctors, nurses and health care organizations have a great opportunity to provide accurate, reliable and truthful medical information to the health care consumer, and help a broad base of patients.


Still, many providers question the communication value of Internet as a whole and social media in particular.  Vast quantities of health information are available on the web and some providers feel that patients may be given inaccurate information.  Still other practices worry about potential liability in commenting on various conditions, or consumer postings on practice Facebook pages.  Finally, some doctors resent the potential ramifications of conflicting medical information.

In a recent New England Journal of Medicine article by Pamela Hartzband and Jerome Groopman the authors note that, "Doctors have to get used to the fact they are no longer the sole source of a patient’s health information. Instead, they need to serve more as interpreters of data, and be willing to separate the tangible information from the increasing amount of noise patients find online".  In discussing the physician's own use of email to interact with patients Hartzband and Groopman continue,"E-mail is quite different from speaking with a patient face to face, and doctors must consider carefully what they say and how they say it...written dialogue is quite different from spoken conversation: replies may be delayed, phrases may be more stilted, tone of voice is absent. We should pay close attention to any unintentional fraying of the physician–patient bond" .  So while caution is noted, the inevitability of the Internet has been acknowledged in the medical community.  The bottom line is that face to face communication still remains critical for the doctor/patient relationship.

The upside in this communication shift is that highly involved and educated patients are proactive in their health care.   By engaging in online health forums, patients get emotional and informational support from medical sources and others dealing with health care issues.  They can gather health information from the Internet to help them gain knowledge, collaborate and share medical information. They in fact become health care consumers that can talk to their clinicians about conditions, concerns and make knowledgeable decisions about their care.

Luckily, researching health information on the Internet has never been easier. Patients can interact in health communities,  on practice sites, research venues and via social media, like Facebook and Twitter.  In fact, 40% of online consumers use social networking sites for health information, and according to one study, 80% of these patients are highly engaged patients that take active roles in their own well-being.

So what does this mean regarding the way physicians and practices communicate with their patients?  Well the data really encourages the health care community to embrace the benefits of the Internet and partner with patients in this new communications frontier. Additionally, the Web will never change the fundamental need for face to face interaction between doctor and patient. That personal relationship will continue to be key for the best patient care and greatest patient/clinician satisfaction.

Note:  The thoughts and opinions on Training Wheels are my own, unless otherwise referenced, and are to be food for thought.  If contemplating business changes, these blog posts are not a substitute for consulting your lawyer or accountant. I"ll bet you already figured that out, didn't you?  

A great blog post: How social media has changed my medical practice

We always hear from the experts how physicians and hospitals should be using social media to be in touch with their patients.  Rarely, however, do we hear from the doctors themselves.  Here is a great blog post from Natasha Burgert, MD on KevinMD.com.  I've only included a bit to tweak your interest, but follow the link below to read the entire piece!

http://www.kevinmd.com/blog/2011/08/social-media-changed-medical-practice.html

How social media has changed my medical practice

by Natasha Burgert, MD |

Last summer, I joined millions of others in the deluge of social media. I committed one year of effort to see if social would enhance or distract from my pediatric practice.

That was my goal, just one year.

At that time, I wanted to dip my foot in the pool, and see if it made any ripples. The unexpected consequence was how much social media has changed my medical practice, and me. Ripples have returned as tidal waves.

My practice has seen tangible, real valuable benefits. I have been intellectually challenged, and have professionally grown.

For my practice:

• Increasing new patient traffic is creating revenue for our group.I average 1 new patient family per week who came because of our social media presence. I know this because they tell me, “I am here to see you today because I found you on Facebook,” or “I found your blog.”
  
  • 52 patients a year x $2700 (average pediatric care for 0-24 mon.) = $140,000 of average billable income over two years.

•  Creating information has added to my “search-ability” in search engines. All my work is available publicly and with fully disclosed authorship, so new patients can find me with ease.

• Investing time in relevant and complete posts actually saves me time in the long run. Questions I am repeatedly asked,  like “How do I start solid foods?“, can be answered quickly and completely by directing them to my site. This saves face-to-face clinic time for more specific concerns for their child.

Read the rest at:   http://www.kevinmd.com/blog/2011/08/social-media-changed-medical-practice.html

Natasha Burgert is a pediatrician who blogs at KC Kids Doc.

Note:  The thoughts and opinions on Training Wheels are my own, unless otherwise referenced, and are to be food for thought.  If contemplating business changes, these blog posts are not a substitute for consulting your lawyer or accountant. I"ll bet you already figured that out, didn't you?