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The Private Medical Practice Academy

The Private Medical Practice Academy

How to start, run, grow and leverage your private medical practice.

Latest From Series

Demystifying Malpractice Insurance with Jennifer Wiggins, Aegis Malpractice

 If you are an employed physician, chances are your employer purchases  malpractice insurance for you. Your first introduction to the complexities of malpractice insurance may come when you leave that employer and have to buy a "tail." And, if when you start your own practice you'll need to understand how to get the best malpractice insurance. Today, I chat with Jennifer Wiggins from Aegis Malpractice to help demystify malpractice insurance. Jennifer has over 16 years experience working for one of the country's largest malpractice insurers. In 2018, she left to start Aegis Malpractice, a broker specializing in malpractice insurance. Here are some highlights:Difference between claims-made and occurrence malpractice insuranceWhen do you need a tail?How often you should shop your malpractice insuranceThe key elements of a malpractice policyAttorneys and who decides when to settle a caseWhy your practice needs a malpractice policy (and not just the individual physicians)How to choose a malpractice carrierDo you need a broker and if so, how do you which oneWe all know that malpractice insurance is a major expense. You want to make sure that your money is buying you the best policy for your practice. Jennifer and Aegis are offering a free, no obligation review of your current malpractice insurance policy. You can learn more at https://www.aegismalpractice.com and be sure to mention this podcast.If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.   And, be sure to join my FB group, The Private Medical Practice Academy.Enroll in my course,  How To Start Your Own Practice and get the step-by-step process for opening your doors.Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.
April 26, 2022

In Network vs. Out-Of-Network with Guest: John Lin MD

Today I had a great chat with Dr. John Lin about how to think about choosing to be In-Network vs. Out-of-Network. We all know that dealing with health insurance companies can be very frustrating. But reimbursement rates are only a part of what makes dealing with these companies a headache.Trying to decide whether it makes sense for you and your practice to be In-Network or Out-of-Network has to be an informed calculation rather than an emotional decision.  Here are some of the topics we hit on:What is the demographics of your practice?Can you "afford" to lose that patient population?What percentage of your payor mix does the insurance company make up?How much time (% of an FTE) does it take you and your staff to get prior authorizations and payment for this insurance company?One of the key points of our discussion is that being In-Network  or Out-of-Network is not an all or none decision. Both Dr. Lin and I started our practices In-Network with most payors in order to get our practices full. And then, with time and experience, evaluated and re-evaluated each payor and their contracts to decide whether it was beneficial to our practices.You'll want to listen to our discussion of the decision-making process as you consider these choices for yourself.Dr. Lin is a private practice urologist in Gilbert, Arizona. He is also an immigrant, operates multiple businesses, is an angel investor, and is a very grateful winner. He is an avid student of efficient practice management and frequently speaks on coding, billing, practice management, and online reputation management. Urologists from across the U.S. and the U.K. have visited his practice to learn about practice efficiencies. Dr. Lin consults for numerous physicians who are starting and running successful practices.He believes in sharing knowledge and paying it forward.Dr. Lin helps urology practices throughout the U.S. as the host of The Thriving Urology Practice Facebook Group. He runs multiple YouTube channels. You can also find him on all the popular social media channels as @jclinmd.If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.    And, be sure to join my FB group, The Private Medical Practice Academy. Enroll in my course,  How To Start Your Own Practice and get the step-by-step process for opening your doors. Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.
April 6, 2022

How Medicare's Local Carrier Determinations Affect You

You’re a Medicare provider. And you know that the Centers for Medicare and Medicaid Services (CMS) runs Medicare. But did you know that CMS is just the umbrella organization? The actual administration is done by a Medicare Administrative Contractor (MAC.)  What is a MAC? A MAC is a private health care insurer that’s been awarded a geographic jurisdiction to process claims for Medicare Fee-For-Service beneficiaries.  CMS relies on the network of MACs to serve as the primary operational contact between the Medicare Fee-For-Services program and providers enrolled in the program.  MACs are multi-state, regional contractors that administer both Medicare Part B claims. Some of the activities the MACs include:Processing claims, enrolling providers, handling 1st stage appeals redetermination requests, responding to provider inquiries, educating providers about Medicare billing requirements, reviewing medical records for selected claims and establishing local coverage determinations One of the functions of each MAC is to establish local coverage determinations (LCD.)  An LCD is a determination of whether a particular item or service is going to be covered on a contractor–wide basis. Before an LCD can be put in place, there's a whole process:The Proposed LCD describes the MAC’s proposed determination regarding coverage, non-coverage or limited coverage for a particular item or service. The public announcement  begins with the date the proposed LCD is published on the Medicare Coverage Database.After the proposed LCD is published, the MAC has to provide a minimum of 45 calendar days for public comment. The MAC has to establish a Contractor Advisory Committee to discuss the quality of evidence used to make a determination. You can volunteer to be part of the CAC. While you won’t get paid for your participation, this is your opportunity to have your interests heard. The MAC holds open meetings to discuss the review of the evidence and the rationale for the proposed LCD.  Once these steps are completed, the final LCD and the response to comment  is published. This marks the beginning of the required notice period of a minimum 45 calendar days before the LCD can take effect. There is an LCD reconsideration process. As a physician you can request a revision to an LCD—either in its entirety or any provision. An LCD can definitely throw a wrench into your revenue cycle management if it takes you by surprise. It’s imperative that your billing folks keep you abreast of any new LCDs or changes to an existing one. Just because something was medically necessary and being reimbursed, that doesn’t mean it will be in perpetuity.You want to make sure that your billers are checking the MAC website regularly. While it may seem that an LCD is merely a billing thing, that’s a very simplistic and largely incorrect view. LCDs have a direct impact on how you practice medicine. The more informed you are the easier it is to evaluate how an LCD effects your practice and can respond pre-emptively.Here is a list of the MACs: https://www.cms.gov/files/document/macs-state-jun-2021.pdfIf you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.  Be sure to join my FB group, The Private Medical Practice Academy. 
March 29, 2022

Supplying Your Practice: Should You Join A GPO

When you run a private practice, you become acutely aware of what supplies you need, think about where to procure them, and worry about prices. To start with, make a list of supplies that you everything you need:  drugs, syringes, gloves, paper for your exam table, cleaning supplies and more. Include how often you are using these supplies because we’ll need this info to figure out the quantities you need to order. You’ll want to develop an inventory system will help you track how often you use each item and when you need to reorder. Before I talk about where to buy supplies—buying  for your practice is no different than buying anything else. You need to comparison shop. There is tremendous variability in pricing. You can buy from individual vendors. Create an excel spreadsheet –put the item name in each row and the vendor in the column so that you can compare prices of vendors. You will also want to consider buying from a General Purchasing Organization (GPO).GPOs were endorsed by Congress as a means of lowering prices in the medical supply market with the expectation of lowering healthcare costs. But not all GPOs are equal.  You will want to shop GPOs. . How do GPOs source and negotiate prices for products and services? GPOs help source and negotiate prices for drugs, medical devices, and other products and services for healthcare providers.  GPOs don’t take own or take possession of the product. They are the middlemen. GPOs have increasingly been trying to differentiate themselves from one another by offering additional value-add services to further reduce costs or improve efficiencies.If GPOs are middlemen, how do they save healthcare providers money?It is simply an economy of scale issue. It takes time and effort fr a supplier to negotiate a price for every item it sells with every healthcare provider that wants to purchase that item. GPOs can decrease costs by lowering transaction costs and prices through joint negotiation. How much can I save with a GPO?GPOs can save providers 10% to 18%.How else can a GPO benefit me?As a small private practice, you may discover that it is difficult to obtain certain products at the scale you need them. Joining a GPO can help you procure the product because they have a steady inventory and a lower per unit cost on each order. GPOs pre-screen vendors to reduce the risk of working with a problematic supplier. GPOs also has access to more member reviews. You can save time and manpower because your staff doesn’t have to screen each vendor for every purchase. How to choose a GPO? You will need to vet any GPO that you want to join. Start by asking other medical practices that you know. There are many large national, regional and local GPOs. Combine that with the ability to join multiple GPOs, easily switch from one to another and the result is competition for members and greater incentives for providers. Can I belong to more than one GPO?In case I haven’t been clear enough, you can belong to more than one GPO. You can belong to multiple GPOs and still buy from individual vendors. How much does it cost to join a GPO? Some GPOs are free, some charge a membership fee. The membership costs usually pay for themselves after the first order so the fees should not be your defining consideration. If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, sign up for my newsletter at https://www.thepracticebuildingmd.com. and join my FB group, The Private Medical Practice Academy.
March 18, 2022

Tips for Staying on Schedule

There are two over-arching reasons for you to stay on time: patient satisfaction and to de-stress you.  I'll be the first to admit that staying on time can be a challenge. Here are some strategies that can help keep you on schedule. Get to clinic before your first scheduled patient. Preferably you get to clinic early. If you show up at 8 am, your first patient is at 8am and then you first need put out whatever this morning’s fire is, you start the day off behind and you will be all day long.  The other advantage to getting in early is to huddle with  your MA so that you have a game plan for potential bottlenecks. Create a block schedule. Train your scheduler the rules of the block schedule.  Communicate scheduling issues with your scheduler. If you have a patient that always takes more time, schedule them in a longer slot. Don't routinely double book. If it takes you 15 min to see a follow-up and you put 2 patients in every 15 min slot you will invariably run behind. There will be times that you have to double-book. Have a code so you don't double book one of those patients that always takes longer. When you enter the room, set an agenda by greeting the patient, and asking them what they are here for today. The better you define and manage the expectations of the visit, the greater the patient satisfaction.  Set the timer on your phone. The vibrating phone is a gentle reminder that  time is up. Have a plan with your MA-instant message, a knock on the door, a "call."Do your absolute best to not answer calls in the middle of clinic. Use HIPAA compliant email and text messaging for quick questions. If you must talk on the phone, set up a time—before patients, after patients or as a scheduled appointment. Have information about diseases and procedures ready to print during the visit. Discussing the patient handout(s) and then handing it to the patient at discharge with improve patient comprehension, decrease phone calls to your office and improve patient satisfaction and outcomes. Most EMRs have instant messaging. If yours doesn’t, install a HIPAA compliant instant messaging application. We all know how questions, unplanned tests and procedures can disrupt your otherwise perfectly flowing day. With instant messaging you can be in an EMR chart and have a separate window open for instant messages to communicate with your staff without leaving the room. Create a list of supplies that every exam room should be stocked with. Standardize your rooms by labeling the drawers and putting supplies in the same place in every room so you don’t have to search for things. Train your staff to check supplies and re-stock daily. Have a tray/cart stocked with supplies for  your most commonly performed procedures. Understand that most  “practice management emergencies” that occur during the day are not true emergencies.  Have a process for everything. Establish a chain of command for urgent questions. Huddle with staff before clinic and then check in after patients to identify  practice management issues.  If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.  Be sure to join my FB group, The Private Medical Practice Academy.
March 2, 2022

Strategies for Reducing After Hour Phone Calls

Recently, one of the members of The Private Medical Practice Academy told me that one of their biggest concerns about private practice is the number of after-hour patient phone calls. In order to reduce the volume of after-hour phone calls, you need to have a policy that implements these strategies.There will always be after-hour calls. Many of these are non-urgent calls related to issues that can be easily addressed during regular office hours.  The key is to implement strategies that help reduce after-hour call volume without sacrificing patient care. 1. Set up your phone system's phone treeWhen a patient calls after hours, your phone system should answer and give the patient a set of instructions. The message should start with, “If this is a medical emergency, please hang up and dial 911 or go to the nearest emergency room.” 2. Automate commonly requested informationYour after-hours message should include the information that patients are routinely looking for like your address, office hours, directions to the office, your fax number and your website URL. Mention your website multiple times during the message to direct patients to that site. The person recording this message must articulate clearly and speak slowly so. this automated message can be easily understood. 3. Divert non-clinical callsNon-clinical calls, including requests to change, cancel and schedule appointments, requests for medical records, and billing questions can account for a significant percentage of your after-hours calls. Set up a phone tree prompt that sends people to a voicemail box that the staff will answer during regular office hours. 4. Automate medication refillsIdeally, refills are timed to patient follow-ups. Have all refill requests come from the pharmacy. Adopt a policy of no refills on nights, weekends and holidays. Employ a phone tree prompt that sends patients to a voicemail box for non-urgent refill requests. 5.  Indicate that you may bill for non-urgent callsAnother strategy is to inform the caller that if they chose to contact the on-call provider, there will be a charge for the service. You can decide whether you want this to apply to all calls or only ones that are not urgent. You can also decide whether or not you actually want to drop a charge. 5. Instruct callers to hang up and dial the answering service directlyIf you are going to use an answering service, I would suggest having a pre-recorded message on your phone system that directs patients who still want to speak with the on-call provider to hang up and call the answering service directly. 6. Target high utilizersTrack your after-hours calls to know who’s calling you and you'll  likely  discover a handful of patients  make up the majority of calls. Even if you don’t want to bill everyone for after-hours phone calls,  you can send the high utilizers a letter informing them of a change in your office policy indicating that there will be a charge for after-hours services. 7. Differentiate patient versus consult callsIf your practice accepts consult calls from the ER or inpatient units, you will want to set up your after-hours phone tree to include a separate option for these calls. If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletterat https://www.thepracticebuildingmd.com.  And, be sure to join my FB group, The Private Medical Practice Academy. If you enjoy this podcast, please help spread the word and leave a review :)
February 15, 2022

The Private Medical Practice Academy

Learn the nuts and bolts of how to start, run and grow your own private medical practice. I'll also talk about how to leverage your practice by adding vertically-integrated services. Using the tips discussed in this podcast you will make more money and take better care of your patients.
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Host

Sandra Weitz

Sandra Weitz

Dr. Weitz is a fellowship-trained, board certified pain management specialist who started and ran a multidisciplinary, multimodality practice with 11 providers. She did a surgery internship, anesthesia residency and pain management fellowship at UCSF. Dr. Weitz stayed on faculty at UCSF as the Director of the Pain Service. After 5 years in academics, she grew frustrated with the red tape, lack of control and limited income potential.

Dr. Weitz recognized that the only way to control the quality of medicine she practiced and her financial potential was to start her own private practice. Dr. Weitz bought a lot and built a 25,000 square foot medical office building to house her clinic and multi-specialty ambulatory surgery center. Dr. Weitz started, ran and grew multiple horizontally and vertically integrated medical businesses related to her medical practice in order to improve patient satisfaction and outcomes as well as generate revenue. She has syndicated shares in businesses to other physicians, sold businesses to publicly traded companies and private equity.

Now, Dr. Weitz teaches other physicians how to start, run, grow and leverage their own private practices. Her goal is to teach physicians the business of medicine so that they can have successful, lucrative medical practices that can be leveraged into other related revenue streams. In addition to The Private Medical Practice Academy podcast, Dr. Weitz has a Facebook group, The Private Medical Practice Academy to provide a supportive community for physicians at all stages of the private practice success path. She also offers consulting through her Private Medical Practice Academy Membership and on a one-on-one basis.

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