As you sit down with your physician partners, practice manager, and consultant(s) over the coming weeks to contemplate your direction for 2022, I thought it may be beneficial to offer a few pointers to help you along the way.

For starters, you should pause to reflect upon new competitors in your catchment area, as well as current competitors and new initiatives they are taking on. For physician practices, a competitive analysis is a means to assess who your competitors are, what value they provide, understanding strengths and weaknesses, and where your practice fits in. A good competitive analysis is a scouting report of the actual market terrain that your practice must navigate in order to be successful. While analyzing the competition is an essential component of your strategy, most medical practices don't conduct this type of analysis systematically enough. However, a thorough competitive analysis is indispensable.

Gather a list of your practice's competitors.

Most of the time, such a list is comprised of who your practice considers to be its chief competitors. However, there may be other healthcare organizations that indirectly compete with yours, perhaps ones outside of your catchment area that offer services such as telemedicine or niche treatment modalities that are aiming for the same patients.

You will also want to include information on healthcare entities that may be entering your market in the coming year. Once you have compiled the list, you can highlight those practices that will be the greatest challenge.

Analyze the competition's services in terms of features, value, and target patients.

How do they market them? How do patients see your competition? How do referring physicians view your competition?

Take an honest look at their offerings. Is your quality commensurate? Do you have similar offerings? What is the unique value you provide that competitors don't or can't? Emphasize these benefits in your marketing.

Compile a list of competitor strengths and weaknesses and remember to be objective.

You will not do your practice any good if you allow bias toward your own physicians, staff, and services to cloud your judgment. Try to see the competition's practice as though you were them. What makes their practice so great? If they are growing rapidly, what is it about their practice that's promoting that growth?

Observe how your competitors market themselves through advertising, collateral material, and physician liaisons.

You will have to go to many different sources to get a complete picture. It takes practice and a little shrewdness on your part to piece together a complete picture of strategies and objectives, so the use of a qualified consultant may be to your benefit. Focus on the facts, be persistent, and trust your intuition to help you.

Determine the current market demographics for your practice.

If the market is flat, then the competition for patients is likely to be fierce. Your practice will find itself scrambling to win market share. The outlook portion of your analysis may seem like forecasting, but it's really a measure of trends. By the time you've done most of your research, you'll have enough information to determine what the outlook really is.

By evaluating yourself against your competition, you'll likely find new ideas for your practice. While compiling a competitive analysis is an interesting piece of work, it can indeed be challenging. Consequently, you may want to seek the help of a healthcare consultant to guide you through this process. You'll learn a lot about your market and in the process become a more valuable resource for your patients and referring physicians.

From there, you will want to get into an abbreviated strategic planning process. That is, a timeline and list of objectives for what you plan to accomplish in 2022.

Strategic planning is an essential business activity; however, several common mistakes must be understood so that physician owners can guard against them. Pointing out these mistakes is not a criticism of the process but acknowledgement of improper implementation. Medical practice leaders must recognize both the benefits and the potential pitfalls of strategic planning because it is their responsibility to ensure that strategic planning is conducted properly to achieve the desired goals. Here are four of the most-common planning mistakes we find:

1. Attempting to forecast and dictate events too far into the future.

In part, this may result from the natural desire to believe we can control the future. It is a natural tendency to plan on the assumption that the future will merely be a linear continuation of present conditions, and we often underestimate the scope of changes in direction that may occur. Because we cannot anticipate the unexpected, we tend to believe it will not occur. In fact, most strategic plans are overcome by events much sooner than anticipated by practice leaders.

This is not a criticism of detailed strategic planning but of planning in more detail than the conditions warrant. This pitfall often stems from the natural desire to leave as little as possible to chance. In general, the less certain the situation, the less detail in which we can plan. However, the natural response to the anxiety of uncertainty is to plan in greater detail, to try to cover every possibility. This effort to plan in greater detail under conditions of uncertainty can generate even more detail. The result can be an extremely detailed strategic plan that does not survive the friction of the situation and that constricts effective action.

3. Tendency to use planning as a scripting process that tries to prescribe actions with precision.

When practice leaders fail to recognize the limits of foresight and control, the strategic plan can become a coercive and overly regulatory mechanism that restricts initiative and flexibility. The focus for staff members becomes meeting the requirements of the strategic plan rather than deciding and acting effectively.

4. Tendency for rigid planning methods to lead to inflexible thinking.

While strategic planning provides a disciplined framework for approaching problems, the danger is in taking that discipline to the extreme. It is natural to develop planning routines to streamline the strategic planning effort. In situations where planning activities must be performed repeatedly with little variation, it helps to have a well-rehearsed procedure already in place.

However, there are two dangers. The first lies in trying to reduce those aspects of strategic planning that require intuition and creativity to simple processes and procedures. Not only can these skills not be captured in procedures, but attempts to do so will necessarily restrict intuition and creativity. The second danger is that even where procedures are appropriate, they naturally tend to become rigid over time. This directly undermines the objective of strategic planning: enabling the organization to become more adaptable. Rigidity is one of the gravest negative characteristics of strategic planning and of strategic plans.

Strategic planning is one of the principal tools used to exercise operational control because it will help you to decide and act more effectively. Remember though, that strategic planning involves elements of both art and science, combining analysis and calculation with intuition, inspiration, and creativity. To plan well is to demonstrate imagination and not merely to apply mechanical procedures. Done well, strategic planning is an extremely valuable activity that greatly improves practice performance and is an effective use of time. Done poorly, it can be worse than irrelevant and a waste of valuable time. The fundamental challenge of strategic planning is to reconcile the tension between the desire for preparation and the need for flexibility in recognition of the uncertainty of the healthcare industry.

, a consultancy specializing in strategic healthcare initiatives for physician practices. His firm helps devise and implement strategies that will allow practices to remain competitive and solvent. E-mail him

Articles

Strategic planning involves elements of both art and science, combining analysis and calculation with intuition, inspiration, and creativity.

Planning your 2022 strategy

, JD, has practiced law exclusively in the areas of asset protection, risk management and wealth preservation for the last 16 years. He helps protect a national client base with more than $5 billion in personal assets, including several thousand physicians. He is a contributing author to multiple books for physicians and a frequent medical conference speaker and CME presenter. 

There are a number of recurring seasonal risks we provide updates and reminders on every year, like our recent look at 

 at the end of each year. Another one of those predictable seasonal risks is the traditional 

. In late 2020 much of the country was under varying degrees of COVID-19 lock-down and pandemic protocols, with a distant promise of vaccines and conditions that had healthcare professionals fighting for life and sanity.

After arguably the most stressful year in the practice lives of many providers and despite recurring surges in coronavirus cases and deaths across the U.S., the wide adoption of vaccines, and the loosening of restrictions on gatherings has many medical practice leaders and staff members ready for an in-person party again. HR leaders feel that 

 is a good way to blow off steam, help build team morale and connections between people who have been working remotely, and thank your team for everything they have done.

For those choosing to hold live events, maintaining covid safety standards need to be a significant consideration.

Make your expectations of safe conduct and requirements for attendance clear beforehand

, including issues like vaccination status, mask-usage for staff (and their guests) and make sure they are enforced in a uniform manner.

, it will help reduce the crowd size, minimize conflict over safety rules and keep the focus on the team, their achievements, and relationships.

 of the venue you use and if you are hosting pay attention to details like safe food and beverage handling that avoids buffets, passed appetizers, and other “shared-touch” items.

; outdoor is best, followed by locations that have open windows, patios or other partially open spaces that allow fresh air circulation followed by indoor spaces with high ceilings and ample spacing. This promotes a higher comfort level with your guests and may help encourage attendance if these details are shared with your invitation.

While some of these risks are altogether new or variations of more familiar ones, the more conventional risks haven’t gone away and some of them may be heightened by current stress levels, contentious social and political environments, and those who may feel they need to, “make up for lost time”. We’ve covered these issues before in 

, so here’s a short summary of some issues and risks to consider that will help ensure your holiday party remains, first and foremost, a safe and professional celebration. 

It’s optional, make that clear and don’t penalize, formally or otherwise, those who do not choose to participate.

Regardless of whether it’s live or virtual, make it inclusive of all faiths, physical abilities, and other individual sensitivities.

 of professional dress, conduct, speech, and behavior clear. They should match the standards enforced in your office during business hours.

Alcohol is not your friend and is the leading cause of issues at corporate events. Monitor and control consumption carefully. No open bar, self-service etc. If possible, use a 3rd party venue like a restaurant etc. that at least partially assumes the risk of alcohol service.

Feed your guests, it creates an activity that keeps them busy and should be considered 

Make it clear that those who need a ride home can rely on you to provide safe transportation home.

Consider your insurance requirements including general liability insurance coverage for onsite events at your office to any special coverage required for offsite events including those based around specific experiences, activities (e.g., escape room, trolley bar, outdoor experiences, etc.) or involving group travel.

Pay attention to the appropriateness of the activities, décor, games, music, and other details in light of all of the above qualifications.

Make it clear that rules apply to all in attendance, including owners and executives. 

If it’s not something that you’d want photographed, filmed and shared on social media, make sure it doesn’t happen.

, JD, has practiced law exclusively in the areas of asset protection, risk management and wealth preservation for the last 16 years. He helps protect a national client base with more than $5 billion in personal assets, including several thousand physicians. He is a contributing author to multiple books for physicians and a frequent medical conference speaker and CME presenter. Learn more at

Ready or not, office holiday parties are back this year. These are some of the risks that practice owners and leaders should manage to help ensure a stress-free holiday and a positive transition to the New Year. 

Managing office holiday party risks

Email is one of the top threat vectors for cyberattacks in healthcare, so security needs to be top of mind. Not only do data breaches create problems for healthcare organizations if a network is compromised, but they can also lead to trouble with the federal government.

Here are some of the top email cybersecurity tips for healthcare professionals. But first, let’s see how HIPAA plays in.

Understanding HIPAA and how it relates to cybersecurity

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a law that protects patient rights and privacy. The 

 establishes protected health information (PHI) security and compliance requirements, and the 

 defines the standards for protecting PHI in electronic form (ePHI).

Violating HIPAA can lead to significant fines and other costs. Some of the most common HIPAA violations include unauthorized access to or disclosure of PHI via successful email phishing attacks.

Even if you don’t get breached, not having the appropriate safeguards in place can also violate HIPAA if you send an email in plain text. Encrypting email prevents hackers from intercepting messages. It makes sure that the only eyes reading your correspondence belong to your intended recipient.

The Department of Health and Human Services (HHS) has left some HIPAA security requirements vague to allow organizations to choose safeguards that are best suited to their needs.

, the email encryption requirement is “addressable,” which means it only needs to be implemented if a risk assessment determines that it is needed for managing PHI risk. If PHI is transmitted electronically (like in an email), then it should be encrypted “whenever deemed appropriate.”

If covered entities determine that encryption is not the best course of action, they need to document their reasoning and implement an equivalent safeguard to protect PHI. However, there isn’t an alternative that is as effective as encryption, which means email encryption is de facto required.

Many email providers automatically encrypt their messages via Transport Layer Security (TLS) protocol. But not every email service supports encryption. 

Around 10% of email is transmitted in plain text

, you must look into a comprehensive email encryption solution that secures all outgoing messages both at rest and in transit.

The easier to use your email security systems, the better—people are prone to making mistakes. In fact, human error is the cause of 

, which is why continuous employee cybersecurity training is important.

Cybercriminals target healthcare providers with malicious emails containing malware. All it takes is one employee clicking on a link or opening an attachment for ransomware to infect your system.

How to recognize and block malicious emails

Hackers are often changing their methods, so employees need to be consistently updated on the latest security issues and how to prevent them. You can also test your team’s preparedness by sending a fake phishing email and seeing who clicks on it to make sure everyone is staying vigilant.

However, no matter how well trained your employees are, you can’t guarantee someone won’t make a mistake, which is why you need to employ robust inbound email security measures.

While you don’t need inbound email security to be HIPAA compliant, it certainly helps prevent data breaches. After all, healthcare providers are a big target for cybercrime due to the wealth of valuable data they store, vulnerable attack surfaces, and lax cybersecurity that is rampant within the field.

Cybercriminals rely on poor inbound email security and human error to infiltrate your system. They can lock you out of your network and affect your ability to treat patients or demand a ransom for the safe return of stolen data.

The HHS Office of Civil Rights (OCR) may conduct an investigation after a breach, which could lead to heavy fines and a corrective action plan if it finds you at fault.

Ultimately, it’s less expensive to implement inbound email security than to become a victim of a cybercrime.

The most significant security risk isn’t related to your IT system; it’s your employees who are prone to human error and falling victim to email scams. That’s why staff training is so crucial to preventing cyberattacks.

But no matter how much training you conduct, human error is unavoidable, which is why having robust inbound email security is a must for healthcare as well.

Even if your email supports encryption, your email will be delivered in plain text if your recipient doesn’t which is a HIPAA violation in and of itself. Be sure to add an additional layer of security before sharing ePHI via email with patients.

Cybersecurity best practices for email communications

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Direct pay medical practice models are sometimes confused with concierge care. But there are important differences to consider.

Direct Pay vs Concierge Practices

is the Educational Program Director and a CERTIFIED FINANCIAL PLANNER

 at MEDIQUS Asset Advisors, Inc. He specializes in wealth management solutions

The end of the year is a good time to check in on your financial plan to see if everything is on track or if some things need adjusting. You will be in a better position for 2022 the sooner these items are addressed and adjusted if they are off-track.

If you utilized your emergency fund at some point this year, it is important to make sure the account is replenished to appropriate levels. The general rule of thumb for appropriate emergency fund amounts is:

6 months if in a single income household.

A 6-month emergency fund is also recommended if one person earns significantly more than the other and their income is relied upon to maintain the family’s standard of living.

The contribution limit for 401(k)s and 403(b)s in 2021 is $19,500. The catchup contribution amount for those over age 50 is an additional $6,500. The deadline for making 401(k) and 403(b) contributions is 12/31/2021. The contribution limit for individual retirement accounts (IRAs) is $6,000 and an additional $1,000 for those over age 50. IRA contributions can be made up to the April 2022 tax filing deadline.

Use Money Saved in Flexible Spending Accounts (FSAs)

Utilizing a healthcare, dependent care, or limited purpose FSA is a great way to pay for certain services on a pre-tax basis. Be aware, most FSAs are use-it-or-lose-it accounts, meaning any money remaining at the end of the year gets forfeited back to the plan, not back to you. Some employers allow a $500 carryover to the following year or a grace period into the spring, but most do not.

The cost of college continues to rise. 529s provide tax-advantaged investment growth to assist with saving for post-high school educational opportunities like university, community college, trade schools, and apprenticeships. Many states offer considerable state income tax deductions for contributing to a 529. To receive a 2021 tax deduction, contributions must be made before 12/31/2021.

You can give up to $15,000 as an individual and $30,000 as a married couple to an unlimited number of people per year without having to pay gift tax. Making gifts can be an effective way of removing assets from an estate to avoid future estate taxes. To count for 2021, gifts must be made before year-end.

If you are hoping to get a tax deduction for donating to charity, those donations must be made by 12/31/2021 to count toward your 2021 taxes. However, to get a tax deduction, you may need to gift a significant amount to get above the standard deduction. Look to see if you have appreciated assets you could donate instead of cash. Donating appreciated assets from your taxable accounts allows you to avoid paying capital gains taxes when the investments are sold. The charity can sell the investments and avoid paying the taxes, and you get to claim a deduction for the full value of the donated investments.

Tax loss harvesting can be an effective tool to reduce taxes. If any investments in your taxable accounts have lost money, those investments can be sold, and the loss captured. This loss can then be used offset gains in other investments or potentially lower your 2021 tax bill. Up to $3,000 ($1,500 if you are married filing separately) of net capital losses can be deducted against ordinary income, self-employment income, and interest income. If you have captured losses above these amounts, the excess can be carried over to future years to offset gains or deduct against income. Tax loss harvesting must occur before 12/31/2021 to count towards 2021.

Major life events can result in a need to update your beneficiaries. If you got married, divorced, had a birth or death in the family, you may need to update the beneficiaries on your retirement accounts and life insurance policies. These events may also necessitate updating your Will and Power of Attorney documents. There is no deadline for these changes, but the sooner the better.

This list should give you a nice head start, but there are likely to be other items to check up on. Speak with your financial advisor and/or accountant to see if they recommend any additional strategies for the year. Doing so should put you on strong financial footing heading into 2022.

Jeff Witz, CFP® welcomes readers’ questions. He can be reached at 800-883-8555 or at 

200 North LaSalle Street - Suite 2300 - Chicago, Illinois 60601

312-419-3733 - Toll Free 800-883-8555 - Fax 312-332-4908 - www.mediqus.com

Investment advisory services offered through MEDIQUS Asset Advisors, Inc. Securities offered through Ausdal Financial Partners, Inc. Member FINRA/SIPC ∙ 5187 Utica Ridge Rd ∙ Davenport, IA 52807 ∙ 563-326-2064 ∙ MEDIQUS Asset Advisors and Ausdal Financial Partners, Inc. are independently owned and operated.

Effective June 21, 2005, newly issued Internal Revenue Service regulations require that certain types of written advice include a disclaimer. To the extent the preceding message contains written advice relating to a Federal tax issue, the written advice is not intended or written to be used, and it cannot be used by the recipient or any other taxpayer, for the purposes of avoiding Federal tax penalties, and was not written to support the promotion or marketing of the transaction or matters discussed herein.

The information contained in this report is for informational purposes only. Any calculations have been made using techniques we consider reliable but are not guaranteed. Please contact your tax advisor to review this information and to consult with them regarding any questions you may have with respect to this communication.

MEDIQUS Asset Advisors, Inc. does not provide tax, legal or accounting advice. This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, tax, legal or accounting advice. You should consult your own tax, legal and accounting advisors before engaging in any transaction.

Emergency funds, retirement accounts, and more. 

2021 year-end financial planning checklist

Employing non-physician practitioners (physician assistants, nurse practitioners, clinical nurse specialists, etc.) is an effective way to increase productivity in a physician office. However, under Medicare rules, covered services provided by non-physician practitioners (NPPs) are reimbursed at a reduced rate (85 percent of the fee schedule amount).

The “incident-to” billing rules provide an exception, allowing 100 percent reimbursement for non-physician services that meet the requirements detailed in the Medicare Benefit Policy Manual, Chapter 15, Section 60 (Services and Supplies Furnished Incident To a Physician’s/NPP’s Professional Service).

There are six basic requirements to meet the incident-to guidelines for Medicare payment:

The Basics of Incident-To billing

Services meeting all of the above requirements may be billed under the supervising physician’s NPI, as if the physician personally performed the service. Documentation should detail who performed the service, and that a supervising physician was in the office suite (although not necessarily the same room), at the time of the service.

Remember: Incident to applies only to Medicare. Further, the requirements do not apply to services with their own benefit category. Diagnostic tests, for example, are subject to their own coverage requirements. “Depending on the particular tests,” the Benefit Policy Manual explains, “the supervision requirement for diagnostic tests or other services may be more or less stringent than supervision requirements for services and supplies furnished incident to physician’s or other practitioner’s services.”

Similarly, pneumococcal, influenza, and hepatitis B vaccines do not need to meet incident to requirements. MLN Matters Number: SE0441 elaborates:

Must a supervising physician be physically present when flu shots, EKGs, Laboratory tests, or X-rays are performed in an office setting in order to be billed as “incident to” services?

These services have their own statutory benefit categories and are subject to the rules applicable to their specific category. They are not “incident to” services and the “incident to” rules do not apply.

Additional rules apply for incident to physician’s services in clinic, and services incident to a physician’s service to homebound patients under general physician supervision. These can be found in the 

Medicare Benefit Policy Manual, Chapter 15, Section 60

Here are six basic requirements to meet incident-to guidelines and get properly reimbursed for your care.

The Basics of Incident-To Billing

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