Senior Vice President of Clinical Services at Air Methods.

Many critical care clinicians won’t discuss what they do for a living to spare themselves the “shock and awe” conversation. When people hear I work in critical care or with pediatric patients, their response often is something like, “Oh wow, I could never do that” or “that must be hard, I don’t how you do it.”

During my time in critical care, I have done the unimaginable. I have seen children who were beaten by a family member to the point that they were brain dead and have still had to treat that family member with respect while they were in the room with the child they abused. I have placed intravenous lines into children, teens, and adults where you never thought a catheter could go. I have placed probes inside of toddlers’ skulls, given medication to sedate adults and teens who were unsafe to themselves, and have pushed so hard on patients’ chests doing CPR to save their lives that I cracked their ribs.

As a critical care worker, what you see daily, changes you. I’m hardly alone when it comes to these experiences. I come from a military family and I often compare the war zone I have encountered in critical care to war zones for soldiers.

Critical care clinicians are unsung heroes who go to battle every day, despite those patients we can’t save. What keeps us coming back are the ones we do save. 

Through the ups and downs in critical care medicine, one thing has remained the same: we are never alone. My team has always been by my side supporting me, teaching me, helping me, and sharing in the trauma of caring for complete strangers.

Build employee trust through effective communication

Nonetheless, critical care workers are all too human. Our constant exposure to pain, suffering, and death exacts a severe toll over time, even as we are conditioned to greet grief with a smile. Some studies indicate a relationship between the effects of cumulative grief in medical workers and profound stress and burnout.

The grief felt by critical care workers is manifested in many ways. Yet many may feel awkward expressing their grief, so they suffer in silence. Some even leave healthcare altogether.

How can clinical caregivers ease the corrosive effects of grief on their lives? We must start by consciously taking better care of ourselves, because self-care is the most proactive and responsible step we can take.

Here’s a list of simple but effective ways medical workers can reconnect with and replenish themselves:

Recognize that you need to rest, eat, exercise, etc.

Talk it out/express yourself to someone you trust

Make time to acknowledge the work you do day in and day out

Families, friends, and colleagues of clinicians struggling with grief also can help by acknowledging what they are going through and offering support. Indeed, talking with coworkers who understand these experiences and emotions is one of the most powerful strategies for clinicians to cope with grief.

I have never been prouder of where I work and who I work alongside. I will never find the words to express how much I respect my team and the work they do. My colleagues are amazing. 

What we have been through and continue to go through is a gift. To care for someone fighting for their life and to have an impact on that life is something none of us take lightly. There is so much heartache in critical care, but alongside that ache in your heart you smile to yourself knowing good things happen as well.

RVUs: The basics of physician compensation

So, when you hear where I work and what I do, when you cover your mouth in shock and say, “It takes a special person to work in a place like that,” I want you to know the truth.

It has been the most heart-wrenching and stressful job I have ever encountered through my 22 years in healthcare. It also has been the most rewarding, life-fulfilling and stimulating job I have ever had.

Stephanie Queen is senior vice president of clinical services at Air Methods.

Articles

Simple, effective ways medical workers can reconnect with and replenish themselves. 

You’re Not Alone: How clinicians deal with grief 

At MGMA’s Medical Practice Excellence Pathways Conference, Ronald D. Spoltore, executive board member of American Health Connection and Amy Lee, vice president and chief operating officer of Central Maine Medical Group, gave a presentation on how practices can ensure they are receiving a good return on investment (ROI) with their patient communication platforms, particularly call centers.

According to the presentation, communications management consists of scheduling/inbound functions (i.e., pre-registration, insurance verification, financial clarence, physician referrals, order capture/indexing, etc.) and outbound functions (i.e., post discharge follow-up, patient satisfaction surveys, appointment reminders, and pre-appointment/visit prep calls).

"Given the wide-spread adoption of technology and expansion of healthcare options, patients are rapidly becoming consumers of care rather than recipients,” the presenters said. “They will demand fundamental changes in Patient Communications processes”

Over the next two years, the presenters estimate, call centers will become more strategic to revenue growth as staffing demands and budgets increase, turnover rate exceeds 18%, advanced technologies increase in cost, facility costs become a premium, and salary/benefit costs rise to meet demand.

To leverage call centers in today’s virtual world, the presenter suggest practices improve productivity and increase effective use of resources, have overflow support, ensure after-hours and weekend availability in call centers, reduce abandoned calls received by the call centers, centralize functions, and eliminate variables.

Below are the ways the presenters suggest practices can measure the ROI of their patient communications.

Measuring the ROI of patient communications

Insights from MGMA’s Medical Practice Excellence Pathways Conference.

Matt Lambert, MD, is a practicing emergency medicine clinician and the Chief Medical Officer at 

. He has more than 20 years of experience as a clinician, CMIO, and change leader in value-based care — and is also the author of two healthcare books: 

Unrest Insured and Close to Change: Perspectives on Change

Healthcare for a Doctor, a Town, and a Country

As providers and payers invest in the move from volume to value, they are facing the reality that clinicians are lacking when it comes to training, education, and technology specific to enabling value-based care over fee-for-service. 

In order to succeed in this transition, practicing clinicians and emerging residents need hands-on support and investment to evolve, fast.

While there has been some discussion on specific ways providers and payers can best support clinicians in this care evolution today—such as offering them tools that are purpose-built for value-based care (aka, not the electronic health record) and even incentivizing these changes—the same cannot be said for clinicians in training. Similar to how we adopted E/M documentation during my own training all those years ago, upfront investment by systems and payers now can help prepare the next generation of clinicians to make value-driven care a reality.

As we approach graduation season for colleges and schools across the country, and inspired by my nephew’s recent graduation from pharmacy school, I have had the opportunity to reflect on a few specific areas where future clinicians can focus to ensure they are prepared to succeed in the next era of healthcare.

. While decisions specific to the residency match have always been difficult, they are becoming even more so today. Knowing that most academic institutions operate primarily in a fee-for-service world, prospective residents should consider how much training they might receive in value-driven best practices from their program.

Three ways nurse practitioners can advance their careers

Another area of focus for residents looking to better practice value-driven care is training in virtual care. Understanding and embracing rapidly evolving virtual care models is mission critical considering the increased role that telehealth will play in 

. Inpatient care will always be a crucial part of delivery, but taking care out of the hospital and to the patient is a trend to understand and prioritize. 

While many skill sets learned during residency apply to all models of care, there are areas of expertise that must be perfected specifically for virtual patient care like how to build patient trust and credibility when not face to face. Knowing the impact that residency training has on our practice patterns, getting smart on optimizing the patient care experience in a virtual environment is a skill best learned early on. Emerging clinicians who understand the nuances between in-person and virtual patient care will be well equipped to practice anytime, anywhere. We can expect the demand for these skills to grow over time with the evolving expectations of patients.

Five Telephone Etiquette Tips for Medical Practice Staff

Lastly, residents need to double down on learning clinical documentation and coding best practices that align with value-based care. Clinical documentation is increasingly becoming a team sport involving clinicians, CDI specialists, and coders. Along with new information-blocking and open notes regulations, patients and payers are part of the team; like any team sport, success is rooted in the team’s ability to communicate and work together. As providers and payers transition to a value or 

, they must ensure that they are arming their clinicians with the tools, coaching, and support to fine-tune this new collaborative documentation practice. Doing so will improve patient outcomes and ensure organizations are appropriately reimbursed for the quality and complexity of care their clinicians provide to patients.

Success in value-based care isn’t possible without the leadership and support of clinicians. The providers and payers that invest now in collaboration and preparation for clinicians and residents related to value-based care will be the organizations poised to lead and define the next generation of patient care. 

How do we guide the next generation of clinicians to prioritize value over volume?

Training clinicians and residents to succeed in value-based care

At MGMA’s Medical Practice Excellence Pathways Conference, Justin Chamblee, CPA and senior vice president of Coker Group, gave a presentation overviewing CMS’s 2021 Final Rule changes and exploring the impact these changes will have on wRVUs and physician compensation.

According to the presentation, some key changes to the 2021 Office / Outpatient E/M codes include:

History and exam no longer count toward code level

Level of service is based on time OR medical decision making

New prolonged care codes specifically for office/outpatient in 15- minute increments

New times associated with office E/M codes

Net increases in RVUs means that Medicare payments for E/M visits will increase in 2021, then fall in 2022 compared to 2021 levels, Chamblee said in his presentation. Furthermore, due to budget neutrality requirements, payments for other services will be reduced and, as a result, some specialties will experience reimbursement increases while others experience decreases

Specialties that focus on office visits are expected to experience the most significant positive impact. Specialties that are hospital-based or focus on procedures are expected to experience the most significant negative impact.

The table below lists how Chamblee has calculated each specialty may be effected.

Below are some tips from the presentation regarding what practices should do to prepare for these changes.

CMS 2021 Final Rule: What practices can do

When reviewing RVUs and collections to understand the impact of the 2021/2022 MFPS changes, Chamblee says practices should review:

Current production (wRVUs and professional collections)

Analyze the impact of the 2021 and anticipated 2022 MPFS changes using 2020 productivity

Compare 2020 to the estimated 2021 and 2022 results

Identify where changes can be made (generally TCC per wRVU) to mitigate the impact to physician compensation

Are you considering selling your medical practice to a larger healthcare system? Make sure you ask the right questions first.

Here are nine questions that can help reveal if becoming acquired and employed by a larger health system is the right move for you and your practice:

Questions to Ask Before Selling Your Practice to a Hospital

Here are nine questions that can help reveal if becoming acquired by a larger system is the right move for you and your practice.

Crypto currency is all the rage and continues to make some physician coin investors small fortunes even as prices swing widely and scams emerge. These are some basic defensive measures to keep your digital wallet safe.

One common bundle of myths about cryptocurrency is, “My coin is creditor proof because it’s secret and no can find it and only I have the key”. Here’s why that’s false and why you shouldn’t hold crypto currency, (or for that matter, 

 significant amount of non-qualified investment, savings, or other assets) in your own name:

Any strategy that relies on “secrecy” also relies on your willingness to commit “perjury” and lie about the existence or value of your holdings in a debtor’s exam, deposition, or similar sworn testimony

Any U.S. court that has jurisdiction over you and your assets can order you to tender the assets to satisfy a judgment, 

this includes access to your crypto wallet

Your crypto assets are discoverable through a variety of methods including your tax returns, where you have a legal 

 and that includes holdings you may be holding through an offshore trust, LLC or similar device. It has come to my attention that physicians have been targeted by marketing that pitches such schemes as 

being secret, tax free and creditor remote

One easy place I’d look for evidence that a debtor had crypto holdings: Their social media accounts. Most investors can’t stop talking about it, hyping their coin of choice up and being triggered by any negative news or comments about their magic beans.

Crypto assets held in your own name are subject to all your personal and professional liabilities, just like all your other liquid assets. As such, holding your coin through a properly structured legal entity that is legally distinct from your unrelated risks is best practice. Some commonly used holding structures include LLCs, Limited Partnerships, and irrevocable trust structures. Long term investors can also consider making their crypto holdings an “exempt’ asset by investing in them through qualified, and legally protected retirement plans including self-directed IRAs.

Are your crypto assets included in your estate plan?

Your estate plan should include your valuable digital assets including your crypto holdings. At a minimum, it should allow the trustee of your estate to identify, take control of, and manage those assets. Some of the basics your crypto estate plan should include are:

Access to your private key and passwords. If you die without providing access to this asset, it dies with you

What coin you bought, when you bought it, and the purchase price

How you are holding it, (i.e., in your own name in an LLC, etc.)

Details on the platform you are using to hold it, (i.e., using an exchange like Coinbase vs. holding it in an online wallet or offline, in physical device like a removable hard drive)

Any specific instructions or wishes on the management and distribution of the assets

Effectively manage medical practice staff

Think about physical and digital security issues

You may have seen horror stories about wallets ranging from thousands to 

 when a password is lost or physical device is lost, stolen or destroyed. If you are using a physical device, it should be stored in a water and fire-resistant document safe to protect it from basic, recurring risks like flood, fire, hurricane or burglary.

Make sure you understand the security differences in the basic ways you can hold coin. As a recent 

Despite being a digital currency, there are four different forms of storage for your Bitcoin to choose from: mobile wallets, desktop wallets, web-based wallets, and physical hardware that acts as a wallet”.

The report also advises that Bitcoin.org itself advises that you maintain two separate wallets, one with limited funds for trading and daily access referred to as a “hot” wallet and a secure, physical, offline “hot wallet” that’s stored in a safe and holds the bulk of your coin. The digital nature of purely online wallets means they are always vulnerable to online hacking and malware, so spreading your risk between several holding methods, including keeping the bulk of your holdings offline on a hardware device, is highly recommended.

, 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

The basics you should know to keep your coins safe.

Asset protection for physician crypto investors 

President of EGC Group and co-founder of 

A challenging year dealing with the COVID-19 pandemic brought about dramatic changes to the healthcare industry and the way physicians operate their practices. It was a year of deferred treatments, increased mental health cases, and substance abuse, coupled with the adoption of telehealth services, contactless waiting rooms, and new payment systems.

For many facilities, the pandemic exposed shortcomings in the patient/physician experience and served as a catalyst to speed-up many necessary changes to the industry that were destined to come eventually anyway. Forced to pivot, just as many industries did, the medical community now faces a post-pandemic normal in which many of these “temporary” advancements will become permanent parts of the way business is done going forward.

Still, there’s one area where many private healthcare practices have been slow to modernize—the marketing of their services through an online presence. The pandemic forced most of their patients onto the internet, to manage virtually every aspect of their lives, including healthcare, and they’ve gotten quite savvy about conducting business there. Has your practice kept up with that level of online sophistication? Will your practice’s website be able to effectively meet the new level of customer service expectations?

Managing a fluid online experience for patients is not generally an element in the typical physician’s wheelhouse, nor should it be. But contracting the services of a digital marketing agency— even simply identifying a marketing group your practice can easily integrate with—can be both costly and time-consuming.

Unfortunately, the marketplace that’s currently emerging in the post-pandemic world calls for even small and privately held businesses to develop a robust online presence - one that will retain existing customers and welcome new ones shopping around for a new practice.

While larger healthcare firms and hospitals can rely on externally sourced marketing teams or big-ticket software programs for their marketing prowess, recent advances in technology now make the same powerful set of marketing resources available to mid-sized practices.

Here’s how some of these practices are effectively managing their marketing efforts, quickly and at a cheaper cost than hiring a full-service agency:

How to make a great first impression at your medical practice

Only a few years ago, a medical practice’s website could readily handle providing customers the essential information about their facility: current services, staff of physicians, office hours and emergency contact numbers.

Today, however, Google and other major search engines have started giving customers as much information about the business as possible in their search results – without making that customer click over to the company’s main site. Suddenly, it becomes more important than ever that Google has accurate information about your practice so they can accommodate these “Zero Click Searches.”

The reality is these business listings are getting 2.7 more views than the practice’s actual websites (Raydeus / Yext).

One big issue with Zero Click Search is something that seems as straightforward as a business listing – location, hours, etc. is often mismanaged and can include outdated and incorrect information. This could easily actually damage your business’s credibility in search. Here are some related stats:

37% of businesses have an incorrect name in Google listings

56% of retailers haven’t claimed their Google My Business listing

When consumers come across inaccurate business information online, they immediately lose confidence in that business. It’s that simple.

Pre-pandemic, a practice would need marketing personnel or a robust software suite to update business listings across multiple channels —business information is often sourced from over 250 digital sources including Google My Business, Apple Maps, Waze, Bing, Yahoo, Yext, Facebook, and Uber—as well as many other sources most don’t consider such as Citysearch, Snap, ABLocal, etc.

But today, there are several emerging “Software as a service” (SaaS) platforms that manage all of these digital sources with one click so business information is seamlessly updated and consistent across all channels.

As voice assistants such as Siri, Alexa, and Google Home become both more popular and more powerful, voice search becomes increasingly important way customers can find your business. In fact, nearly 40 percent of all internet users in the US—a third of its total population—currently use voice search (eMarketer, 2019). The use of voice-enabled speakers is predicted to grow by over 130% in 2021 (credit, Yext 2020)

What does that mean to your medical practice? Today’s consumers expect search engines to literally understand them. Unlike traditional computer search that links keywords to a business website, these new voice-powered platforms allow customers to get direct, actionable answers no matter how they ask their questions. It’s time for your business to think about a voice strategy, just as you once developed an SEO or Keyword strategy for your landing page.

7 Financial Reports Your Practice Needs to Run

A practice that relies on customer traffic needs to know: what’s driving their phone inquiries, what their patients are saying in reviews and on social media about their experiences, and whether they are realizing an ROI on their marketing investment.

While there are independent software and service providers that focus on one or more of these aspects, they often cost tens of thousands per subscription. Alternatively, new SaaS marketing platforms provide a 360-degree marketing view for only about a $100/month, well within the reach of small and mid-sized practices looking to automate the marketing process.

The union of artificial intelligence and data are making a host of effective marketing tools both more accessible and more affordable to franchise and mid-sized business ventures. Business owners too often adopt a “set it and forget it” attitude towards their marketing efforts and online presence, but it’s time for them to move with the times and prepare themselves for the post-pandemic consumer surge. Fortunately, technical advances born from a year in lockdown have made the tools more widely available than ever before.

Nicole Penn is the president of EGC Group and co-founder of

Technical advances born from a year in lockdown have made the tools more widely available than ever before.

How to improve your practice’s online presence post-pandemic

Internal medicine physician and Senior Director, Clinical Knowledge - 

Podcasts

Physicians Practice® spoke with Chuck Lee, MD, about the complications of low patient health literacy levels and how physicians can improve these levels through communications, partnerships, and outreach.

Increasing health literacy levels in your patient populations

For a modern healthcare practice, patient communication on every level is a key factor in achieving good outcomes. There was a time in healthcare when practitioners could limit communication with patients, positioning themselves as experts who informed rather than collaborators who listened. There was a time when a quick conversation during a 15-minute appointment was considered sufficient opportunity for patients to ask questions and learn about their treatment plan.

Today, patient-centered care is essential to both patient satisfaction and health outcomes. That’s why an effective patient experience platform is an essential tool for the modern healthcare practice. Frequent communication, effective education, and continual patient engagement will improve patient satisfaction, staff efficiency, business growth, and health outcomes.

How to become a superstar practice manager

At the most foundational level, your practice’s use of technology should improve the patient experience. Features like being able to schedule online appointments and fill out intake forms online help streamline the patient experience. Convenient appointment reminder texts and emails help patients feel valued, and they also help patients stay engaged in their care, enabling them to easily confirm or reschedule if needed. Online onboarding and intake reduce wait times, enabling patients to spend less time in the waiting room and more time receiving care. Providing quick, convenient access to health information and personal health records enables patients to quickly view results of lab tests or get more information about a recent diagnosis, all of which increases patient knowledge and therefore 

A patient experience platform can also give patients an automatic opportunity to fill out a customer satisfaction survey or a 

 after their appointment. Including this as a standard part of a practice workflow demonstrates care what patients think and help improve their experience. Surveys and reviews provide a practitioner important data that can be used to improve patient satisfaction. Setting this as a standard for a practice recognizes the role of a patient as an evaluator of healthcare, which is a key concept in patient-centered care.

In addition, having a database of patient reviews readily available online provides transparency to new patients, giving them valuable information to make informed choices about their care. Over time, a database of positive patient reviews becomes a marketing tool for a growing practice.

Patient Experience Software Improves Staff Satisfaction 

Most healthcare practice staff spend hours per week on rote patient communication. Administrative tasks such as scheduling appointments, sending reminders, rescheduling no-shows, and sending invoices require significant staff time. Performing these tasks by hand adds no value as compared to automation, and it’s frustrating and time-consuming for staff. In addition, many practices have insufficient systems for tracking informal communication, resulting in even greater inefficiency.

A good software can automate much of the work of communicating with patients while maintaining personalization. Patient actions can trigger specific communications, allowing staff to focus their time on more interesting and complex customer care needs instead of rote administrative tasks. A patient experience platform can also maintain automatic, instant records of every patient communication, ensuring seamless transition among different staff members.

For providers, too, a patient experience software can streamline care in a variety of ways. Features like digital contactless charting help providers spend less time tracking information and more time caring for patients. When communication is fully integrated with EHR, a provider can see everything about a patient—from healthcare records to recent conversations—at a glance, giving providers more detailed information about patients and enabling more efficiency, higher satisfaction, improved communication, and better care.

A Good Patient Experience Grows a Healthcare Practice

Gaining new patients and retaining existing ones is another key benefit of a powerful patient experience platform. Because it makes communication personalized, easy, and seamless, software can enable a practice to implement new marketing initiatives with little effort. Built-in email features enable quickly creating and sending a newsletter that includes personalized information for each patient. Refer-a-friend features help a practice grow organically by referral. And, as mentioned above, inviting patients to fill out online reviews helps build a positive reputation for a practice.

But there are two ways to grow a practice. The first is by gaining new patients; the second is by increasing care for existing patients. The patient experience is especially valuable for the second type of growth. Many existing patients don’t seek care as frequently as they should, especially in primary care practices. Automated reminders are a powerful tool for encouraging patients to schedule an appointment, which many patients put off when they feel healthy.

Calculating the Right Number of Staff for Your Medical Practice

Patient Experience Improves Health Outcomes

Finally, a patient experience platform can help improve overall outcomes for a practice and its patients. Software tools accomplish this through a variety of paths.

First, and perhaps most importantly, it improves outcomes by improving patient involvement and education. Software tools accomplish this by providing opportunities for communication that are personalized and targeted, without requiring undo administrative effort from the practice provider and staff.

For example, imagine a patient who is overdue for his annual checkup with his primary provider, and who has also been experiencing minor concerns related to a chronic condition. Since he doesn’t currently feel any urgency to solve a health problem, this patient is likely to delay scheduling an appointment until the minor problems become more serious. Conversely, software could send him an automated text reminder to schedule his checkup.

This patient would be likely to schedule his appointment with just a text reminder. But what if the system went even further, and included in the text a link that he could click to ask a question of his doctor? Clicking the link could enable him to immediately ask a question about the concerns he’s experiencing and receive a quick answer, enabling the doctor to assess whether the patient needs an earlier appointment or needs to take additional actions first. By providing convenient, quick communication tools

 patient experience software enables a patient to be more active, informed, and knowledgeable about their health and healthcare needs.

For a private practice, implementing a patient experience tool can improve marketing, increase efficiency, and boost patient satisfaction. It can also exponentially improve a provider’s ability to communicate with patients to help them better understand their health, know more about their care, and be more involved in making decisions about their care. Software is a powerful tool for provider-patient collaboration, which is one of the most important factors for determining outcomes in every area of health. That’s why a patient experience platform is such an essential tool for every healthcare provider who wants to offer effective, quality care.

Lisa C. Baker is a freelance writer, consultant for 

Software is a powerful tool for provider-patient collaboration, which is one of the most important factors for determining outcomes in every area of health.

Patient Experience Software: Advantageous for everyone

In this video: Dr. Janis Coffin, DO, discusses how she has witness telehealth adoption change over the course of the pandemic.

Videos

How telehealth adoption has changed over the course of the pandemic.