Serinus Health is the leader in Remote Patient Monitoring, RPM, from home. Enhanced Serinus’ RPM includes vitals monitoring and related Personalized Health Assessments for early detection of emergent risks. Serinus also secures effective patient engagement which drives medication compliance; and Serinus coordinates evidence-based timely health care upon any Vital or Assessment Alert.

This Case Study summarizes the outcomes and benefits observed over the last 2 years performing enhanced RPM: 1. better health outcomes; 2. substantial increase of physicians group revenues; and 3. significant reduction of ER/Hospitalizations expense.

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Remote Patient Monitoring Benefits Analysis

Below are the five states with the lowest physician salaries in 2019. 

5 states with lowest physician salaries in 2019

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Physicians in these five states made the lowest, on average, compared to their peers. 

Best states for physicians in 2020: 5 states with the lowest average physician salaries

Considerable and well-deserved attention has been paid to the mental health of those heroic frontline healthcare workers in hospitals and ERs caring for COVID-19 patients.

However, there are many other providers, like primary care physicians, internists, and specialists, as well as PAs, NPs, and RNs, who are also experiencing exceptionally high levels of depression, anxiety, and fear.

I study the influence of pressure on performance and how elite athletes, pilots, soldiers, and others in high-stress positions have learned how to mitigate its negative effects. My colleague at The University of Exeter in the U.K., 

, PhD, is a lecturer in nutrition with a background in studying the relationship between diet, physical activity, and health outcomes in nurses.

Overcoming telehealth reimbursement risks

Recognizing that all providers today need help coping with the COVID-19 crisis, we partnered with Dignity Health Global Education (DHGE) to create a one-hour micro-course called 

. Here are twelve steps that research tells us are vital to help providers manage the stress, depression, and anxiety associated with COVID-19.

 Science tells us that the most successful people in any profession are often the most positive. They work hard to keep doubts away and focus on their own development rather than comparing to others.

 Recognize that managing anxiety and worry during the current health crisis is going to be difficult. Prepare and plan for it. Set goals to manage your stress and anxiety and think around the barriers that may prevent you from sticking to them. Then, “just do it” — get going so your actions become a habit. Stick to your plan and remind yourself why you set specific goals.

 Mindfulness is the awareness that emerges through paying attention in the present moment, non-judgmentally, to the unfolding experience. To reflect on your own mindfulness status and habit, ask yourself where your mind goes when you stop and sit. While many of us reflect on the past, don’t spend time reliving old failures. Work to focus on the here and now (let that be one of your goals).

Treat yourself as you would a best friend.

 Doctors, who often set very high goals for themselves, can be their own worst enemies. However, compassion and kindness for oneself are vital during a crisis. Self-compassion is neither a show of indulgence nor complacency, but one of courage. When you limit self-judgment, you can perform to your greatest ability.

Be aware of your environment and feelings.

 Are you getting enough sleep, are you eating and hydrating well? Are you dealing with reality but focusing on how you react to what you can control? Remember that what we dwell on has a massive impact on how we interpret our external environment and react to it.

 are greater than perceived coping resources, we enter a threat state. If 

 are greater than perceived demands, we enter a challenge state. Challenge states (believing that we can cope) are associated with a range of positive outcomes (performance, emotional and psychophysiological). Keep this famous quote by Henry Ford in mind: “Whether you think you can or think you can’t, you’re right.” 

5 questions to ask about wRVU compensation

Aim to have a main meal before you go to work.

 Don’t rush; take a moment to relax. Avoid heavy foods that make you feel sluggish and remember that fresh is best.

 That means choosing nutrient-dense foods like complex carbs, lean protein, and lots of fruit and vegetables that are high in antioxidants.

 Small nutritious bites can provide energy and help you avoid feeling hungry between meals. Think cheese and whole-grain crackers, single-serve nuts, etc. And because we are in a COVID world, avoid snacks that require contact with your own and others’ hands, like sharing chips, pretzels, or whole fruits with peels.

—go for water whenever you can. Other options include no-sugar flavored water, milk, or fresh-squeezed juice. Avoid sodas, and products that contain high amounts of sugar and caffeine, as these impact sleep and increase irritability. Drink between 6 to 8 glasses (about 8 ounces) of fluid per day.

 When a pick-up is needed, it is OK to have a cup of java. However, know how much you are drinking. An average beverage from a coffee shop has 125 mg of caffeine; 300 mg is the recommended maximum daily intake. Anything higher, and you’ll run the risk of nervousness, high blood pressure, and insomnia—especially if taken close to bedtime.

Find an exercise you enjoy and make time to do it.

 Walking is a proven way to manage stress, especially if done in daylight hours. But other activities can be done as well. The key is, just as you eat, drink, and go to work, you must also make exercise a part of your routine.

While there is hope on the horizon, the COVID-19 crisis and its aftermath will continue for the foreseeable future. There will continue to be unprecedented challenges and uncertainties. However, we do know that to care for patients, you must first care for yourself physically and mentally. Follow the guidance you give those you care for, and remember to be mindful, positive, and most importantly, kind to yourself.

, PhD, is a Professor of Performance Psychology and Head of the Department of Sport and Health Sciences at the University of Exeter in the United Kingdom—one of the world’s top schools for the study of sports’ performance psychology.

It starts with mindfulness, nutrition, and exercise 

12 steps providers can adopt to better cope with the effects of COVID19

Maintaining the connection and awareness to the obesity problem is critical, Julia Wright MD said during our conversation. Here, she explains how telehealth is providing a new front in obesity treatment and weight management.

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How telehealth is providing a new front in obesity treatment and weight management.

Connecting and coaching weight management through telehealth

, a California-based health care management consulting firm.

If only resuming clinical operations during a pandemic were as simple as flipping a switch and welcoming patients back, health care providers across the country would be in a very different situation. The reality is more complicated, as COVID-19 has completely upended past outpatient clinical operations, requiring a “new normal” going forward.

As an outpatient health care leader, as you develop a plan for successfully resuming operations, you’ll need to answer many fundamental questions. How will I keep patients safe? How will I protect my staff? How many staff do I need? How can we leverage data to be nimbler and more responsive? 

 have published helpful guides on restarting non-emergency clinical care.

The reopening experiences of a high-volume outpatient clinic also provides several valuable lessons learned. In planning for and working through its business resumption, this clinic focused on three principal areas of importance: safely serving patients, ensuring staff safety, and resuming operations.

Patient safety was the top priority. The clinic quickly established a robust pre-screening process to keep individuals who may have been exposed to or experiencing symptoms of COVID-19 away from the outpatient setting, and triaged them to a COVID-19 screening center. The pre-screening also incorporated scripting that allowed the clinic’s staff to communicate to patients any changes that had been implemented to keep them safe within the clinic.

Initially this pre-screening process was entirely manual and involved the time of countless staff members. The clinic’s goal was to transition as much of this screening to digital as possible. A two-phased plan was developed to bring patient pre-screening online. After just six weeks, more than half of the clinic’s patient pre-screening was being done electronically. This freed time for clinical staff to do more work with patients in the clinic and spend greater time on the phone with patients who reported positive symptoms during the pre-screening process.

Understanding the importance of rapid communication to patients, the team quickly revamped an existing web site and repurposed it to provide critical patient updates. This included information on visitor restrictions, changed hours of operation and facility changes to maintain social distancing, as well as the clinic’s enhanced cleaning protocols.

Most critical in terms of patient safety were the changes the clinic made to scheduling, to ensure that patients did not overlap and that there would be ample time between appointments for cleaning of equipment and shared spaces. The clinic’s prior scheduling templates were modified and reduced by 30 percent, subsequently extending the clinic’s hours to accommodate a comparable volume of pre-COVID-19 volume.

Ramping up clinical capacity also meant thinking differently about doing everything possible to keep staff safe while also providing care. The same safety measures for patients were also applied to staff, such as requirements for mask-wearing and social distancing. For clinic staff, physical distancing proved the most challenging, as staff had previously worked in close proximity to one another. To counteract this, the clinic began staggering staff schedules and placed limits, based on office square footage, on the number of staff members in any one clinical area.

The clinic also established an all-staff screening program for exposure to COVID-19 and symptoms of COVID-19, similar to the one used for patients. The clinic is currently investigating the feasibility of both wide-spread and intermittent testing for all of its frontline workers.

While patient and staff safety were the clinic’s priorities, there was still a need to provide clinical care and resume revenue-generating activities. After severely minimizing its clinical activity to only the most urgent of patient cases, the department faced a significant backlog of outpatient appointments which had been cancelled. The combination of rescheduled appointments and new volume could not fit within the newly reduced capacity. The clinic began using patient visit data to determine appropriate staffing levels and created dashboards to project volumes and hours of operation required to match demand and revenue requirements.

With daily operational changes in the clinic a new norm, a cycle of daily huddles enabled staff members to assess what was working well and what needed to be changed. These daily huddles allowed staff members to respond more swiftly to quickly changing operational dynamics.

The clinic’s recovery continues, as its leaders foresee a lengthy uncertain future ahead. However, based on the clinic’s new emphasis on safety and communication, with data-driven metrics and dashboards guiding the way, the department has been able to successfully return to 80 percent of its prior daily patient volume.

How a high-volume clinic opened during the pandemic by planning for three principal areas of importance. 

A clinic’s lesson after opening during COVID19

Pediatric Endocrinologist at Texas Children’s Hospital

While health care professionals and patients are adjusting to telemedicine as the new normal during the COVID-19 pandemic, some chronic conditions are more complex than others to address digitally, and yet, continuation of care for these patients is essential. 

, nearly 1.5 million Americans are diagnosed with diabetes every year and cases are certainly not on pause during this global health crisis.

For those caring for people with diabetes, connecting regularly with this at-risk population is key to continued success of disease management, especially for newly diagnosed patients. Real-time continuous glucose monitoring (CGM) can make the process of transitioning to telemedicine significantly more seamless for providers and patients.

Real-time CGM systems use a small, wearable sensor and transmitter to continuously measure and send glucose levels wirelessly to a smart device or receiver, giving patients real-time glucose data without the need to prick their finger. The systems also offer customizable alerts and alarms to help avoid dangerous low and high blood sugar events, and a function that allows patients to share their glucose data instantaneously with up to 10 followers, including their caregivers. Additionally, real-time CGM systems, such as the Dexcom G6, connect to CGM data analysis software platforms that display clinically relevant glucose patterns and trends in interactive reports for healthcare providers. These reports help clinicians track remotely how patients are managing their diabetes and provide actionable data for optimizing diabetes treatment plans.

COVID-19 has amplified the need for telehealth, and telehealth has amplified the need for real-time, cloud-based health data so providers can continue with uninterrupted patient care. This virtual care model is here to stay, and now is the time for healthcare professionals to lean into emerging technologies like CGM, proven to help clinicians provide exceptional care in a remote environment.

The rule of seven and restarting your business

Real-time CGM systems provide people with diabetes’ and caregivers with real-time alerts for hypoglycemia and hyperglycemia, as well as seamless, remote access to key data such as time-in-range, daily glucose patterns, and time spent in hypoglycemia and hyperglycemia. These insights give clinicians information they would not be able to obtain otherwise–allowing them to identify patterns and make treatment adjustments, insulin dosing shifts, or lifestyle recommendations for the patient.

shares real-world evidence of how CGM devices and virtual check-ups are an effective approach for the management of patients with diabetes of all ages, even those newly diagnosed. Similarly, during the pandemic, hospitals across the country are looking for ways to remotely monitor diabetes patients who are hospitalized at higher rates and more prone to complications with COVID-19. Only a few weeks ago, the FDA made real-time CGM temporarily available for in-hospital use with COVID-19 patients where finger pricks were still the standard of care. Real-time CGM devices allow providers treating COVID-19 patients in inpatient settings to consistently and remotely monitor patient’s glucose levels, allowing them to quickly address concerns while also reducing staff exposure and preserving personal protective equipment.

In my own practice, we had just begun to offer telehealth services when the pandemic hit, and we were nimble enough to quickly evolve to a digital care model. We were able to establish clear procedures and processes to ensure visits with patients are personal and impactful. Appointments are conducted via our telehealth video platform to more easily share screens and information. CGM plays a critical role in this process to ensure we have the best data and insights on how each patient is managing their diabetes, including a glucose management indicator (GMI) to replace the traditional hemoglobin A1c (HbA1c), a measure typically taken in-person. By leveraging technology, we have been able to continue to see hundreds of diabetes patients remotely during this pandemic.

Even as health care facilities begin to reopen and in-person visits resume in staged approaches, healthcare providers should be thinking about the future of care and how to strategically use and benefit from technologies like CGM and virtual visits. The COVID-19 pandemic has made us reconsider the way in which we provide care, and technology has provided effective tools to help manage diseases remotely. Providers must be open and nimble, willing to jump into this digital age, leveraging all the tools in our toolbox to provide the best care for our patients. While we’re all anxiously awaiting the days when COVID-19 is behind us, an acute focus on telehealth and technologies like CGM that enable its effective implementation is a COVID-19 byproduct that should remain well beyond the end of the pandemic.

Continuation of care for chronic conditions is essential.

Healthcare technology shouldn’t disappear with COVID19 

Many physician practices have reopened and are trying to get back to “business as usual”. However, it is essential that physician practices take the time to review whether their employment agreements served them well during the pandemic, and what changes might be needed. This is especially important given that we may yet face a second wave of COVID-19.

Most physician employment contracts contain a provision requiring parties to a contract to agree to any modifications in writing. However, as a result of COVID-19, medical practices facing closures and forced service reductions found themselves in a dilemma. How could the practice afford to continue paying full compensation to physician employees with no/reduced revenue? It should be noted that although many physician practices received loans and grants as a result of the COVID-19 pandemic, most practices received inadequate support and the majority of employment decisions came before funding was even available.

Unfortunately, physician practices largely did not follow their written contracts when faced with the challenges of the pandemic. A lot of employers (including large institutions) unilaterally modified their contracts verbally, via email, or a written memo to all employees. Although most employees went along the proposed modifications, others sued their employers for breach of contract.

Understanding Management Services Organizations (MSOs)

Of those employers that complied with their contracts, most entered into proper written amendment with their physician employees. Where an agreement could not be reached by the parties, some employers provided notice of termination without cause and paid out the contract term. In other cases, giving notice to the employee brought the parties to the table and an agreement was ultimately reached. Unfortunately, there were some employers that summarily terminated employees who refused to sign amendments and still others who fabricated grounds for termination to avoid their obligations. These unscrupulous employers will likely face litigation as a result of their actions.

From the perspective of an employer, the world has changed. In order to be prepared, physician practices should consider the following updates to their written employment contracts:

Employers should give themselves the right to unilaterally modify compensation.

 It should be tied to certain events (such as a closure or reduction in services below a fixed amount), and all employees should be treated the same across the board. Employers should clarify when the reduction will end based on objective measures, such as a return to a certain volume of collections, patient volume or similar measurement. Offering a repayment plan to employees or a chance for employees to earn additional income is also a very welcome approach.

Employers should give themselves the right to terminate a contract more quickly when certain events occur, such as a closure of the practice or perhaps a reduction of practice volume below a certain amount.

 I prefer that termination not be immediate and that a reasonable notice period be provided, but lengthy without cause provisions (i.e 180 days) are inadvisable.

Employers may need to have the right to assign employees different hours and locations in the event of certain specific circumstances.

 I am always in favor of specificity in a contract as it relates to schedule/location in order to reflect the parties’ understanding; however, the pandemic made it clear that employers made need the right during a crisis to close locations and/or modify clinic hours, and thus the need for flexibility becomes key.

When COVID-19 hit, many physician practices elected to immediately terminate/furlough their physician employees without regard to what the written employment agreement required. It’s important to remember that a contract generally can only be terminated in accordance with its terms, so a physician practice that wants the ability to furlough its physicians or immediately lay them off must revise its contract to allow for such an approach. Again, I suggest the conditions when some provisions may be used be specifically described so as to make the contract as reasonable and fair as possible to both sides.

8 Ways to Play the Prior Authorization Game

Every physician practice must think about the challenges it faced (and may still be facing) during the pandemic and what contract provisions could be helpful. Practices should revise their contracts now with practical solutions for potential disaster that could occur in the future, whether related to health, natural disaster or even war. 

, JD, LLM has practiced in the area of regulatory and transactional healthcare law for more than 20 years. She represents physicians and other healthcare providers across the country in their day-to-day legal needs, including contract negotiations, sale transactions, and complex joint ventures. She also works with providers on a wide variety of compliance issues such as Stark Law, Anti-Kickback Statute, and HIPAA. Ericka has been writing for Physicians Practice since 2011.

Revise contracts now with practical solutions for potential disaster that could occur in the future.

Written employment contract updates for physician practices to consider in the wake of COVID19

In today’s world, technology is playing an unmatched role in every industry as well as in our daily lives. Of all of the industries that technology has positively impacted, healthcare remains to be the most significant one.

Worldwide Research and Development Spending Growth Rate in Medical Technology (

Medical technology is a comprehensive field where innovation plays a vital role in sustaining health. Areas like pharmaceuticals, biotechnology, medical devices and equipment, and information technology have all made notable contributions to ameliorating the health of people across the globe.

In this piece, we will be looking at a few technological innovations that physicians can incorporate within their practice to scale it up.

Keeping up with regulatory changes during COVID19

Physicians can involve themselves with their patients in a better way by leveraging patient engagement solutions such as 

 their practice. These platforms help physicians to stay in touch with critical patients, and both can exchange essential updates. The physician can also offer guidance for small ailments the patients face.

At the same time, patients can easily keep a track of their blood pressure, blood glucose level, physical activity, scheduled medicines, and so on. These features within the app not only help patients to maintain their health but also provide the physician with essential data whenever required in a hassle-free manner, further motivating physicians to achieve better patient outcomes.

The application of Artificial Intelligence (AI) is developing rapidly in healthcare.

Diagnostics is one of the many ways AI is transforming clinical care. Utilizing AI to detect data patterns that are comparatively difficult for humans to trace can provide a deeper understanding of certain diseases and new insights into their mechanism of progression. Beyond diagnosis, it will also enable personalization and evidence-based optimization of treatments within the physician’s practice.

Physicians can also use AI to examine their discussions with patients, take notes, and enter required information directly into 

. These applications will gather and study patient data, then present it to the physician.

Automating manual processes of a physician aids the administering of important patient information in an efficient, fast, and precise manner. By leveraging an integrated physician-patient workflow system, physicians gain benefits of both time and accuracy in the sharing of billing and other clinical information.

A few years down the line, the capabilities of EHRs to generate and extract data in as close to real time as possible will be reinforced further via new application programming interfaces and novel ways to harness data. This can optimize patient care in the clinical setting as practitioners get the information they need at just the right time in just the right setting and greatly reduce physician burnout.

Cloud computing is a robust solution that enables physicians to leverage a network of remotely accessible servers wherein they can store large troves of data in a secured manner.

, the global healthcare cloud computing market is anticipated to hit $35 billion in the next 2 years, with an annualized growth rate of 11.6%.

Physicians can now easily outsource data storage and security with HIPAA-compliant cloud storage platforms. These platforms provide data storage of patient EMRs that abides by legally mandated requirements for data privacy and security.

Remote patient monitoring solutions make patients active participants in maintaining their health. When your patients feel more empowered in the process of acquiring care, they will naturally become more invested in improving their health with your guidance.

 provides an excellent means for patients to share data with their physicians. These devices track things like exercise routines and sleep patterns, which have a significant effect on holistic wellbeing, but aren’t included in medical records.

With regular, remote updates provided willingly by patients, doctors will be able to see less congested waiting rooms, as well as improved patient health overall.

Scale up your practice with these innovations.

5 technical innovations for physician practices

Comorbidities that complicate an individual’s response and recovery to an infection of SARS-CoV-2 are still varied and relatively unknown. Julia Wright, MD, explains that obesity, like other chronic conditions, could be a factor for worsened disease and that individuals suffering from obesity should take extra precautions to limit factors of contagion.

Julia Wright, MD, explains that obesity, like other chronic conditions, could be a factor for worsened disease and that individuals suffering from obesity should take extra precautions to limit factors of contagion.

Obesity’s role in combating SARS-CoV-2

For many physician owners, their practice is like their child. As such, they invest the majority of their time and resources into ensuring the business stays healthy and has opportunities to grow and maximize its potential. Few focus on preparing for that inevitable moment in the future when they will have to hand their baby over to someone else.

 is a critical concern for a business of any size, it could literally be a matter of life or death for a physician practice. Physician-owned enterprises are particularly vulnerable because business discussions can be complicated or derailed by the emotions involved in addressing such difficult issues such as aging, death, and financial affairs. To ensure that the medical practice you worked so hard to build and nurture continues to thrive after retirement or death, you must develop a succession strategy that enables an orderly transition of both ownership interests and management responsibilities while minimizing complications between the partners. Additionally, your succession strategy must provide for economic support of all relevant parties involved.

 Your questions about liability insurance, answered

While there is no “one size fits all” succession planning solution, and the details will vary according to the distinct dynamics of your situation, the following are key considerations as you embark on developing a succession strategy:

 Ideally, it is best to begin this process as far in advance as possible. This will give you the opportunity to explore all of your options and prevent hasty decision making that can undermine the stability and value of the business. 

 This might be the most challenging aspect of this process for physician practices. As I have written about before, there are many considerations in the selection and grooming of a physician partner. You may have a physician in the practice that does not have the interest or skills to take over the practice. Therefore, to ensure that you place your practice in the best possible hands, I recommend making a rigorous and honest assessment of the relative strengths and weaknesses of all potential heirs. 

 in physician succession planning can be well worth your investment here. Engaging such an outside expert to conduct this analysis to help make objective and rational decisions regarding the best future interests of the practice and to de-emphasize emotional attachments (as well as any potential family politics) will ultimately be effective for the succession strategy.

It is also important to remember that management and ownership are not necessarily one and the same. Thus, it may be in the best interests of the practice to appoint an employee to take the business to the next level. Even if physician owners are not holding the business operations reins day-to-day, they will still retain an ownership interest and exercise the requisite level of control via various governance mechanisms (partnership meetings, executive control, voting shares, etc.).

the right legal structure for transferring your business.

 There can be significant financial implications and tax consequences with ownership changes. Furthermore, there are numerous legal methods for transferring your business. As a result, the experienced consultant you engage should be pulling in your accountant and attorney at the appropriate times so that together, the team can advise you on the correct direction and appropriate steps. No two medical practices are the same and you should be leery about professionals approaching you with any sort of template or preplanned outcome.

The best option for you and your business will indeed depend on a host of needs and circumstances particular to your practice. In the past, I have written on several transactional methods. Two common avenues are for physicians to 

 This creates cash for you to use as you ride off into the sunset. The sale would be based on fair market value (FMV) after a valuation is performed. Potential buyers include other physicians or practices, hospitals, or private equity-backed MSOs (management services organizations). Depending on how the sale is structured and what all is included, there could be various tax implications.

 prearranges the sale of the practice to another physician partner. This agreement enables you to maintain control until the occurrence of a triggering event that the agreement specifies. At that time, the buyer typically becomes obligated to purchase your remaining interests from you. There are many different ways that buy-sell agreements may be constructed and I cannot say I have ever seen two that are exactly the same, but this is a simplification of generally how they work.

 Though trimming expenses is always a key concern for physician practices, skimping on succession planning today can jeopardize financial security for you and your family and threaten the continued viability of the business you worked so hard to build. As you saw from the brief overview in this article, there are substantive complexities to managing this process. It is strongly recommended that you begin by contacting a seasoned consultant with experience in succession planning. As I mentioned above, that individual should be bringing in other professionals (i.e. attorney, accountant, financial advisor) throughout the process so that collectively a sound succession plan will be constructed.

Terminating the Physician-Patient Relationship

When you first begin working with the consultant, he/she should be devising a strategy based on your timelines. Some physician owners I work with want a rapid exit and thus we work to create a diligent plan that allows for such a departure from the practice. Other physician owners are looking at an exit some ten years from now. In those cases of a future planned exit, I recommend that the succession plan be updated every two or three years. There is so much change in the healthcare industry as well as local competitive factors and also internal physician partner dynamics, (not to mention any personal changes in your life), that a periodic review of the strategy is definitely warranted. Good luck! Your patients, referring physicians, and employees are counting on you to have a strategy to hand off the baton.

, 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

Four tips for ensuring a smooth transition of ownership interests and management responsibilities while minimizing partner complications.

Setting a succession strategy for physician practices

Senior Vice President, Office-Based Physicians at

While COVID-19 has presented challenges to every healthcare industry sector, physician practices have taken some of the most significant financial hits over the past few months. A recent Medical Group Management Association (MGMA) survey found that 97 percent of practices have experienced a negative financial impact 

directly or indirectly related to COVID-19

To recoup lost revenue, practices now face the challenge of re-engaging with patients and convincing them to schedule appointments and come back to the office. But when patients do decide to return, they’ll expect the same easy, contactless consumer experience they’ve been receiving during quarantine from companies such as Amazon, Netflix and Zoom.

During these uncertain times, it’s important to think strategically; many physician practices should consider working with partners who can help them identify solutions to ensure business continuity, while also addressing safety concerns and consumer needs. This article will specifically look at how an EHR-agnostic revenue cycle platform can drive substantial improvements to the patient financial experience and help physician practices operate effectively in the post COVID-19 world. 

5 states with the lowest physician salaries

An EHR system is a critical component of any healthcare organization’s infrastructure. In addition to digitally recording patient data—including medical history, treatment plans, and insurance information—it easily transfers this information between various providers versus relying on front desk staff to fax or email paper records. Similarly, it’s important to have digital alignment between a practice’s EHR system and an RCM platform to easily transfer patient data across the continuum of care, and ensure claims are billed correctly and collected efficiently on the back end.

Instead of trying to connect disjointed solutions across a patient’s care continuum, an EHR-agnostic revenue cycle platform has the technology, automation, and performance analytics needed to create standardized workflows that ensure full data transparency and a seamless exchange of information. This ensures timely reimbursement, lower denial rates and increased cash flow, while reducing operating costs since much of the traditional back and forth manual work is eliminated.

Interoperability between an EHR system and the revenue cycle offers major benefits to both physician practices and their patients, especially in our current environment. Embedding automated RCM workflows into a practice’s EHR system allows for faster hand-offs of patient information throughout the revenue cycle process. This reduces cost to collect, speeds up and ensures accuracy for patient payments, and allows practice staff to focus on more strategic tasks such as proactive patient outreach.

To increase volume and revenue in the coming months, practices need to get patients to schedule wellness checkups and appointments for elective procedures. Given that many practices will most likely be working with smaller teams, staff members need to focus on bringing business back into the practice versus keeping up with administrative work and billing procedures. Because EHR-agnostic revenue cycle platforms also offer digital patient experience solutions, it enables practices to send on-demand messaging via email or text. Practices can use these communication tools to remind patients to schedule appointments, utilize telehealth services, and notify patients of safety procedures implemented in response to COVID-19.

From a patient perspective, EHR-revenue cycle alignment delivers the optimal financial experience. It eliminates the need to fill out clipboards of information during each visit, and for patients to work with practice staff to receive medical records, fax them to different providers and then complete all new paperwork when referred to another specialist. Having a digital patient record that can be easily transferred through the revenue cycle process on the back end makes the financial and administrative aspect of receiving care much easier, which in turn encourages patients to schedule future appointments.

The digital patient experience solutions that are part of EHR-agnostic revenue cycle platforms also offer many patient-preferred capabilities. Tools like online/mobile self-scheduling and registration, self-service check-in, and online bill pay/automated payment plans help facilitate the convenient, user-friendly, and contactless experiences today’s consumers are looking for and expect—especially when factoring in COVID-19. If a patient knows they can easily schedule an appointment with little to no in-person interaction during the actual care experience, they will be much more likely to engage.

Marketing and promotion strategies for medical practices

It’s no secret that we’re operating in a different world as a result of COVID-19. To thrive in this new environment will require adopting new technology that allows consumers to receive services the way they want them. Being that it’s expensive to build, manage and maintain an effective revenue cycle platform in-house, the best approach is to work with an end-to-end revenue cycle partner that has experience integrating with existing EHR systems and knows how to effectively automate internal workflows to see the best results.

As practices work to determine where to go from here, they need to consider how revenue cycle transformation can help reduce administrative burdens, create better experiences for patients and most importantly improve financial health during this difficult time. Practices are already facing enough challenges coming out of COVID-19–don’t let an inefficient revenue cycle continue to be something that holds you back. Instead, take the first step toward being the cohesive, convenient provider patients want and need right now.

Align with consumer demands for optimal patient experiences and operational efficiencies.

Succeed with an EHR-agnostic revenue cycle platform post-COVID19

What are the best states for physicians to practice in? Find out in Physicians Practice Best States to Practice 2020 exclusive data project.

For our analysis, our editors ranked the states based on 2019 data covering five categories:

Tax climate (state collections per capita)

Physicians Practice obtained the data from publicly available sources and partner organizations.

 provided malpractice premium averages for each state.

Here’s a brief description of our methodology: We ranked each state on the criteria described desirable outcome per criteria, then averaging those scores resulted in the ranks of the states below and in other sequences in the slideshow series.

Below is a collection of the full ranking of all states and territories included in our 2020 analysis. 

Best States to Practice: 2020 Rankings

Here is the full 2020 ranking of all states and territories included in this years' analysis. 

The best states for physicians in 2020: The complete ranking

. They have succeeded in making the recovery of accounts receivable a profitable endeavor for more than four decades. Today, they use automation technology partnered with the experience of their attorneys and staff to seamlessly integrate with their clients; manage compliance in multiple jurisdictions; and collect for their clients. For more information, visit www.thefishmangroup.com or call (248) 353-4600.

Despite countless phone calls and emails, you’re still waiting on payment from a client, which can obviously be frustrating. Certainly, sympathy is called for when the client is going through a difficult situation, especially considering the times of crisis we’re living in now. But when you have people on your payroll and expensive equipment and materials to pay for, the survival of your firm can depend on the conversion of these accounts into cash. At a certain point, you have to concede that it’s not something you can handle on your own, and you send it a 3rd party collections firm. The most often pursued options are collection agencies and collection law firms, and the differences between the two are important to note in your consideration of your collection strategy. In terms of their success in pursuing collections and the exceptional caution they exercise in representing your practice, collection law firms prove to be a superior option for firms looking for third-party collections.

The differences between collection agencies and collection law firms mainly lie at the tools they have at their disposal in pursuing collection. Collection agencies tend to utilize persistence as their main tactic with debtors. They’ll call and ask for payment, and they tend to do so efficiently with sophisticated technological systems, but how productive can this be when you and your front office staff have done this on multiple occasions? They also have the option to place the debt on the debtor’s credit report. Again, this does not seem to be rather effective since the chances are that the debtor will already have multiple delinquent accounts and thus multiple creditors waiting for payment. In fact, about 

 have debt in collection, meaning that without an effective collections strategy, you’ll just be waiting in line behind other creditors for payment.

Collection law firms, on the other hand, have measures they can take in the legal realm to induce payment. The first call coming from an attorney representing you can indicate that you’re serious about receiving payment. From there, with your permission, the attorney can pursue a forbearance plan with the debtor, which would help both parties in avoiding the headache of going to court. However, if the individual is not complying with your efforts, the firm will file a lawsuit on your behalf and move to obtain a judgement in court. The judgement can be used to garnish wages, bank accounts, and tax returns; seize cars; lien property; and compel a debtor's appearance in court to satisfy a judgment. Collection agencies have the opportunity to use legal tools by contracting cases out to collection attorneys, and they sometimes do, but they often refuse to do so because it’ll mean that they’ll have to give up half their fee.

Another factor you must consider is which option will protect your firm from legal and ethical liability. Unfortunately, collection agencies have often been known for their legal errors and ethical transgressions, a reality that puts your firm at risk since they are acting on your behalf. Collection law firms understand the law and ensure they stay within its boundaries as they pursue payment on your behalf. They often even employ a compliance attorney in their office specifically dedicated to matters of liability. In these times where people’s ethical standards should be—and have been—heightened, you cannot afford blunders from those representing you.

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As time passes, your chances of collecting on a given account dwindles. In fact, on accounts that are more than 90 days overdue, the account is only worth 

. You really can’t afford to be slow to respond to this matter, as every day can count in the world of accounts receivable. Dealing with collections yourself can also be a serious burden on you, your staff, and operations, when you’d much rather be deploying your time and resources toward pursuing new clientele. Having a firm by your side you can rely not only to achieve superior results, but to also express proper legal caution and protect your firm’s image is critical. Collections law firms are more likely to deliver for you in collections and be a good steward of your reputation.

The differences between the two are important to note in your consideration of your collection strategy 

Collection Law Firms vs. Collection Agencies: What physicians need to consider

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Two recently unsealed False Claims Act cases involving violations of material federal requirements provide a glimpse into areas that physicians and providers should be evaluating for continued compliance.

“Medicare is generally required… (for services covered under Part A … [and] for services covered under Part B) to pay for services furnished by providers on the basis of reasonable costs … 42 C.F.R. § 413.1 (2014)” There are of course requirements that need to be met. For example, 

Medicare Conditions of Participation: Medical record services

 requires that a patient’s medical record include “[p]roperly executed informed consent forms for procedures and treatments specified by the medical staff, or by Federal or State law if applicable, to require written patient consent.” 42 C.F.R. § 482.24(c)(4)(v) (2012). Subsequently, the Centers for Medicare and Medicaid Services (“CMS”) interpreted this regulation in the 

CMS State Operations Manual, App’x A – Survey Protocol, Regulations and Interpretive Guidelines for Hospitals

, A-0466, Interpretive Guidelines §482.24(c)(4)(v), p. 289 (2018) (Rev. 95, effective Jun. 7, 2013) to mean 

“[a]n informed consent form, in order to be properly executed, must be consistent with hospital policies as well as applicable State and Federal law or regulation

The underlying principle of informed consent brings us to two recent False Claims Act (“FCA”) cases.

United States ex rel. Garrett v. Kootenai Hosp. Dist., No. 2:17-cv-00314-CWD (D. Idaho June 17, 2020).

The Relator alleged that six specific acts were legally fraudulent false claims, including: the defendant submitted claims to Medicare for services rendered at facilities misrepresented as “provider-based”; for services provided by non-physicians but billed under the Medicare Physician Fee Schedule; for inpatient admissions without physicians’ orders; for patients billed for co-payments in violation of the Emergency Medical Treatment and Labor Act; for claims with false diagnosis codes; and for patients whose rights Kootenai had violated. The U.S. District Court denied the defendants’ Motion to Dismiss. 

United States ex rel. Zaldonis v. University of Pittsburgh Medical Center et al.

, Case No. 2:19-cv-01220-MJH (W.D. Pa. Sept. 24, 2019).

 The allegations in this case stem from the defendants knowing failure to properly obtain informed consent from patients for surgeries, which led to the filing of false claims, which were filed with various government agencies, including CMS. The court has not yet ruled on a Motion to Dismiss.

Informed consent can only be obtained by a patient who has decision making capacity. As I indicated in a 2017 

 article, “[f]ederal regulations governing informed consent are known as the Common Rule and are found at 45 C.F.R. Part 46 (Subpart A).” Hence, it appears as though obtaining a patient’s informed consent is material to the federal government’s payment of claims. By way of analogy, this makes sense. For example, in 2019, Vanguard Healthcare, a nursing home chain headquartered in Tennessee, 

 with “the United States and Tennessee … that five Vanguard nursing facilities failed to administer medications as prescribed; failed to provide standard infection control, resulting in urinary tract infections and wound infections; failed to provide wound care as ordered; failed to take prophylactic measures to prevent pressure ulcers, such as turning and repositioning; used unnecessary physical restraints on residents; and failed to meet basic nutrition and hygiene requirements of residents.” The notion of applying unnecessary restraints on residents, especially in the emergency room setting where hospitals may be tempted to restrain patients against their will in order to bill for stabilization and treatment under the Emergency Medical Treatment and Labor Act (EMTALA). Additionally, like a nursing home, an acute care hospital may choose to provide substandard care in order to not have to deal with a patient and subsequently bill the patient for additional costs associated with the substandard care or worthless services. Either way, the two FCA cases are ones to watch, while simultaneously reviewing compliance with informed consent and other federal and state standards.

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, JD, MBA, advises clients on compliance and transactions in healthcare, cybersecurity, corporate and securities law, while representing plaintiffs in False Claims Act and Dodd-Frank whistleblower cases. She also teaches bioethics at

in Houston. Rachel can be reached through her website,

Two recently unveiled cases provide a glimpse into areas physicians and providers should be evaluating for continued compliance.