 and the Co-Managing Member of Koehler Fitzgerald LLC, a law firm with a national practice. Christine leads the firm’s health care practice and is dedicated to assisting and defending plans and patients.

. As an ERISA/Employee Benefits compliance and planning attorney, Jack has over forty years of experience in human resources and plan sponsor leadership roles.

The Consolidated Appropriations Act, 2021, signed into law at the end of 2020, includes the “No Surprises Act” which prohibits hospitals and doctors from issuing surprise medical bills for certain health care services.

) took effect to protect health plan participants from surprise medical bills for emergency services as well as care received from out-of-network providers at an in-network facility. The NSA does not apply to out-of-network providers, except in emergencies.

The NSA includes open negotiation and independent dispute resolution (IDR) procedures for health plans and out-of-network health care facilities and providers to determine applicable payment rates.

Simple NSA compliance will increase employer-paid medical expenses and add to the cost of coverage. Transparency is expected to add to medical cost inflation by prompting both in-network and out-of-network providers to increase charges.

The NSA covers all privately insured people in employer-sponsored and individual and family health plans.

Plan administrators should understand about how this will change the administration of their plan with respect to non-network providers.

The best response is through an approach that is both strategic 

compliance oriented. A dual approach will minimize the compliance challenge, reduce the cost of coverage for both the employer and employees, and, at the same time, improve both the perceived and actual value of health coverage.

Even with greater transparency, significant price variations can still exist across hospitals and providers for standard procedures. To mitigate this, many self-funded health plans have adopted 

 (RBP) strategies. Designed to moderate excessive hospital costs, RBP establishes a benchmark fee schedule and payment ceiling instead of negotiating fees with a provider network. Plan administrators can benefit from the consistent application across all providers and health networks.

RBP is one of the fastest growing solutions in health benefits cost management. It brings stability to health care prices and point of purchase cost sharing by using Medicare reimbursement rates and other provider cost data to provide an objective cost baseline. This offers disciplined pricing - fair and rational reimbursement for providers.

The IDR process added by the NSA triggers a new risk for health plans that use RBP with a network of providers or plans that directly contract with providers and facilities.RBP may be subject to the IDR process where plans directly contract with facilities and providers. Self-funded plans should be aware of this risk. 

Providers may challenge RBP determinations even where the NSA doesn’t apply – such as for plans where there is no network of providers, where services are provided in a non-network facility, or by a non-network provider in a non-network facility. Where the NSA does apply, out-of-network providers who challenge the RBP determinations shift the risk for charges in excess of RBP from the participant to the plan sponsor.

The most effective way to address this legislation may be to adopt a pure RBP plan which will put the patient in the driver’s seat as a health care consumer. Pure RBP plans should remain unaffected by this rule. That’s because there are no out-of-network claims, nor is there any determination of a median in-network rate. Adopting a pure RBP plan that puts the patient in the driver’s seat as a health care consumer is the most effective way to respond to the legislation.

Just as important, deploying RBP may avoid unreasonable or excessive provider charges – potentially lowering both the cost of coverage (employer and employee contributions, over time) and employee point of purchase cost sharing (deductibles, copayment, coinsurance).


Today, plan sponsors, administrators and participants benefit from data insights through innovative software and tech-driven data analysis solutions. Real-time price information of the true cost of care enables engaged plan administrators and participants to make the most advantageous cost-benefit decisions. A tech-driven approach provides information and tools to better manage health care costs.

White paper offers guidance on No Surprises Act (NSA) for employer-sponsored health plan administrators: risks and opportunities

No Surprises Act: What Every Plan Sponsor Needs to Know

 serves as a valuable resource for employer-sponsored health plan administrators. It offers benefits professionals guidance regarding the NSA’s provisions and interim final rules – encouraging plan sponsors to respond with an approach that is both strategic and compliance oriented. A dual approach will minimize compliance challenges, reduce cost of coverage for both the employer and employees, and improve both the perceived and actual value of health coverage.

Articles

Transparency is expected to add to medical cost inflation by prompting both in-network and out-of-network providers to increase charges.

No Surprise Act – The best compliant, strategic approach for  employer-sponsored health plan administrators

Dhiren Patel is the Senior Vice President of Commercial at Pack Health, a Quest Diagnostics company. In this role, he oversees the organization’s medical affairs, marketing and commercial initiatives focused on empowering health plans, employers and life science organizations to provide virtual coaching services for individuals with complex chronic diseases. In addition to having a Doctor of Pharmacy (PharmD), Patel is a Certified Diabetes Educator.

Many Americans struggle with chronic conditions. In fact, the CDC estimates 6 in 10 U.S. adults have a chronic disease, and 4 in 10 have two or more. As the leading cause of death and disability and a driver of the nation’s more than $3.8 trillion in annual healthcare costs, four main risk factors have been identified for preventable chronic diseases: tobacco use, lack of physical activity, excessive alcohol use and poor nutrition.

Proper nutrition is extremely important in maintaining baseline health and reducing risk of chronic disease. A healthful diet can help people diagnosed with chronic conditions manage their diseases and prevent complications.

 Unfortunately, food insecurity threatens an ever-increasing number of communities across the country.Food insecurity has become a leading nutrition issue, with fifty million Americans (over fourteen percent) identifying as food insecure in 2013.

 Since then, that number has only grown, leading to a concerning amount of possible negative health consequences stemming from poor nutrition.

Research shows that those with unhealthy diets may have a relatively greater number of chronic conditions.

 Given this data, a core intervention strategy across all evidence-based treatment plans to prevent chronic disease includes the promotion of healthy lifestyle behaviors, including improved diet. In addition, it is estimated that programs designed to help patients meet basic nutritional needs can translate to $200 per month in healthcare savings per patient.

Moreover, increasing access to nutrition is essential in helping patients overcome unmet needs and keeping individuals engaged in their healthcare. Oftentimes, patients with poorer nutrition are less engaged, and research shows that adults experiencing food insecurity are significantly more likely than their food-secure counterparts to delay or forgo medical care because of cost concerns.

 Studies have also shown that patients who are more engaged with their providers are more proactive

, meaning they may be more likely to schedule check-ups, stay up to date on vaccines, and have testing done on schedule, likely leading to better health outcomes.

Given the obvious benefits of nutrition to health, should health plans incorporate nutritional and food access strategies into their services for members with chronic conditions? Based on our experience at Pack Health providing these services to health plans, the answer is yes, provided the strategy incorporates three key steps.

When members feel understood and supported by their health plan, we see much higher engagement. But patients who are food insecure are dealing with a host of issues, from mental health challenges to lack of access to technologies like telehealth. At Pack Health, we have learned that a one-size-fits-all approach does not work to improve food security and quality nutrition.

To that end, focusing on providing personalized services that meet patient needs is an important first step. As an example, some populations we work with require simple food delivery, while others need medically tailored meals with specific recipes. For some populations, directed spend cards are a better alternative. Yet one thing remains true across the board: programs designed to address food insecurity have the potential to change lives, preventing as many as 3.28 million cardiovascular events, 620,000 deaths, and 120,000 cases of diabetes.

Additionally, since access to technology can be a barrier, our tools exist solely through the phone – any phone, with no app required – and include individually tailored support resources delivered via text and email to ensure personalization of care. We meet members where they are and start with a simple conversation to assess need without pressure.

Still, removing barriers like access is only a start. As an example, providing food through grocery delivery services does not address the root causes of poor nutrition, which, for some, may stem from an educational issue. But the good news is that, with a little creativity, it is possible to educate and spur behavioral changes leading to better health.

For instance, we recently produced a program for a major health plan that coupled grocery and meal delivery services with nutrition education through digital health coaching via weekly one-on-one calls, texts and emails with our nutrition experts, generating an 86% overall program satisfaction rating.

One thing the process of delivering food to the insecure has taught us – especially throughout the COVID-19 pandemic – is that the process must be collaborative. Listening to patients and their individual experiences is an elemental first step. Here, trust and connection are critical, as well as finding an experienced coaching provider capable of executing against these three steps. When plans work with the right partners to deploy needed engagement options, screening tools or data collection, processes can be put in place to get resources to insecure communities sooner.

Encouraging health plans to adopt patient engagement tools and tools that address critical components of health like nutrition is vital to curbing costs and promoting a healthier world overall. Nutrition and health are so closely intertwined and must be treated as a priority for decision-makers. Employers, plans and all those who consider the health of at-risk populations to be important should reexamine the ways they might attempt to get patients engaged in their healthcare. By improving access to food and other related services, better health can be achieved for these populations – all it takes is making the first step.

Dhiren Patel is the Senior Vice President of Commercial at Pack Health, a Quest Diagnostics company. In this role, he oversees the organization’s medical affairs, marketing and commercial initiatives focused on empowering health plans, employers and life science organizations to provide virtual coaching services for individuals with complex chronic diseases. In addition to having a Doctor of Pharmacy (PharmD), Patel is a Certified Diabetes Educator. 

Willett WC, Koplan JP, Nugent R, et al. Prevention of Chronic Disease by Means of Diet and Lifestyle Changes. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006. Chapter 44. Available from: 

. Co-published by Oxford University Press, New York.

 Gundersen, C., & Ziliak, J. P. (2015). Food insecurity and health outcomes. Health Affairs, 34(11), 1830–1839. 

https://doi.org/10.1377/hlthaff.2015.0645

 Fanelli, S. M., Jonnalagadda, S. S., Pisegna, J. L., Kelly, O. J., Krok-Schoen, J. L., & Taylor, C. A. (2020). Poorer Diet Quality Observed Among US Adults With a Greater Number of Clinical Chronic Disease Risk Factors. Journal of primary care & community health, 11, 2150132720945898. 

 Seth A. Berkowitz et al., “Meal delivery programs reduce the use of costly health care in dually eligible Medicare and Medicaid beneficiaries,” 

, April 2018, Volume 37, Number 4, healthaffairs.org.

 Jaclyn Bertoldo, Julia A. Wolfson, Samantha M. Sundermeir, Jeffrey Edwards, Dustin Gibson, Smisha Agarwal, and Alain Labrique, 2022: Food Insecurity and Delayed or Forgone Medical Care During the COVID-19 Pandemic. American Journal of Public Health 112, 776_785, 

 Hibbard, J. H., &amp; Greene, J. (2013). What the evidence shows about patient activation: Better health outcomes and care experiences; fewer data on costs. Health Affairs, 32(2), 207–214. 

https://doi.org/10.1377/hlthaff.2012.1061

Lee, Y., Mozaffarian, D., Sy, S., Huang, Y., Liu, J., Wilde, P. E., Abrahams-Gessel, S., Jardim, T. de, Gaziano, T. A., & Micha, R. (2019). Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study. PLOS Medicine, 16(3). 

https://doi.org/10.1371/journal.pmed.1002761

A healthful diet can help people diagnosed with chronic conditions manage their diseases and prevent complications.

Food security is the missing link in managing chronic conditions

Wendy Dean, M.D., is a psychiatrist and the president and co-founder of Moral Injury of Healthcare.

The figurative ills of the nation are made manifest in our health care. COVID-19 has laid bare the fractures and injustices in the systems that serve people at their most vulnerable. It reveals that the financial framework of care depends inordinately on elective procedures and that a splintered, privatized health care system fares poorly when coordination is paramount.

Our collective failure to invest in public health and preparedness means the nation, as a whole, is unprepared for the coronavirus crisis. Everyone is at risk. But it exacts the highest tolls in places and populations already challenged by scarce resources and least able to protect themselves by isolating — low-income areas, those chronically underserved with social services and health care, and communities of color. For too many, these challenges overlap and compound one another.

Physicians watched the first wave approach, helpless to stop the devastation they read about in China and Italy. They were angry that the disparities and skewed priorities they had known and fought against for decades were putting individual patients and populations they care deeply about in serious danger. They are watching, helpless again, as the country opens up and unmasks, failing to heed the dire warnings sent mere weeks ago from overwhelmed hospitals in New York City, New Jersey and Seattle.

COVID-19 hit health care systems already in crisis. Nearly half of clinicians in the U.S. reported at least one symptom of distress last year. Trust had eroded between health care staff and organizations as financial constraints cut staffing, supplies and space to the bone; staff members were micromanaged and hypermonitored to drive optimum efficiency; and leadership offered tea carts, lunchtime yoga and mindfulness meditation as reparation.

Those offerings, though well intentioned, were often perceived as either performative or patronizing. The pandemic is highlighting the vulnerabilities in health care organizations, increasing tension with staff and sometimes devolving into painfully public breaks in decorum.

Resource constraints also foist unimaginable choices onto clinicians: How are scarce resources such as ICU beds or ventilators allocated? Such discussions are anathema to U.S. health care, and clinicians, therefore, are not well-versed in applying the principles. Most are not psychologically prepared to engage in those ethically charged decisions. Physicians are left taking responsibility for those exquisitely painful decisions alone.

At the same time, tens of thousands of physicians were sidelined as elective procedures shut down. Those clinicians struggled with what one called an identity crisis. How could their exceptional care, the dramatic improvements in quality of life they offered patients, be so readily abandoned? They struggled with the prospect of closing long-standing practices, furloughing staff and coping with personal financial devastation. The deep irony of health care workers facing job insecurity in the midst of a pandemic was not lost on them.

The language of clinician distress has shifted in recent years from burnout to moral injury, as clinicians have adopted a framework that better expresses their experience. Jonathan Shay, M.D., Ph.D., in his book “Achilles in Vietnam,” defines moral injury as a “betrayal of what’s right, by a person who holds legitimate authority in a high-stakes situation.” Shay’s definition applies to soldiers in combat, but the COVID-19 crisis neatly fits that definition and has propelled the adoption of the term, as evidenced by the crude metric of Google alerts. Those alerts have gone from an average of one or two articles several times a week to three to five articles nearly every day during the pandemic. Clearly, the concept of moral injury resonates in the context of COVID-19.

Clinicians are bombarded with daily evidence of brazen betrayal at every level — local, state and federal. Hospitals failed to heed warnings about the massive need for personal protective equipment (PPE). When those predictions came true and stores ran low, safety standards quickly shifted from optimum to minimum, and federal guidelines supported the shift. Clinicians wade into the breach without sufficient protection, even as their pay is cut, their protests gagged and their employment threatened and as they watch their colleagues and friends fall ill. No longer is there a question about the harm done to clinicians, patients and the nation at large by the financial framework of health care. The evidence is everywhere.

Now, in the wake of the response to the coronavirus’s proverbial shot across the bow, physicians are reckoning with all they have observed and experienced, personally or vicariously. They see what the virus can do firsthand, read the accounts or talk to doctor friends in epicenters. If they have not seen it yet, they know it is only a matter of time before they do. They are doing the hard work of integrating the risk posed by this virus with the cavalier disregard exhibited by too much of the public and too many public figures — yet more betrayal and moral injury on top of that already perpetrated.

They are struggling with a litany of losses — patients, colleagues, personal safety, job security — and the prospect that this may be just the beginning of a brutally long campaign. Ideally, this is an opportunity for leadership to recommit to doing the right things for staff and patients: ensuring enough PPE, providing professional support for psychological recovery, working together to address operational challenges and easing up on those who are in the thick of COVID-19 care. But, at the very least, most clinicians would happily trade hero worship for universal masking in public until this is truly over.

The pandemic hit a health care system — and physicians — already in crisis.

What COVID-19 reveals about physician moral injury

is the Director of Digital Media and Social Strategy for

One of the most crucial parts of providing medical care to patients is the initial development of an individualized care plan. This unique plan creates a framework to assess, diagnose, plan, implement and evaluate.

An effective practice social media marketing plan should be no different. In fact, much like the delivery of quality health care, implementing an effective social media campaign takes time and should follow best prescribed guidelines.

Throughout the marketing industry, there are 5 standard actions that are considered to be key elements for developing the groundwork of a successful social media plan.

First, and most importantly, is to listen.

 Much like you would listen to your patient, work to better understand what the current need is, what is working best and what the ultimate goal is. Also, it is important to also listen to what is not working well and is not resonating. By doing so, it will be much easier to take the necessary steps to make corrections.

 When recommending long-term approaches to health, a common practice is to encourage regular physical activity. The same goes for the health of a social media campaign. Frequent and regular activity will allow your content and posts to live up to their full potential and have the greatest impact.

 By developing and evaluating key performance indicators (KPIs), medical practices will be able to better track and measure the success of social media efforts against established benchmarks.

Fourth, stay informed on the latest breakthroughs.

 Do not rest on outdated or stale content. It is important to stay relevant and current on the latest news and timely information. This is important to achieve success with the various social media platform algorithms, as they continually analyze posts to decide what appears highest in newsfeeds.

 Connecting with your social media audience on a person-to-person level is a strong practice for creating trust and ultimately, ongoing engagement.

Whether your practice is focused on primary care, specialty care, or post-acute services, the above strategies are designed to withstand the test of time and deliver optimum results.

, located in Oradell New Jersey, has recognized the importance of a consistent social media plan to increase their brand awareness and assist in patient acquisition.

“We continue to see a high degree of engagement from our patients and referral sources that get to know us on a more personal level through our active social media presence,” said 

 CEO, New Jersey Brain and Spine. “Our social media activities are designed to show patients and potential patients what we believe in and who we are. Our content plan is designed to showcase the highest levels of expertise, conservative care plans and compassion that is at the core of what we offer.”

As a result of their social media strategy, New Jersey Brain and Spine has received 4.8 million total post impressions since implementation. In addition, the practice has earned a 52% increase in their Facebook page following.

Whether your practice’s social media goal is to help demonstrate a commitment to patients, showcase new services and capabilities, or simply present a more accessible side to your physicians and providers, your efforts do not need to be complicated.

 social media use by physicians continues to grow with younger females having the greatest online presence. However, surgeons and more tenured physicians were found to have an overall greater social media activity and often had a greater social following.

No matter your experience level or practice specialty, by following the plan and principles above, you will be well on your way to becoming a trusted and influential source of content to a healthcare hungry consumer audience. Remember, while having the right tactics is initially important, having the right mindset as you begin this marketing journey is what will best position your practice for success.

Social media should be a key part of your practice's marketing strategy.

Creating a social media care plan for your medical practice

Burnout has become as much a part of medicine as the stethoscope, with too many doctors feeling overworked, over-regulated, and underappreciated. The result is physicians retiring early, changing careers, or losing their love of medicine at a time when there is already a shortage of primary care physicians.

In the Medical Economics 2019 Physician Burnout Survey, 92 percent of respondents indicated they have felt burned out from practicing medicine at some point in their career, 68 percent said they are burned out right now, and 73 percent said they have thought about quitting medicine. Despite the prevalence and scope of the problem, only 13 percent plan to seek or have sought professional counseling.

Solutions are elusive, because the causes can vary by specialty, location, or practice, and doctors rarely have any control over contributing factors like regulations or EHR design. But that doesn’t mean all doctors have given up or are willing to tolerate the status quo. In fact, as burnout has become increasingly common among physicians, so, too, has the fight against it.

Here are the stories of seven health professionals and what they are doing to battle burnout in the profession.

Gabe Charbonneau, MDFamily Medicine, Stevensville, Montana

Gabe Charbonneau, MD, experienced burnout in 2009 when the demands of practice limited the time he and his wife, also a practicing physician, were able to spend with their new son. When the family grew to three kids, something had to change. His solution was to share a practice with his wife, so that one of them would always be at the practice while the other was with the kids.

“It was super scary, but the best decision we ever made,” says Charbonneau. “We gave up a massive amount of income and had to throw some material things overboard, but our quality of life went way up.”

From there, he began to think about how he could help other doctors fight burnout. “I met so many people who were intelligent, smart, and good doctors, but they were stuck with issues that were insurmountable,” says Charbonneau. “I had an idea that I needed to come up with something symbolic that would give hope to these smart people that they could get to a better place than where we were stuck.”

The result was an image of the Rod of Asclepius being lifted out of the ashes by a phoenix that he printed on a shirt and displayed on his website, fightburnout.org. The American Medical Association wrote an article about his efforts, interest in the shirts and the cause grew, and now he describes himself as “an accidental person who became an expert on burnout.”

He hopes that his efforts lead to greater awareness of the problem, and that employers will take a hard look at physician workloads and start indexing their burnout so they can measure progress-or lack thereof.

“Leaders often talk about well-being and burnout, but it doesn’t make it onto their financial spreadsheets,” he says. “They offer wellness classes and nice things that are supposed to be helpful, but there is no accountability for physician well-being. They can make a decision in the boardroom that can destroy their doctors, because they are chasing after every dollar.”

One proven solution for reducing burnout is to have physicians meet in a social setting outside of work to share experiences, where they can see they are not alone in their feelings and can share coping advice, he says. There is also a doctor-to-doctor peer support group on Facebook if no local group is available.

“I throw down the challenge that all of us need to start to help unravel this problem before we lose more good physicians and drive them out of medicine,” he says. “I know we can do better. As a society, we have to own this problem.”


Tyree Winters, DO, wanted to be a physician since he was five, with a great desire to help others. “But then you get out there and realize it can be a thankless job,” says Winters. “Even though you want to help people, sometimes as much as you do, it’s never enough.”

His loss of interest created an internal conflict: What do you do when you’ve wanted to be a physician your entire life only to achieve your goal and realize that maybe it wasn’t the best choice?

The breaking point came about five years ago. His mother had just passed away, and the next day, while trying to be both an administrator and filling in as a pediatrician, he diagnosed a child with a cold and offered the mother advice on basic care measures that would help. The mother was furious, telling him, “You don’t care about my child. You physicians don’t care about anything.”

“It was the perfect storm,” he says. “I was thinking to myself that I don’t want to do this anymore.” Winters accepted the fact that he was burned out and needed help, not only by seeking counsel, but also in identifying what his passion was. He found a different way to reach his dream of helping people.

“Even if I’m not seeing patients, I’m doing things like teaching and attending community events, using my medical degree to educate people to make an impact in their lives,” says Winters, who is medical director of the Healthstart Pediatric Clinic and associate program director of pediatric residency for Atlantic Health System. “That’s what motivated me to get over the feeling of burnout. I’m not immune to burnout, but I want to get up in the morning.”

Winters says medical students need to be educated on the challenges of being a physician and the risks of burnout. “They need to be able to seek help-not even professional counseling, but just surrounding themselves with individuals who are going through the same thing. There’s an unwritten rule where doctors are taught to believe if you are not able to handle things, then that’s a weakness. So people keep it to themselves and we need to get over that stigma.”

Winters says doctors don’t always recognize signs of burnout in themselves, such as apathy, or coping through alcohol or food. “They write it off as just having a bad day or just needing some sleep,” he says.

Physicians need to focus on what brings joy in their lives and find a way to escape from the rigors of their day. He recommends finding a couple of hours to do something that isn’t work-related, whether it’s exercising, binge-watching Netflix, or in his case, dancing.

“Doctors have to be able to step away and just live their life,” he says. “And don’t be afraid to be open and direct with your supervisor or department chair to tell them you are starting to feel burned out and that you are looking for advice. You might be surprised how a lot of institutions respond.”

ACP vice president for clinical education, Philadelphia

Smith leads the ACP’s efforts to demystify and build awareness about burnout, including how physicians can identify warning signs in themselves. “We need to fix the water clinicians are swimming in,” says Smith. “We know medical students are more resilient when they start medical school, but their risks increase as they complete their training.”

She says it’s important for doctors to recognize burnout in colleagues, because it can be contagious, spreading through an entire staff. “It is part of your responsibility to not only identify and address it when you see colleagues suffering, but to also help intervene and fix the overall culture.

“The overall causes of burnout are a workload where people keep adding more and more things to front-line clinicians, but nothing gets taken away,” says Smith.

Physicians should look for sudden changes in behavior in their colleagues as a warning sign that all is not well. “If someone who was outgoing and is now withdrawn, that can be an indicator,” says Smith. Missing meetings or conferences, or even not answering pages can also be a sign of potential burnout. Physical pain, difficulty sleeping, changing appetite or a crisis of confidence are other warning signs.

“They may have a lack of confidence in their work that comes from a sense of powerlessness because they can’t change things or make things better,” she says. “They may become more cynical, be quick to anger or have relationship problems or trouble getting along with family or friends.”

The ACP has resources on its website for physicians who feel burned out and has trained a cadre of 160 members around the country to fight burnout. “Our message is, don’t worry, you are not alone in this,” says Smith. “This is a common issue and a problem that everyone needs help with sometimes. We encourage them to reach out to a friend, a colleague or call their employee assistance line-whatever they feel comfortable with.”

In addition, the ACP is looking to patients as allies in fighting burnout. “The same things that bother doctors are bothering patients,” says Smith. “They want more time together. We think if we join forces with patients and patient advocacy groups to reform healthcare delivery, we might be successful.”

Internist and AMA practice transformation officer, Oak Park, Ill.

Brown says that many organizations are well intentioned when they set up mindfulness training or yoga classes for physicians, but that while such programs may be helpful in some regards, they can also contribute to burnout.

“Offering classes without fixing the working environment just sends the doctor home an hour later and exacerbates their time away from their family, and takes away time that could be used for exercise or sleep,” says Brown. “We also know burned out physicians write more prescriptions, send out more referrals, make more errors, order more tests, and have higher readmission rates. In every other profession, the higher the education level, the more control the person has over their day and the work they do, with the exception of physicians.”

Brown focuses much of her efforts on helping doctors find small solutions to free up more time. “They often say, ‘What can I do, I can’t fix the whole system?’” says Brown. “What I suggest is to begin by looking at their practice and the things they control.”

For example, Brown changed how she prescribes medication for chronically ill patients. It’s common to write a prescription for three months with one refill, so physicians are refilling the same prescription every six months. She suggests changing that to three months plus four refills, so that doctors are writing the prescription once per year. “If you do that, six months from now, the number of refills decreases by half,” says Brown. “With that extra hour, you can stop drowning long enough to see what else you can do.”

Another area to examine is the EHR. Brown says doctors need to look at all the notifications they are receiving. She turned off discharge summaries and notifications about tests that did not include results.

“I decreased my inbox by about 50 percent,” she says. “It doesn’t take any resources and doesn’t cost a lot of time. When you are at your wits end, this is something you can do tomorrow.” She also encourages physicians to seek peer-to-peer training on using their EHR more efficiently.
Whenever possible, make sure patients who require lab work have their labs completed before the visit. “That way when you see them, you’ll have everything you need to have a discussion,” says Brown.

“The greatest driver in preventing burnout is being able to deliver quality care, but there are so many obstacles that stop us from delivering it,” says Brown.

Urogynecologist, director of physician engagement, Rowan University School of Osteopathic Medicine, Stratford, NJ.

“If you do not have engaged physicians who have a vested interest in being there five years from now, you are not going to be able to provide a good patient experience,” says Adam S. Holzberg, DO, adding that healthcare organizations that want to improve their patient experience must tackle physician burnout. “Every study has shown that if you have engaged providers, the patient has a better experience and that results in better outcomes.”

Healthcare administrators must start by measuring burnout in their organization. They should do this by enlisting an outside company to survey the doctors, says Holzberg. “You have to be willing to then act on it and create an action plan,” he says.

Progress is possible when leaders take the time to listen. In a prior position, Holzberg helped move the physician engagement scores from the 24th percentile compared to the national average to the 73rd percentile in less than five years. “It wasn’t because we gave them so much more, we just listened to them,” says Holzberg. “We had good methods of communication.”

The organization created a blog to keep physicians up to date on changes. It included a way for doctors to make suggestions on how to improve working conditions. Doctors always got a response to their suggestions, even if they weren’t feasible. “You can say no with a good explanation-you would be surprised at how much they appreciate that compared to no response at all,” Holzberg says.

Listening is a great way to reduce burnout. “There’s not a lot that providers want,” says Holzberg. “They want to take care of patients, have a say in the plan for the organization, and have some recognition for what they do. They want to have the supplies and tools they need to do their jobs and do it without a lot of obstacles. If you pay attention to a lot of that, you will be surprised at how much difference it can make.”

Pulmonary/critical care fellow at Boston Medical Center



Swamy was a third-year medical resident working nights with two small children at home when burnout hit him. “I became very cynical and laughed about a lot of things-beyond the gallows humor physicians typically use to get by,” he says. “I was falling apart, getting less sleep, and I felt like I was failing with my patients and at home.” He says his work was becoming shoddy and he was being selfish and passing patients off to the next shift.

“It was unprofessional and a really bad spot for me,” he adds. “The big takeaway is, at the time, I could not have told you it was because I was burned out. I couldn’t recognize it in myself, and if I had done so, there were innumerable supports that could have helped.” When he rotated off that shift, his situation improved. Now, he advocates for doctors to look for signs of burnout in each other and to take action when they do.

He advises doctors who suspect a colleague might be heading for burnout to meet with them outside of work to discuss it. “Say, ‘Hey, is everything OK?’ or use other open-ended questions,” says Swamy. “You don’t have to say burnout, because people are often sensitive to that. They might be defensive in the moment, but it lays the groundwork to actually talk to them.”

Speak with them alone, he adds, and not from a position that implies they are unable to do their job. If there is no personal relationship, talk with someone who knows them better and tell them about your concerns. For residents, Swamy advises speaking to the chief resident, but choose your words carefully.

“There’s a big stigma speaking about mental health in medical culture, and burnout relates to that” says Swamy. “If you are in a world where you cannot show weakness and someone is very clearly suffering, the answer is not to go to their seniors and effectively say you think they are weak.

You never want to throw people under the bus.”

While he appreciates employers providing yoga or massages for physicians, those do not address the root causes of the problem. “I personally find a lot of wellness in running and doing yoga, but that doesn’t address the root cause of sitting in front of a computer going mad trying to click all the boxes.

“Burnout is a symptom of an incredibly broken healthcare system,” says Swamy. “It needs addressing, but the root causes are deep and pervasive."

How physicians fight burnout

Inga Shugalo is a health care industry analyst with Itransition.

Diverse medical software has already become essential for the efficient operation of any healthcare provider, be it a cross-state healthcare network or a small private practice. Though providers can probably make use of any type of 

, the financial resources they can invest in medical solutions differ significantly based on the type of practice.

There are numerous healthcare providers’ classifications. In this article, we use the one that divides providers into groups depending on the life cycle stage the clinic is at the given moment. According to this classification, medical providers fall into three groups:

Healthcare providers are business entities, so their life cycle, like that of any business, consists of the early stage or launch, growth, and maturity. At each stage, providers have different priorities and goals, and the choice of medical software solutions should be made accordingly.

The launch phase can be tough. At this stage, the profits are usually low and providers may even incur losses. Hence, they need tools that would enable efficient work at this point, such as an EHR solution, a patient scheduling tool, and billing software. Those tools can make a solid foundation for any clinical operation.

An EHR tool stores patient health data, including medical histories, lab data, and more. This information is paramount for accurate diagnostics. Scheduling solutions allow providers to coordinate patients’ appointments with clinicians’ schedules and the available rooms, thus preventing confusion and ensuring time- and cost-efficiency. Billing software automates billing and filing insurance claims and helps manage them. Such software can also inform users about upcoming deadlines on document submission or payments. With those solutions in place, a clinic can function properly and provide due treatment and care.

At the stage when the profits are stable, providers are aimed at increasing their customer base. This is when mobile technologies may be of help. As of 2021, 

 own a smartphone. This means that medical providers can consider integrating some engaging mobile apps in their practice. The experts recommend setting off with a mobile-friendly patient portal, as it allows providers to build strong relationships with their patients.

Using the portal, a patient can view, download, and send their health information to selected practitioners. They can also view and suggest edits to their treatment and medication plans, which improves their treatment adherence. While patients manage their health independently, doctors can always be around to supervise.

Experts recommend setting up a telemedicine solution after launching a portal. Telemedicine tools worked like life vests for medical providers during the pandemic outbreak, offering an opportunity to deliver care without virus exposure. Though the crisis is subsiding, telemedicine tools remain relevant. They can prove to be valid solutions for non-urgent care provision for busy professionals, chronic-condition patients, and people from remote and rural locations.

Medical software for well-established providers

At this stage, all clinical processes are up and running. However, their course is not always smooth and trouble-free, so there is a need for process optimization. Direct messaging solutions and speech recognition software can speed up clinical processes and even reduce clinicians’ burnout rate. According to a recent poll by 

 struggle with it. Curiously, it’s not the pandemic that is to blame here. Instead, the burdens are caused by the complexity of administrative tasks. So how can technology help reduce the burnout rate? Direct messaging solutions and speech recognition tools are relevant for this matter.

Direct messaging solutions ensure secure health data transmission across a private network run by a Health Information Service Provider (HISP). Healthcare providers use direct secure messaging to send referrals, transfer patient care plans, and communicate with patients. Such tools are HIPAA-compliant and support confidentiality of patient-doctor communication. Those tools save clinicians a lot of time and effort on secure data sharing.

As for speech recognition software, the tools transform speech into text, thus allowing clinicians to save time on tasks like taking patient notes.

Well-informed decision-making is often the key success factor in healthcare, and analytics solutions can bring this process to a new level. While such tools are optional for beginners, they are a game-changer for well-established providers. Analytical tools help improve health outcomes for diverse patient populations, speed up some operational aspects, and enhance the quality of medical research.

Today, medical software types are numerous, and each helps speed up or refine daily healthcare tasks. Unfortunately, deploying all necessary tools at once is hardly possible due to budget constraints providers typically face. Therefore, they need to select solutions meeting their goals at a given life cycle stage. Deploying the necessary tools at the right time helps make healthcare provision smooth and efficient without incurring unbearably high costs.

Selecting the best software can be the key to unlocking your practice's potential.

How to choose medical software for your practice

Renee Dowling is a compliance auditor at Sansum Clinic, LLC, in Santa Barbara, California.

Q:We are implementing a new policy to define new and established patients.Can you please refresh our understanding of how to determine this?

A:New patient codes carry higher relative value units (RVUs), and for that reason are consistently under the watchful eye of payers, who are quick to deny unsubstantiated claims.

According to the CPT codebook, a “new” patient is, “one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.”

Also, the Centers for Medicare & Medicaid Services (CMS) further defines a new patient in 

Medicare Claims Processing Manual, Chapter 12

An interpretation of a diagnostic test, reading an X-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.

So what do each of these key components mean?Let’s break it down.

:If the provider has never seen the patient face to face, a new patient code should be billed.

: The general rule to determine if a patient is “new” is that a previous, face-to-face service must have occurred at least three years from the date of service.

Different specialty/subspecialty within the same group

: This area causes the most confusion. For Medicare patients, you can use the National Provider Identifier (NPI) registry to see what specialty the physician’s taxonomy is registered under. For other payers, this usually is determined by the way the provider was credentialed.

If a doctor changes practices and takes his patients with him, the provider may want to bill the patient as new based on the new tax ID. This is incorrect. The tax ID does not matter. The provider has already seen these patients and has established a history. He cannot bill a new patient code just because he’s billing in a different group.

If a doctor of medicine (MD) or doctor of osteopathy sends a patient to a mid-level provider (i.e., nurse practitioner (NP) or physician assistant (PA)) and the visit does not fall under incident-to, the NP or PA should calculate new vs. established patient based on the specialty they are working in.If the MD is a family practice provider and the NP sees hematology patients, for example, the specialty is different and a new patient code can be billed. But if the NP is also considered family practice, it would not be appropriate to bill a new patient code.

If one provider is covering for another, the covering provider must bill the same code category that the “regular” provider would have billed, even if they are a different specialty. For example, a patient’s regular physician is on vacation, so she sees the internal medicine provider who is covering for the family practice doctor. The internist must bill an established patient code because that is what the family practice doctor would have billed.

Don't lose out on revenue by misidentifying patients.

Refresher:  How to determine new vs. established patient

Nance Goldstein, MDc, ACC, PhD, partners with physicians as a leadership coach to find ways through today’s tough times and enjoy medicine more.

Her evidence-based work enables physicians to sail through the challenges of influencing others to deliver excellent care. Her clients learn simple, quick ways to lead high quality, thriving care groups – one conversation at a time. She’s an Affiliate Faculty at AriadneLabs (Brigham & Womens Hospital and Harvard’s Chan School of Public Health), as well as a scholar at Brandeis University WSRC. 

https://www.linkedin.com/in/nancegoldstein/

, curates recent research and stories of physicians making medical practice better – leadership that honors their purpose 

 improves their experience of practicing.

Her podcast offers conversations with seasoned women MDs talking about how they navigated the competing demands of practice, family and the rest of life.

She’d like to hear what troubles you in your practice. Email her: 

MESSY MOMENT: What would make your GenY/millennial happier at work?

Millenials flaunting rules because they see a better/easier way

A junior MD enters the room of a patient who may have COVID. The MD has no PPE.

When asked about this, he says that the (experienced) overnight physician had probably ordered testing as a knee-jerk reaction. He says, based on his information, "all this stuff is really a waste of resources."

You must talk with this MD. What do you do?

You decide your own intention. Useful directions here include:

To understand others’ perspectives and to express that you value others’ Points-of-view

To find a way to speak meaningfully and supportively with the young MD to draw him into the care group and at same time to reduce his assumptions and ‘othering’ the older, overnight MD

To create a safe container for candid conversation, reprimand-free. So each feels heard and understood 

To promote a culture of learning where everyone learns from each other

Use multi-generation discussions to reveal assumptions and preferences for more productive relationships

Make every conversation multi-generational if at all possible so together you reveal and understand differences and identify commonalities – because both are critical

Ask everyone to re-consider their assumptions and judgments about others’ motivations. Ask: ‘What was the context last night?’

Ask ‘What could [each of you] have said or done differently so the hand-off fostered understanding?’

The younger MD may prefer an electronic note that includes the Why. The senior MD may prefer talking directly with the MD. Create a plan for next time. Together they may agree

That the probability of COVID was low, yet

It’s critical to follow precautions strictly until test results are known because everyone’s safety is vital. And discuss where they have choices.

In future they’ll meet in-person for 2 minutes to handover all patients or…

Each feels heard and validated. They have a real conversation, so it's easier next time. They build a foundation for collaboration.

What does this do for you and your practice?

Millenials (born between 1981 and 1996) are now half of all US nurses and a third of our MDs.

Young generations have a much higher share of people of color than each older generation. Most millennial physicians are women. That means that attitudes, assumptions and misunderstandings may be complex. Feeling safe and belonging to the care group become even more crucial when multiple sources of bias and exclusion are present.

Unsuccessful communication among generations is understandable. The generations were raised with differing values, priorities, cultures. Expectations of the job, the care group and themselves differ. Without exploring assumptions and communications styles, some in the practice will feel excluded and ignored. That is unacceptably costly. It triggers misunderstanding and mistakes that jeopardize patient outcomes safety. And younger people will leave – which takes a toll on everyone who remains.

Millenials want to be told the information they need candidly. They want to know what is expected of them. This critically helps them deal with medicine’s highly uncertain, complex and high stakes moments.

They want to be respected and to be listened to. This starts give-and-take relationships and dialogue that enable them to ask and learn while on the job.

This softens frictions and conflict so it’s a calmer place to work.

Respecting varied PoVs reduce burnout – theirs 

 yours. It replaces a harsh hierarchy telling them what to do.

Engaging everyone in the common mission unleashes their contributions and energy for patient care.

This can be done anywhere (though it helps if it’s quiet and focused) in a short time – rounding or after-shift huddles.

"There was no respect for youth when I was young, and now that I am old,

there is no respect for age - I missed it coming and going."

- John Priestly, Novelist and social commentator

Reducing generational tension among staff can make your practice run smoother.

Messy moments: Physicians productively address relational problems so that it’s better for everyone

Associate Editor for Medical Economics, Physicians Practice

With all the useful information available on Physicians Practice, it is easy to become overwhelmed.

With this in mind, the tip of the week is a chance to reflect on some of the wisdom found all across the site.

confidentiality and consent when treating minors,

“In the majority of treatment and disclosure of protected health information (PHI) scenarios, parents or legal guardians are entitled to provide informed consent for the treatment of the minor and may request the minor’s medical records. From both a legal and an ethical standpoint, informed consent is fundamental to medical treatment because of the value placed on a patient’s autonomy.”

Come back next week for another tip of the week!

Your weekly dose of wisdom from the Physicians Practice experts.

Practice tip of the week: Confidentiality and consent considerations when treating minors

What’s the difference between a highly successful practice and one that just gets by? Oftentimes, it comes down to focusing on a handful of key financial details. Physicians who institute best practices bring in more revenue and profit than those who do not, and this can be the difference between being successful and being out of business.

® 2021 Physician Report, only 11% of practice owners said they did better in 2020 than in 2019, while 46% said they were doing worse. The top reason listed was lost revenue and increased expenses due to COVID-19.

With patient volumes still below normal because of the pandemic, growing competition from urgent care centers and retail clinics and rising operating costs, experts say every dollar counts. Here are the five best financial strategies to boost a practice’s bottom line.

Practice leaders who want to succeed must track key performance indicators so they can identify opportunities for improvement, says Andrew Hajde, assistant director, association content, Medical Group Management Association. These indicators include physician productivity, accounts receivable, insurance claims, reimbursement, and denials. Other measurables might include compensation to staffing ratios, expense management, performance to budget, and patient satisfaction.

With that data, Hajde says practices can not only track their own performance over time, but also benchmark themselves against data from similar providers. (National data is available from MGMA and other sources.) “It gives them a bar to see if they’re doing well or if they have some opportunities for improvement in any of those areas,” Hajde says.

Practices need to take action to find the formula for success. “What are the other practices actually doing to get that patient engagement and quality rating and everything else?” asks Hajde. “I think that’s where it is critical to work with your peers across the country that are achieving those best practices via conferences, member communities with associations, and in researching, reading articles, podcasts or any way you can get in front of how people are achieving those things to bring to your practice.”

Naresh Rao, D.O., FAOASM, a private practice physician who is also the founder and CEO of MAX Sports Health Inc., says he and his private practice partners get a lot of useful information from talking to peers at conferences. He seeks out those who are also in private practice so they can compare strategies for tackling different challenges.

The most successful practices analyze their claims denials and take action to reduce them. “It’s really important to go and look at what denials are actually coming through from which payers, whether it is commercial payers or Medicare or Medicaid, and then look to see why they are happening,” says Hajde.

Physicians who institute best practices bring in more revenue and profit than those who do not, and this can be the difference between being successful and being out of business.