, the chief medical officer at Kyruus, discusses how data consistence will allow providers to thrive as virtual abilities increase in demand from patients and change internal processes and workflows.

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How data consistence will allow providers to thrive.

Provider data management will increase virtual care viability

. He has more than two decades of experience in digital marketing, having helped thousands of small businesses grow their online presence.

Have you thought about what it is like for a new patient that discovers your practice and chooses you as a provider? The patient journey is the entire sequence of events that your patient experiences. By putting yourself in their shoes at each step in the process, you can start to design an experience that will generate more happy, healthy patients for your practice.

Goodwill: How it factors into a medical practice sale

A patient’s journey begins when they first discover they have a problem and begin to conduct research. They may speak to friends and family, but more than likely they will begin their search for answers online.

Think about the types of symptoms and problems that your patients are likely searching for and then develop content pages for the most common problems. Web pages should include background on the symptom, links to authority resources, and ideally a related video. Being discovered during the research phase will position you as a trusted expert early in the patient journey.

As patients become more educated on their symptoms, they will begin to seek out providers to help. In this stage, it is important to have pages on your site that are specific to the service that you provide. For example, if you have a physical therapy practice you will want to ensure that you have a page on your website with content that speaks to what makes your practice different from the competition and that this page is properly optimized for search engines.

Positive online reviews play a significant role in the decision process, which is why it is critical to have an online reputation management program in place. 

 using online reviews to evaluate providers and 

 say they trust reviews as much as personal recommendations. After a visit or a defined number of visits, send a follow up email and text message with a link to your 

How difficult is it to find your practices contact information on your website? What happens when a patient contacts your practice to schedule an appointment? When making healthcare decisions, consumers prefer convenience and access even above insurance coverage and quality of care. 80% of patients said they would switch practices for convenience purposes alone, according to 

68% of patients surveyed say they are more likely to choose a practice that offers the ability to book online. Online scheduling can lead to an increase in new appointment requests, and when paired with appointment confirmation and reminder emails, it often leads to less no-shows.

When a patient is scheduled for a visit, how do they complete registration paperwork and sign important documents? Minimize wait times by allowing patients to pre-register online. When a patient receives their appointment confirmation, include a link to an online form where patients can enter demographic information, insurance medical history, and sign documents. Due to the sensitive nature of healthcare information, intake software will need to be HIPAA compliant.

Could the 529 be the holy grail of asset protection?

When someone visits your practice what is their first impression? The waiting room experience and your front desk staff interactions play a major role in how quality of care will be perceived. Long wait times, a lack of privacy, and uncomfortable surroundings are all common complaints.

Actual wait times are not as important as perception of wait times. You can help patients feel more connected to their care by offering free WIFI and directing them to helpful educational content on your website in the form of articles and videos. For patients who did not pre-register you can offer tablets or direct them to online registration forms.

What happens after a patient visits your practice is just as important as the activities leading up to a visit. Patients should receive an email thanking them for a visit and a survey to gauge their satisfaction. A best practice is to use a 1-10 rating scale, with 9-10 considered promoters, 7-8 considered passive, and 0 to 6 considered detractors. This is known as a Net Promoter Score and is a widely accepted measure of consumer satisfaction. Any promoters should be directed to your Google Review page.

A patient portal is a secure online website or mobile app that gives patients 24/7 access to their health information. You can utilize a portal to send HIPAA compliant, secure messages or test results to your patients. Portals can also be used as a way to accept outstanding payments and to send payment reminders.

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Their journey begins long before entering your practice.

Building the optimal digital patient journey

, the chief medical officer at Kyruus, discusses what independent practices need to consider when implementing newer virtual care offerings into their preexisting care workflows.

What independent practices need to consider when implementing newer virtual care.

How practices can integrate virtual care into preexisting, in-person care

, 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 Baylor College of Medicine in Houston. Rachel can be reached through her website, 

It is no secret that fraud associated with the Provider Relief Fund (PRF) and Paycheck Protection Program (PPP) is a priority for the U.S. Department of Justice (DOJ). With the impending reporting period upon providers, this article highlights the current status of Reporting Period 1 and relays some recent enforcement actions.

Why the revenue cycle is vital to exceeding patient expectations and driving financial performance

First, providers who received PRF monies are required to complete and submit reports. Although the September 30, 2021 Reporting Period 1 deadline remains unchanged, a 60-day Grace Period is in place. According to the 

Health Resources & Services Administration (HRSA) website

, here are the latest items that providers for which providers need to be aware:

While you will be out of compliance if you do not submit your report by September 30, 2021, recoupment or other enforcement actions will not be initiated during the 60-day grace period (October 1 – November 30, 2021).

The grace period begins on October 1, 2021 and will end on November 30, 2021.

Providers who are able are strongly encouraged to complete their report in the PRF Reporting Portal by September 30, 2021.

Providers should return unused funds as soon as possible after submitting their report. All unused funds must be returned no later than 30 days after the end of the grace period (December 30, 2021).

Importantly, this Grace Period has no impact on the Period of Availability to use the PRF payments. Recipients are mandated to comply with the 

A recent example of a government enforcement action related to 

 occurred in the Central District of California. Here, an individual was “charged with the theft of government property and wire fraud in connection with $229,454 that he obtained from COVID-19 relief programs”, including the PRF. The case is set for trial and is being prosecuted by Trial Attorney Alexis Gregorian of the Los Angeles Strike Force.

Making prior authorizations less burdensome

In sum, this should serve as a reminder to providers regarding compliance with reporting obligations and appropriate use of the funds.

, 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,

With the impending reporting period upon providers, this article highlights the current status of Reporting Period 1 and relays some recent enforcement actions.

Provider Relief Fund recipient reporting obligations and government enforcement actions

Lauren King, director of customer service at DoctorsManagement, a medical and healthcare consulting firm based in Knoxville, Tenn., recommends that her clients use a behavioral-style approach to customer service training. Staff members are trained to pick up on cues that signal a patient's particular behavioral style so they can better respond to their needs. For example, one patient might appreciate getting a lot of personal attention while another might value efficiency over bedside manner.

"You can customize patients' experiences based on their behavioral styles," says King. "It also helps with teamwork because you can assign people to jobs that are more suited to their personalities."

The behavioral styles fall into two broad categories - task-oriented and people-oriented - each of which has two subtypes. Here are some of the traits associated with each of the four types:

Why you should know your patient’s behavior styles

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Understanding your patients' behavioral styles can help you customize their practice experience and boost satisfaction. Here's how.

Samuel Giordano, M.DD., is a practicing gastroenterologist, author, real estate investor, and co-founder of 

 a website designed to help physicians and other high-income professionals at vetting passive real estate syndication deals. 

His ultimate goal for himself and others is financial freedom and to live the life of our choosing on our own terms. 

Many physician colleagues who are several years out of training ask me what I am doing with any expendable cash outside of traditional investing in the equities or stock market. It seems over the last few years this question has become more and more common and is truly no surprise. As physicians, we are asked to do more and more administrative tasks outside of our clinical responsibilities. Combine this with the recent Covid-19 epidemic and it's not surprising to see the rate of physician burnout skyrocketing.

I believe that one of the ways to combat this tendency of physician burnout is to establish passive income outside of our day jobs that can diversify us in the case of job insecurity or instability. As busy professionals, we often don't have time for active involvement, and this is where passive income comes in.

One of the huge benefits of establishing passive income streams outside of our medical practice is the ability to decide in what capacity and how much we want to work. Having passive income streams that produce cash flow monthly can be used to offset any of the decreased compensation that may come when a physician decides to cut back on clinical duties or responsibilities. As these alternative income streams grow it is empowering when it becomes our choice to decide what capacity and how we want to spend our time. To achieve freedom in time allocation is the biggest cure for physician burnout and something we should all explore as to whether this fits our lives.

When considering passive income streams, my focus is to keep it passive. As a full-time practicing physician, I am not looking for an extra job. A passive income can be accomplished by investing as a limited partner in real estate syndications.

Physicians may not be aware of this form of investing but should be. Four years ago, when I started this journey, I didn't know many physicians that had made these types of investments. Encouragingly, more physicians are becoming familiar with real estate syndications cash flow and tax benefits.

In these scenarios, one typically invests a certain amount of cash that can range from a $5,000-$50,000 minimum depending on the platform. For that investment, you now have fractional ownership in the real estate asset. These investments can be made in multifamily apartments, self-storage, mobile homes, etc. The beauty of this model is that you get many of the benefits that are afforded to the actual owner such as appreciation and tax benefits. Much of the income that is given off by these investments are typically tax-free when it's offset by depreciation. As the business plan is enacted and the properties begin to produce cash flow, investors are sent a check either on a monthly or quarterly basis into their accounts for the duration of the deal. In addition, once the deal is sold or refinanced, the investors get a lump sum during those capital events. There may be a tax liability at that time, but this can often be offset by investing in a new deal and using depreciation from that to offset sale proceeds.

Much of the work in this type of investment is upfront before we make the transaction in vetting the sponsor, the market, and the deal. Education is the one thing that can overcome the fear of that first step, so you must make that time commitment to learn before investing.

As physicians, our income is, for the most part, tied directly to our active involvement and participation in our clinical duties. We are limited by the number of hours we can work in a week to obtain our income. The beauty of passive investing in the fashion outlined above is there is no limit to the scale and depth of the investments that you make other than your financial capacity to do so. In addition, this type of income comes in without your direct involvement and therefore can continue to grow without any limitation.

Using RVUs to Measure Physician Performance

Establishing a passive income stream is not a requirement for all physicians, but in my opinion is something that would benefit most. It does require some upfront commitment to education, which can take time, but is well within the bounds of our intellectual capability to do so once committed.

Samuel Giordano, M.D., is a practicing gastroenterologist, author, real estate investor, and co-founder of

Passive Real Estate Investing: Basics and Benefits

After working for years to build a successful medical practice, are you ready to move on to retirement or something new? To maximize the value of your practice and properly sell or pass it along to the next generation, a succession plan should be in place.

Succession planning can be a slow-moving and difficult process. While many physician owners claim they look forward to days when they can retire, they often fail to create a transition plan. Daily clinical duties and caring for patients take precedent over long-term planning concerns and this pushes succession planning to the back burner often for long periods of time.

It can be more comforting for the physician owner if the succession planning process starts years before their actual transition. It’s also important because the more time spent shifting the core business responsibilities of the practice away from the current owner, the better.

To facilitate this process, it’s necessary to document the core areas of responsibility. This will help segregate various aspects of the owner’s responsibilities and create a clear vision for which tasks can be allocated to others as potential backups. It also provides clarity when searching for a successor on key tasks they will need to be able to perform. The more that is known about the role, the easier it will be to find a match.

Effective succession planning doesn’t happen overnight. It can take many years to understand organizational challenges, identify solutions, and then get all the puzzle pieces to fit. The key is to establish a goal retirement date and then work backwards from there. Since things often change in the healthcare arena, it’s not essential for the date to be an absolute. However, a rather flexible goal date that can change as needed is best.

Planning at least four years in advance will allow for maximum planning time and efficiency. Working with the end in mind is the best way to approach succession planning and allows for the complex process to be broken into smaller pieces. Your succession plan should include a detailed list of circumstances and, if applicable, dates for all major steps in the succession plan. Depending on the situation, your timeline may stretch across many years.

A critical component to successful succession planning is determining a successor. Although every situation is unique, there are three primary methods of ownership transfer:

: If you are a co-owner, you could sell your interests back to the practice. If you are the sole owner of a medical practice, you may sell your practice to an outside party (e.g., another physician group, MSO, or hospital).

Rather than selling ownership interests back to the practice, you may sell your share or interests directly to an existing partner.

 You may choose to pass ownership interests along to a physician currently employed within your practice.

Once you have determined which transfer option is best for your specific situation, a succession plan can be crafted.

Although you may have a single successor in mind, it is best to list multiple options organized by order of consideration. If you are not planning to transition soon and do not have a set successor list in mind, begin by listing qualifications, skills, and/or personality traits you would like to find in a future successor.

It’s important to identify a successor as early in the planning process as possible. Without an identified successor, much of the work of succession planning is quite limited. Beyond this, the job of most physician owners is so complex that it may require a great deal of time to conduct training, introduce them into relationships, and coach them through transition. Start the training processes as soon as reasonably possible. This will ensure a maximum amount of time to transfer organizational and business knowledge.

Once a successor has been identified, there will be opportunity to share tasks or responsibilities. It’s not uncommon to see a successor approach a task or tackle a challenge in a way the current owner may not. Don’t be alarmed, it’s important to be open to the new ideas, processes, and ways of doing business that a successor can bring to the table. Open the door for them by allowing them to manage some existing responsibilities and make them part of the decision-making process quickly.

If you plan to sell your medical practice to an outside party, determine how appealing your practice may be:

Does your practice have a history of profitability? 

Of course, a financially stable medical practice with a history of consistent profitability will be more attractive to potential buyers than a struggling practice.

Where is your practice located? Is it in a highly desirable area based on the type of specialty you are in? Do you have a consistent patient base and loyal referring physicians? 

Positive answers to these questions point towards long-term profitability and higher medical practice value.

 Assets with market value and remaining useful life assist in increasing practice value and potential buyer attraction.

Medical practices that appear worth purchasing usually have good retained earnings, great net worth, and low or nonexistent debt.

 If you had a valuation performed on your practice more than one year ago, it is definitely outdated.

Planning for succession well in advance of a transition is extraordinarily helpful for increasing the practice’s marketability. Succession planning offers peace of mind for any physician owner, regardless of retirement timetable, but it is no small task. These are emotional decisions which require structured thought and time to contemplate. You may want to consider consulting professional advisors to assist in the tasks outlined in this article and to work with you to develop a comprehensive strategy.

, 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

Maximize the value of your practice and property by putting a proper plan in place.

How to build a succession plan for your practice

, the chief medical officer at Kyruus, discusses how consumer access preferences have changed over the course of the COVID-19 pandemic as depicted in a Kryuus report. She also covers how independent practices can respond to these changing demands.

How independent practices can respond to these changing demands. 

How consumer access preferences have changed throughout the COVID-19 pandemic

At its core, improving patient engagement is about involving the patient in their own care, and as a result, enhancing outcomes.

EHRs are often blamed for a decline in patient interaction, as some physicians are forced to spend more time looking at their screens and less time making eye contact with their patients. However, if leveraged properly, EHRs can actually allow for more effective interactions with patients during visits. The result will be a more collaborative form of care.

Here are four specific ways that physicians can use EHRs to enhance patient engagement:

Four ways an EHR can improve patient engagement

Patient engagement is about involving the patient in their own care. So use one of your key tech tools - your EHR - to help boost that involvement.

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

Our last installment in this series covered the potential 

 for the off-label prescribing of Ivermectin for the treatment and prevention of COVID-19. A recent article published by the American Council on Science and Health, “

Ivermectin and the Practice of Mob Medicine

” further highlights the dangers to both patients and healthcare facilities when the administration of specific treatment is dictated by a public “mob” comprised of politicians, the public, and lay people, and the courts rather than scientific evidence and the sound judgment of treating physicians. The article covers the legal issues at play, including a recent case overruling the court ordered administration of Ivermectin by a hospital at the demands of a family and a 

“While this court is sympathetic to the Plaintiff and understands the idea of wanting to do anything to help her loved one, public policy should not and does not support allowing a physician to try “any” type of treatment on human beings. Rather, public policy supports the safe and effective development of medications and medical practices. … What is more, public policy, in this case, encompasses

broader issues, including a hospital's standard of care decisions, mandating doctors and nurses to provide care they believe unnecessary, ethical concerns of all doctors involved, patient autonomy, fiduciary duty, accreditation standards for patient protections, obligating one doctor to carry out the treatment regimen/plan of another doctor, interplay of RC. 4743.10, and whether a court should medicate or legislate from the bench.”

Physicians and hospitals across the country 

 and refusing to allow the mob to control care decisions, and with those decisions, the 

 assumed for providing it. In some cases, the treatment has had actual adverse results that treating physicians and hospitals who are litigating this issue can point to. 

Top 3 ways physicians can ensure an early retirement

Robotic Surgery Risk – Is the Doctor or the Robot Responsible?

The law, like medicine, is a constantly evolving discipline and it changes and expands with technology. The advent and increasing use of robotic devices that can do specific things with greater dexterity or accuracy than humanly possible with the right human guidance has been good for patients and medicine in general. One question that the law is unsettled on however is the division of liability between the physician responsible for the selection and administration of a specific robotic procedure and the manufacturer of a machine designed for a specific purpose. As an example from 

In his essay, Pasquale offers an example of a traditional surgery in which a surgeon slips cutting a vital tendon with the scalpel. But what if, Pasquale poses, that surgeon is using a robotic device designed and marketed with a special component to avoid such a mistake. Who’s liable then? The surgeon or the device maker?

The article touches on a variety of the legal issues at play including the strict liability standard that may be applied by the courts, how liability may be apportioned between parties, the question of adequate training, and points to the importance of documenting the selection and use of a specific device for a specific patient.

Three Examples of Self-Inflicted Business Liabilities by Physicians

Covid-19 Disinformation Leads to License Suspension

 for allegedly engaging in a variety of unsafe practices with patients in his office including violating safety protocols and actively promoting disinformation on masks and vaccines.

Fertility Clinic Liable for HIPAA Breach in Group Email

 brought by a patient after emailing her private information to the individual’s entire work team. Illustrates the need for compliance, training and high limits of data breach liability insurance coverage.

Seven social skills they don’t teach in medical school

Reputational Damage to Employer Brings Lawsuit

 and is the subject of a restraining order for falsely using his former titles repeatedly in media and in interviews. The employer argues that the disinformation that the physician promotes on a variety of COVID-19 and vaccine related issues creates reputational damage and risk for the institution. Essentially, he can say what he wants, but not that he still works here, when he in fact does not.

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

In part seven of our look at medical malpractice risk we examine specific liability issues from recent media reports and about physicians and healthcare. 