Michael Sappington

So, how’s that EHR working out for you? Has more technology at your practice made for an easier, zen-like experience, or has it added cost and complexity?

If I’m guessing correctly, the mere thought of technology has produced feelings of frustration and anger. As CEO of a company that is a part of the electronic health movement that is taking place, I have always felt that we were in competition with other vendors that thought about the short-term, and let’s just say that they had their own interests in mind. Of course you can’t be a business-minded leader without being profit-minded. However, with the right focus and business model, you can both serve the customers and the business owners. In healthcare this doesn't work.

When you take a look back to the EHR gold rush, we have actually come full circle to a point where the true impacts of that era have come to full bore. Independent practices are at an apex of confusion, complexity, and confounding interests. Go into any practice and hold a conversation around technology, and I wish you the best of luck. You would be in better shape if you sold happiness and came in with a master's in psychology.

What does this mean for the future of private, independent practices?

When we think of the future of practices, and the role that technology plays within, it should be thought of as a service that comes with support. The best technology becomes an extension of the practice. By combining business and technology services focused on practice-minded solutions, independent practices might actually have a fighting chance against "big healthcare."

Time cannot be erased, and the issues of yesterday are not able to totally be swept under a rug. For any practice that is looking at their existing EHR as a big headache, I cannot blame them. However, it is a reminder that it is a business problem, and technology is a part of the solution. The only formula for a thriving future is to find a partner that can help you with your business first and also has a technology platform that truly supports the practice.

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Technology can solve your business problems, but it has to be the right system with the right partner to truly result in success.

Technology’s Lasting Impact on the Medical Practice

We're approaching the halfway point of 2014. Yes, half of the year is over. Take a minute to breathe that in.

Over the past few months I have circumnavigated this country visiting more than 100 independent practices. It's been a tremendous thrill, but mostly an eye-opening experience. I brought with me a fair amount of conclusions and beliefs of what was happening in today's practice, and the result of my experiences meeting practices confirmed my understanding and provided more clarity as I traveled.

When I think of how today's practices are operating, I look at the confluence of rising costs and complexities being the number one factor forcing the hand of both providers and practice managers alike. Sure, patients have become more demanding and knowledgeable, but it's external regulatory factors and fixed costs that have sent independent practices down an unsustainable road. Too often, the practice decision makers find themselves focusing on near-term change as being a more troubling move than an achievable one, resulting in decisional paralysis. The top excuse is usually a lack of knowing where to start.

I've got a news flash for everyone running a practice: It is easier than you think!

Let's start by creating a plan, and we're not talking one of those overbearing multi-page plans - it's just too darn long! You need to start with a single-page strategic plan or just a single-page plan.

For those of you who are asking yourselves: "Does my practice need a strategic plan?," then you are in the other group of practices that need to begin a strategic thinking process. For the rest, you sit in a group that probably used a strategic plan as a practice-wide morale building exercise a few years back. You may not have realized it at the time, but the strategic plan was dead on arrival when it started if it wasn't actionable. Actionable, strategic plans for the practice need to be clear, concise and 

Yes, it is possible to have a plan that is one page long (

). Not only will it save on paper for the office supply costs, it will more importantly create a vision that is direct and actionable.

So, why do I stress so much about the length of a document that is focused more on business operations than patient engagement? Office-wide or practice-wide business messages are the difference between alignment and disorganization. By solidifying a concise vision, the entire practice can align to a forward direction that is clear and truly inspiring at its core.

With so much uncertainty currently permeating the independent practice culture, the onus is truly on the practice itself to see the existing change climate as beneficial to its own operations. While change will be consistent, and the strategic plan may have to be continually revised, today's independent practice must align and focus on a vision in order to embrace the culture of complexities and rising costs, and make a plan that is actionable.

Your practice needs a strategic plan to guide it into the future. And it's easy - all you need is one page to set a clear and concise path.

Medical Practice Strategic Plans: The Key to Dealing with Change

The idealized American healthcare ecosystem cannot survive without the independent medical practice. Before that’s pushed off as some obvious statement, each of us as Americans should think of independent practices in the same way that we think of this nation’s small businesses.

Looking for more ways to thrive as an independent practice? Join experts Rosemarie Nelson, Lucien W. Roberts, Elizabeth Woodcock, and others as they help improve your medical practice and your bottom line at 

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No matter your political stance, the American small business is both the engine and the driver of a strong economy. Heck, the idea of a specific day for small businesses has been heavily commercialized. The bottom line is that a strong healthcare ecosystem needs multiple components, with its smallest at the very core.

How do we as a nation rally around the independent practice?


To start, I’m not making the argument that hospital-affiliated practices are a negative part of the healthcare equation, nor am I making the point that all independent practices are doomed. To think either concept would be both irrational and not helpful to the greater, nationwide conversation around healthcare.

The reason many doctors are giving up on their medical practices is because they feel out of control, but once they go to work for someone else they quickly realize they have no control. I recently heard of a health system that laid off 18 of its doctors. Remember, this is a business after all.

In my view, rallying around the independent practice starts with the concept that all businesses (reminder: medical practice = business at core) need to rethink the way they are organized. There are actually some business models emerging where doctors retain their independence and partner with an organization to manage the compliance and apply business processes, all while reducing the complexity and cost of running a medical practice. This hybrid model allows doctors to retain their medical decision making and control over their practice. This model is rapidly becoming the viable alternative to giving up control. 

 - that thought brings me to a point that describes the true essence of simplicity in the practice. When I speak to physicians, I am often overcome with the most disappointment when I hear that they are "over the latest regulations," or that they "don’t see a bright future for the practice." While they are describing statements that are laced with emotion, what they are truly saying is that they are not involved in the full ownership of the practice results. This describes a lack of full investment, and a troubling evil when we consider how a practice can be thrust into success in a more simplified world.
 

A strong healthcare ecosystem needs multiple components, with its smallest at the very core.

Why the Healthcare System Needs Small Medical Practices

Do you remember when 2014 was months and years off in the future? How about the calls for preparation that have since evolved into action?

I strongly believe that we are on the cusp of a dangerous deadline where many practices will have the realization of change hit them straight between the eyes without perceived notice. The result is not going to be pretty. Imagine thousands of practices scrambling to attend to their business needs, while trying with all their might to provide as best of care to patients as possible. That just seems impossible when spelled out.

Let’s face it - today’s practices potentially work harder than ever, and yet get less in return. That’s a raw deal. If you think taking a $10 bill to a gas station will get you anything meaningful today, then you must be of the same rationale that less is more - well, it isn’t.

I’ve made a personal effort to speak with as many of our practices as possible, and I hear the same thing. Meaningful use and ICD-10 are important to them, but the biggest crunch is coming from both the insurers and decreased reimbursements from Medicare. Those are real challenges that have an impact on the bottom line and on allocated resources.

I believe that the year 2014 is an absolute tipping point for the independent practice that is looking to make it to 2015 and beyond in a strong position. I have some simple rules that will help make that belief into a reality:

1. Don’t let delays distract you. Move forward as if each CMS-related deadline is permanent.

2. Understand your business acumen resources. These resources might come from partnerships or even consultants. Bottom line: Your best resources may not be in the practice walls.

3. Create an actual business strategic plan. Medical practices are businesses at their very core and need to act and plan in a similar fashion.

4. Look at the 2014 milestones as part of a larger transition plan. While this year’s changes may come across as insurmountable, they will only be larger and more challenging down the road if you fail to give them the proper attention.

5. Think of how the patient will be impacted at all moments. Though most of these strategies are business related, you are in a performance-based business where patient care is of the upmost importance.

The year 2014 will be a tipping point for independent medical practices. Make sure your practice is prepared.  

Simple Ways to Situate Your Independent Medical Practice for Success 

Have you heard that the first week of January is one of the most depressing of the year? Just think how outrageous that is. I thought that you were supposed to kiss a loved one at midnight, not put on your pajamas, and contemplate everything negative that has happened to you. While the new year brings with it immeasurable hope, we have essentially set such a high expectation level for change that once the calendar flips, we have been built up for a letdown.

Let’s translate what this looks like to medical practices. Walk into any independent medical practice and ask them about the Stage 2 rules for meaningful use or the ICD-10 coding transition, and the majority will give you the same answer: "It will just get delayed again." You might even get the famous line: "I’m just over all of these changes."

Yes, these things are openly said about regulations that will directly impact the bottom line and patient interaction for the foreseeable future. Talk about taking something lightly, this is beginning to feel more and more like there are people openly hoping that something like Tax Day might somehow get delayed this year. I’ve got news to you - it won’t, and you should act like it won’t as well.

In no way do I consider myself a part of Pavlov’s greater research organization, but many individuals at practices have essentially become conditioned to practice uniformity. I’ve spoken previously about the theory that 

practices are truly optimized for the status quo

, and it is from this belief that you can see the direct ties to a malaise of indifference.

I don’t see, however, all of the blame in the direction of practices. When you look at how all deadlines from officials of the CMS and the Office of the National Coordinator for Health IT has been fluid and constantly in a state of flux, the newsworthiness and the continued interest of each forthcoming impact is tremendously reduced. It’s the same feeling you get when the weather reporter warns of an imminent storm coming in your direction, only to be greeted by a few inconvenient showers or breezes. Repeat that feeling multiple times over as there always seems to be one pending storm on the doorstep.

Now, don’t get me wrong, I think the impacts of ICD-10 and the Stage 2 rules of meaningful use will be more than a mere inconvenience. I am simply suggesting that the numbness of change in 2014 will directly lead to a bigger impact than we have ever seen before.

Let’s take a big dose of reality. Could there be another delay down the pike? Perhaps. Why take such a big gamble on your practice, when you can instead use moments like these to directly create a practice infrastructure that can ignore deadlines since it is ahead of the curve? Changing the practice-wide mentality from one of reaction first to change/proactive first can get your practice on the right track for the future.

2014 is going to be harder for most medical practices than many believe mainly due to change apathy and paralysis in dealing with major changes.

Healthcare in 2014: Take a Proactive Approach to Major Changes

Change - it's truly one nasty six-letter word. It's a term that comes with the natural human reaction of fear, followed by realization. For today's independent practices, 'change' can also be seen as the newest "practice dilemma," where stagnation poses the greater potential of failure.

One of the biggest changes that I can foresee in the wake of both existing trends, along with the soaring consumerization of technology, comes in the way that practices will have to market themselves in order to create new patient pipelines.

We know what this looks like because it's already happening around us. With traditional referral networks being attacked from multiple angles, it is the invaluable efforts of the marketing-minded physician, practice manager, or other go-getter that has already proven to be a practice differentiator. I'm sure we don't have to go that deep in the memory banks to think of a practice that has already taken the necessary steps to become the "go-to" specialty purely based on name-recognition alone.

Is there a blueprint that works for everyone? No, unless you want to go through a similar cycle a number of years from now. It should be reminded that whichever channel is taken, must also account for rapidly changing trends for media consumption. Placing the practice name on a NASCAR or Indy Racing car may not necessarily meet with your target audience, regardless of the extraordinary cost associated with either. The same can go for placing an Internet banner ad, in the case when the majority of your existing and prospective patients do not use the Internet.

What can you do immediately? While each approach may be different, an audit of existing Web properties and competitive medical practice profiles would be a strong start. If we already know that a certain percentage of patients use WebMD (and other similar properties) as knowledge-based resources for self-remediation, then a greater analysis of the Web landscape might return a result that can lead to an opening strategy. What are other individuals saying about your practice? What channels (i.e. social media) are other practices using to promote themselves?

As inferred by the reference to competition, the Web audit strategy also presents a chance to understand a key element to the SWOT (strengths, weaknesses, opportunities and threats) analysis of your practice. Threats at their very core highlight an external pressure on the practice, altering the landscape from self-control to external forces of change. I've talked 

about SWOT as a strategic tool in the past

, but as you can see its elements extend to marketing practices.

I would be remiss in speaking about marketing efforts, if I didn't discuss the idea of using existing personnel capital in order to open up new channels. Each employee is inherently an extension of the practice, and a chance to open up new referral networks and discover new extensions to the patient pipeline. By reflecting the marketing wishes of the provider or practice manager on the entire team, each member can feel invested in both the process and the effort.

As you can immediately tell, the elements of change are rapidly creating new channels, alongside the innovative roles in the practice. Creating true differentiation, while building stronger referral channels, is not an easy task. However, recognizing that change needs to take place with a keen eye to marketing efforts, can be the difference the next time somebody drops that six-letter word in your lap.

One of the biggest changes medical practices face is how they market themselves to new patients. Here's some guidance to help you for the future.