Middle-ware: The Independent Way

For those of us with EMRs, one common challenge that exists is how to interface in-office lab analyzer data with your EMR software.   Basically, there are 4 ways to get lab data into your EMR:

1. Manually: Inefficient, slow, error prone.  DO NOT do it this way.
2. Scan results: Time consuming, error prone 
3. Middle-ware: If you are fortunate to have an analyzer that interfaces seamlessly with your specific EMR, this is the best solution.
4. Customized software: If your analyzer outputs data in a digital format, you can develop a solution easily and inexpensively, even if you have no programming knowledge yourself.  I recently developed one for my semen analyzer.

Your goal should be to efficiently and automatically get data into your EMR where you can sign off on the result and act accordingly.  Electronically is the best way to do this.

Good luck

Dr S

Tips for staying sane and viable through the tough times

This is one challenging economy.  Here's how you can manage to stay in good shape.

Avoid these pitfalls:

• Over-extending: good times don't last forever
• Over-contracting: neither do bad times
• Panicking: don't jump at your first rescue option, it may not be the best one
• Putting your head in the sand: the payment system is changing.  You'll need to adapt or die.
• Second guessing: too much wasted energy better spent on planning and acting.

Good luck,

Dr S
s

Why Do I Use a Different Pool Guy Every Year?

I have a pool--which I don't recommend.  The house came with it.  I maintain but have a service open and close it for me.  Every year it seems we use a different service.  Why is this?  For the most part, it is because the pool companies have not been following up with us through the winter.  We lose their numbers and forget their names and have to look up another one every May.
Crazy!  And in this economy.
Don't run your medical office like that.  Reach out to your patients, the active and the inactive ones on a routine basis.  Doing this is neither difficult nor expensive.
Just do it.
Dr Schoor

A Cost of Woking for Someone Else

These doctors assumed someone else would take care of their insurance needs.

I've said it before.  I'll say again.

Your practice, your problems, even if you work for someone else.

Dr Schoor

5 Key Practices to Help You Through This Recession

This is a tough recession--the worst I've been through certainly.  Only the fittest will survive this one.  Here are some survival tips that you can use:

1. Focus on collections: Obtain deductible information prior to seeing the patient and collect up-front if your contract allows.  If not, use a service like this. 
2. Scutinize all costs: Trim some and expand others--cost center vs profit center.
3. Smarten up your office hours: Avoid overtime while maximizing office visits.  Use your data to figure when patients "want" to be seen and staff heavily at these times, light at others.
4. Leverage technology: EHR, smart phones, VOIP, webforms, sms, etc
5. Answer your phones

Good luck.
Dr Schoor

Miami Urologist takes a stand

This urologist's patients are welcome in my office!

http://www.nytimes.com/2010/04/03/us/03doctor.html?ref=health

History

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History in the making

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21% Cuts: The perfect storm?

If you have had your head in the sand or too immersed in patient care issues, our fearless lesaders have let the Medicare's SGR proceed and with it a 21% cut in Medicare reimbursements to doctors across the board.  Whether you take Medicare or not, no matter what your payer mix may be, this affects you dramatically.  For many, if not most of us, our private payer contracts are tied to Medicare rates.  So  in essence, you can expect a 21% cut in gross payments while the private insurance companies have just recieved a 21% windfall.

Do you have chest pain yet?

How will you survive?

Well, you may not.  This may reresent the perfect storm, the trifecta of bad luck that has befallen the American doctor: rising liaility inurance rates, falling reimbursements, a severe recession. 

Or you could try some of the following:

1. Stop seeing Medicare patients.  Not out of protest, but because these patients are too sick and labor intensive to care for and still make money.
2. Increase volume.
3. Go ou of network with some private plans.  This works better if you are a primary care doctor or a specialist that sees emegency room patients.
4. Re-negotiate your contractswith the private payers.  Good luck with this one, but you never know.
5. Merge, merge, merge.  If the other strategies don't work, this drastic move may be the only viable approach. 

Good luck and let me know how it goes.

Dr Schoor

Well, the whole day is not lost!

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Prevent the Cuts!

Contact congress now.  If you live in Long Island, see these links.

Congressman Israel, from Huntington:  http://israel.house.gov/

Congressman Bishop, Smithtown and Brookhaven: http://timbishop.house.gov/

The Speaker of the House: http://www.house.gov/pelosi/

Senator Schumer, NY: http://schumer.senate.gov/

Senator Gillebrand, NY: http://gillibrand.senate.gov/


These people work for you!  Contact them and ask them to reverse these devastating cuts.

Dr Schoor

Never Back and Animal Into a Corner

With devastating cuts to Medicare looming to take effect March 1st, us doctors are taking our message to everyone.  We will not go down without a fight.  This is a letter I sent to ALL of my Medicare age patients.

2/23/2010

Dear friend,

MEDICARE is under threat!

Unless we take action now, congress will allow MEDICARE to drop reimbursements to all

doctors by 21.6% effective March 1st.  For most of your doctors, that would account for greater

than 20% loss of the practice's total income; income that we use to pay our staff, purchase office

supplies, pay for our equipment, care for you, and support our families and the local economy.

If the US Congress allows the drop to go through on March 1st, many of your doctors, like your

internist, family practitioner, endocrinologist, urologist, dermatologist, and others, simply will no

longer be able to survive and remain in practice.  Those that can weather the storm will be forced

to make drastic cutbacks in services to Medicare beneficiaries or drop out of Medicare altogether.

I implore you to contact your local representative to the US Congress and ask them to prevent

MEDICARE from proceeding with the devastating 21.6% cut to the physician fee schedule.

Feel free to contact me directly if you have any questions or would like to know who to contact.

You can email me at rich@drschoor.com.

Or visit www.theindependenturologist.com for links to members of congress.

Do it now!  Our beloved MEDICARE depends on our action.

Sincerely,

Dr Schoor

The End of an Era

I disconnected the last of my remaining VONAGE lines today, the phone that sat in my house and served as an office line, just one that happended to be in my house.

It feels a bit sad, nostalgic almost.  While VONAGE was the source of much of my telecom pain in the early and not-so-early days of my fledgling urology practice, it was VONAGE's then avant-guard service that enabled me to grow in those first critical months cheaply and mobily.

In many ways, it was VONAGE that put me on the map.  And for that, I thank them.

Ultimately, I outgrow its capabilities, however.

For the past few months, as I have been looking to cut cost whereever possible, VONAGE was always near the chopping block, but the off-site line still served a function, even though improvements in cell phone reliablity  at my house enabled me to make and receive calls from almost any room in my house.

Still, I held a special place in my heart for this little phone company that could, silly as it seems.

Then my VONAGE router died--just went kerplunk--and that was the catalyst.

Several minutes ago, I called and canceled my service.

Fairwell old friend.

Dr Schoor

Dwindling Down My Paper Usage

I am down to two!  Pieces of paper that is.  Everything else is the glorious e.

Patient records--electronic

Radiology reports--electronic only

Lab reports--electronic only

Patient intake & demographic form--electronic (actually, I don't even have one.  I got rid of it.)

HIPAA acknowledgement form--electronic, signature and all!

Consents--electronic

Patient statements--electronic.  They are actually mailed on paper, just not be me or my staff.

ABN (Assigment of benefits) consent form--you guessed it, electronic.

That is it.

So what is still paper?

We still send claims for secondary insurance by paper.

My biller insists on continuing to use paper encounter forms.  Alright.  If it ain't broke. . .

Dr Schoor

Unintended Email Consequence

My staff has been getting email addresses from patients.  Over the past few months, they collected 212 emails--not too shabby.  Thanks guys!

Yesterday I uploaded the email addresses to my email management site and sent the patients a confirmation email (I don;t want to be a spammer, so the patients must opt-in again to confirm they wish to be on my email list).

Most people have opted in, but what I did not expect was the number of emails from patients regarding billing issues.

It seems I have awakened a sleeping dog.

I get it, I think.

I think I finally "get" Twitter.  Or at least I figured how I plan to use this seemingly inane service that millions love.

Twitter is best used when the tweeter draws attention toward someone else, rather than himself.

The "I'm at Starbucks" tweet is boring and useless.  On the other hand, the "check at this new gadget" tweet, well that might be interesting.

As in any form of marketing, the best type places attention on the other person, rather than the marketer himself.

Better to be "how can I help you?" than "how can you help me?"

New Years Resolutions

Try these on for size:

1: Go E.H.R.
2: Improve your E.H.R.
3: Start PQRI
4: Decipher "meaningful use"
5: See more patients or...
6: See less patients
7: Learn 10 new codes
8: Get rid of 1 piece of paper
9: Do away with 1 process
10: Write a book

Happy New Year

Dr S

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Miniature Circus

If the Medicare cuts go through, I am going to run away and join the miniature circus.
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Come on, come out, Sun.

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Using an EMR to Solve Problems

If someone came to you with a solution to 3 out of the 5 biggest problems you face, you would probably take it--or at least listen to their proposal, right?

Imagine if someone said to you, "you know that persistent problem you have with your filing system, I found the perfect solution and you'll never have to deal with that again."  I don't know, I'd be all ears.

Every doctor has problems.  Filing and retrieving, lab tracking, order tracking, prescription refills, handwriting issues, messaging handling; these just name a few.   I certainly had my issues.  Many of them are now past tense issues.

Prescription issues:  99% solved.  On rare occasion I forget to initial a narcotic script or my rx printer malfunctions.


Message handling:  100% solved.


Handwriting issues: bye bye!


Filing/retrieving:  see ya.


Lab tracking: 90% better.  I am still learning my EMR's functionality.


I still have problems, but just not these problems.


A good thing.