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You Need a Budget
For many years, I chaired the office efficiency course at the American Academy of Dermatology’s annual meeting. Each year, I asked how many participants compiled a yearly budget for their practices. In an audience of 400, the largest affirmative response I ever received was three, and some years there were no raised hands at all.
Why do physicians so vigorously resist an exercise that is so basic to every other business and profession on the planet? Typically, I hear one of two reasons: It’s tedious, or my colleagues seem to be doing just fine without one.
But the days of "doing just fine" are coming to an end. As competition for patients increases, expenses continue their upward spiral, and the government continues its steady encroachment on private practice, physicians who plan ahead will have an advantage.
Budgeting need not be tedious; determine what you need to do yourself and what can be delegated. And now, as the year winds down, is an excellent opportunity to map out your finances.
The first step – the basic gathering of numbers that everyone seems to dread – can be delegated. Ask your accountant to compile the practice’s gross income over the last 12 months, in monthly increments.
Break it down by type of service: office visits, hospital visits, surgery, lab fees, and so on, listing both the amounts billed and collected. This is not only for calculations of collection ratios, but to determine your "seasonality" – which I’ll discuss in greater detail next month. Do the same for expenses, and again break them down by category: salaries, rent/mortgage, business and medical supplies, and so on.
In many cases, the mere collection of this raw data will save money. You might discover, for example, that expenditures for business supplies are unexpectedly high. Perhaps a competing vendor can do better, or perhaps you have an overuse or theft problem.
Once the numbers are accumulated, start extrapolating them into next year. If your income rose by, say, 6% this year, can you expect a similar rise next year? Why or why not? To get a fix on a realistic goal, go through each component of your gross income and decide where the increase could come from. Can you raise prices for office visits or cosmetic procedures, renegotiate at least one third-party contract, or add another exam room in order to see more patients?
Perhaps there is an impending change in your area that you can factor in, such as a competitor who is retiring. If that physician is known for a specific service, and it’s not a service you offer, could you start?
You are, I hope, beginning to see that this exercise is well worth the effort. After you have mapped out income, turn to expenses. Perhaps some of the assumptions that you’ve made on income will affect expenses; for example, adding a new procedure may require the purchase of new equipment. If you have a higher census goal, you may need an additional assistant.
If you’re considering adding an associate, you can determine if he or she will bring in enough revenue to cover salary and expenses by completing two versions of next year’s projected budget – one with the associate and one without.
Once you have prepared your budget, follow it. Your accountant or manager can generate monthly spreadsheets comparing actual financials with projections, and the year-to-date, compared with previous years. There are many parameters to explore.
Look for deviations from predictions and possible reasons for them, such as factors you didn’t (or couldn’t) anticipate. Make a note of them; it will help you with next year’s projections.
A budget can be justified in two major ways: You’ll better understand where your practice is going, and the forces at work to change it. And you’ll become aware of unexpected events while there is still time to influence them, rather than making such discoveries well after the fact – or worse, never finding out at all.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
For many years, I chaired the office efficiency course at the American Academy of Dermatology’s annual meeting. Each year, I asked how many participants compiled a yearly budget for their practices. In an audience of 400, the largest affirmative response I ever received was three, and some years there were no raised hands at all.
Why do physicians so vigorously resist an exercise that is so basic to every other business and profession on the planet? Typically, I hear one of two reasons: It’s tedious, or my colleagues seem to be doing just fine without one.
But the days of "doing just fine" are coming to an end. As competition for patients increases, expenses continue their upward spiral, and the government continues its steady encroachment on private practice, physicians who plan ahead will have an advantage.
Budgeting need not be tedious; determine what you need to do yourself and what can be delegated. And now, as the year winds down, is an excellent opportunity to map out your finances.
The first step – the basic gathering of numbers that everyone seems to dread – can be delegated. Ask your accountant to compile the practice’s gross income over the last 12 months, in monthly increments.
Break it down by type of service: office visits, hospital visits, surgery, lab fees, and so on, listing both the amounts billed and collected. This is not only for calculations of collection ratios, but to determine your "seasonality" – which I’ll discuss in greater detail next month. Do the same for expenses, and again break them down by category: salaries, rent/mortgage, business and medical supplies, and so on.
In many cases, the mere collection of this raw data will save money. You might discover, for example, that expenditures for business supplies are unexpectedly high. Perhaps a competing vendor can do better, or perhaps you have an overuse or theft problem.
Once the numbers are accumulated, start extrapolating them into next year. If your income rose by, say, 6% this year, can you expect a similar rise next year? Why or why not? To get a fix on a realistic goal, go through each component of your gross income and decide where the increase could come from. Can you raise prices for office visits or cosmetic procedures, renegotiate at least one third-party contract, or add another exam room in order to see more patients?
Perhaps there is an impending change in your area that you can factor in, such as a competitor who is retiring. If that physician is known for a specific service, and it’s not a service you offer, could you start?
You are, I hope, beginning to see that this exercise is well worth the effort. After you have mapped out income, turn to expenses. Perhaps some of the assumptions that you’ve made on income will affect expenses; for example, adding a new procedure may require the purchase of new equipment. If you have a higher census goal, you may need an additional assistant.
If you’re considering adding an associate, you can determine if he or she will bring in enough revenue to cover salary and expenses by completing two versions of next year’s projected budget – one with the associate and one without.
Once you have prepared your budget, follow it. Your accountant or manager can generate monthly spreadsheets comparing actual financials with projections, and the year-to-date, compared with previous years. There are many parameters to explore.
Look for deviations from predictions and possible reasons for them, such as factors you didn’t (or couldn’t) anticipate. Make a note of them; it will help you with next year’s projections.
A budget can be justified in two major ways: You’ll better understand where your practice is going, and the forces at work to change it. And you’ll become aware of unexpected events while there is still time to influence them, rather than making such discoveries well after the fact – or worse, never finding out at all.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
For many years, I chaired the office efficiency course at the American Academy of Dermatology’s annual meeting. Each year, I asked how many participants compiled a yearly budget for their practices. In an audience of 400, the largest affirmative response I ever received was three, and some years there were no raised hands at all.
Why do physicians so vigorously resist an exercise that is so basic to every other business and profession on the planet? Typically, I hear one of two reasons: It’s tedious, or my colleagues seem to be doing just fine without one.
But the days of "doing just fine" are coming to an end. As competition for patients increases, expenses continue their upward spiral, and the government continues its steady encroachment on private practice, physicians who plan ahead will have an advantage.
Budgeting need not be tedious; determine what you need to do yourself and what can be delegated. And now, as the year winds down, is an excellent opportunity to map out your finances.
The first step – the basic gathering of numbers that everyone seems to dread – can be delegated. Ask your accountant to compile the practice’s gross income over the last 12 months, in monthly increments.
Break it down by type of service: office visits, hospital visits, surgery, lab fees, and so on, listing both the amounts billed and collected. This is not only for calculations of collection ratios, but to determine your "seasonality" – which I’ll discuss in greater detail next month. Do the same for expenses, and again break them down by category: salaries, rent/mortgage, business and medical supplies, and so on.
In many cases, the mere collection of this raw data will save money. You might discover, for example, that expenditures for business supplies are unexpectedly high. Perhaps a competing vendor can do better, or perhaps you have an overuse or theft problem.
Once the numbers are accumulated, start extrapolating them into next year. If your income rose by, say, 6% this year, can you expect a similar rise next year? Why or why not? To get a fix on a realistic goal, go through each component of your gross income and decide where the increase could come from. Can you raise prices for office visits or cosmetic procedures, renegotiate at least one third-party contract, or add another exam room in order to see more patients?
Perhaps there is an impending change in your area that you can factor in, such as a competitor who is retiring. If that physician is known for a specific service, and it’s not a service you offer, could you start?
You are, I hope, beginning to see that this exercise is well worth the effort. After you have mapped out income, turn to expenses. Perhaps some of the assumptions that you’ve made on income will affect expenses; for example, adding a new procedure may require the purchase of new equipment. If you have a higher census goal, you may need an additional assistant.
If you’re considering adding an associate, you can determine if he or she will bring in enough revenue to cover salary and expenses by completing two versions of next year’s projected budget – one with the associate and one without.
Once you have prepared your budget, follow it. Your accountant or manager can generate monthly spreadsheets comparing actual financials with projections, and the year-to-date, compared with previous years. There are many parameters to explore.
Look for deviations from predictions and possible reasons for them, such as factors you didn’t (or couldn’t) anticipate. Make a note of them; it will help you with next year’s projections.
A budget can be justified in two major ways: You’ll better understand where your practice is going, and the forces at work to change it. And you’ll become aware of unexpected events while there is still time to influence them, rather than making such discoveries well after the fact – or worse, never finding out at all.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
Firing an Employee Is Never Easy
My recent column on good hiring practices, which stressed the importance of replacing marginal employees with excellent ones, triggered an interesting round of discussion. "Isn’t it true," asked a colleague, "that most physicians tolerate marginal employees because it’s less painful than firing them?"
Indeed it is. Firing someone is never easy, and it is particularly tough on physicians. But sometimes it is unavoidable to preserve the efficiency and morale of yourself and your other employees.
Before you do it, however, be sure that you have legitimate grounds, and assemble as much documentation as possible. Record all terminatable transgressions in the employee’s permanent record, and document all verbal and written warnings. This is essential; you must be prepared to prove that your reasons for termination were legal.
Former employees will sometimes charge that their civil rights were violated. For example, federal law prohibits you from firing anyone because of race, gender, national origin, disability, religion, or age. You cannot fire a woman because she is pregnant, or recently gave birth. Other illegal reasons include assertion of antidiscrimination rights, refusing to take a lie detector test, and reporting OSHA (Occupational Safety and Health Administration) violations.
You also can’t terminate someone for refusing to commit an illegal act, such as filing false insurance claims; or for exercising a legal right, such as voting or participating in a political demonstration.
And you cannot fire an alcohol abuser unless he or she is caught drinking at work; but many forms of illegal drug use are legitimate cause for termination. Other laws may apply, depending on where you live. When in doubt, contact your state labor department or fair employment office.
If a fired employee alleges that he or she was fired for any of these illegal reasons, and you do not have convincing documentation to counter the charge, you may find yourself defending your actions in court.
As I’ve mentioned in the past, consider adding employment practices liability insurance (EPLI) to your umbrella policy, since a wrongful termination lawsuit is always a possibility despite your best efforts to prevent it.
Once you have all your legal ducks in a row, don’t procrastinate. Get it over with, first thing on Monday morning. If you wait until Friday afternoon you will worry about the dreaded task all week long, and the fired employee will stew about it all weekend.
Explain the performance you have expected, the steps you have taken to help correct the problems you have seen, and the fact that the problems persist. Try to limit the conversation to a minute or two, have the final paycheck ready, and make it clear that the decision has already been made, so begging and pleading will not change anything.
I’ve been asked to share exactly what I say; so for what it’s worth, here it is: "I have called you in to discuss a difficult issue. You know that we have not been happy with your performance. We are still not happy with it, despite all the discussions we have had, and we feel that you can do better elsewhere. So today we will part company, and I wish you the best of luck in your future endeavors. Here is your severance check. I hope there are no hard feelings."
There will, of course be hard feelings, but that cannot be helped. The point is to be quick, firm, and decisive. Get it over with and allow everyone to move on.
Be sure to get all your office keys back – or change the locks if you cannot. Back up all important computer files, and change all your passwords. Most employees know more of them than you would ever suspect.
Finally, call the staff together and explain what you have done. They should hear the story from you, not a distorted version through the rumor mill. You don’t have to explain your reasoning or divulge every detail, but do explain how the termination will affect everyone else. Responsibilities will need to be shifted until a replacement can be hired, and all employees should understand that.
If you are asked in the future to give a reference or write a letter of recommendation for the terminated employee, be sure that everything you say is truthful and well documented.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
My recent column on good hiring practices, which stressed the importance of replacing marginal employees with excellent ones, triggered an interesting round of discussion. "Isn’t it true," asked a colleague, "that most physicians tolerate marginal employees because it’s less painful than firing them?"
Indeed it is. Firing someone is never easy, and it is particularly tough on physicians. But sometimes it is unavoidable to preserve the efficiency and morale of yourself and your other employees.
Before you do it, however, be sure that you have legitimate grounds, and assemble as much documentation as possible. Record all terminatable transgressions in the employee’s permanent record, and document all verbal and written warnings. This is essential; you must be prepared to prove that your reasons for termination were legal.
Former employees will sometimes charge that their civil rights were violated. For example, federal law prohibits you from firing anyone because of race, gender, national origin, disability, religion, or age. You cannot fire a woman because she is pregnant, or recently gave birth. Other illegal reasons include assertion of antidiscrimination rights, refusing to take a lie detector test, and reporting OSHA (Occupational Safety and Health Administration) violations.
You also can’t terminate someone for refusing to commit an illegal act, such as filing false insurance claims; or for exercising a legal right, such as voting or participating in a political demonstration.
And you cannot fire an alcohol abuser unless he or she is caught drinking at work; but many forms of illegal drug use are legitimate cause for termination. Other laws may apply, depending on where you live. When in doubt, contact your state labor department or fair employment office.
If a fired employee alleges that he or she was fired for any of these illegal reasons, and you do not have convincing documentation to counter the charge, you may find yourself defending your actions in court.
As I’ve mentioned in the past, consider adding employment practices liability insurance (EPLI) to your umbrella policy, since a wrongful termination lawsuit is always a possibility despite your best efforts to prevent it.
Once you have all your legal ducks in a row, don’t procrastinate. Get it over with, first thing on Monday morning. If you wait until Friday afternoon you will worry about the dreaded task all week long, and the fired employee will stew about it all weekend.
Explain the performance you have expected, the steps you have taken to help correct the problems you have seen, and the fact that the problems persist. Try to limit the conversation to a minute or two, have the final paycheck ready, and make it clear that the decision has already been made, so begging and pleading will not change anything.
I’ve been asked to share exactly what I say; so for what it’s worth, here it is: "I have called you in to discuss a difficult issue. You know that we have not been happy with your performance. We are still not happy with it, despite all the discussions we have had, and we feel that you can do better elsewhere. So today we will part company, and I wish you the best of luck in your future endeavors. Here is your severance check. I hope there are no hard feelings."
There will, of course be hard feelings, but that cannot be helped. The point is to be quick, firm, and decisive. Get it over with and allow everyone to move on.
Be sure to get all your office keys back – or change the locks if you cannot. Back up all important computer files, and change all your passwords. Most employees know more of them than you would ever suspect.
Finally, call the staff together and explain what you have done. They should hear the story from you, not a distorted version through the rumor mill. You don’t have to explain your reasoning or divulge every detail, but do explain how the termination will affect everyone else. Responsibilities will need to be shifted until a replacement can be hired, and all employees should understand that.
If you are asked in the future to give a reference or write a letter of recommendation for the terminated employee, be sure that everything you say is truthful and well documented.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
My recent column on good hiring practices, which stressed the importance of replacing marginal employees with excellent ones, triggered an interesting round of discussion. "Isn’t it true," asked a colleague, "that most physicians tolerate marginal employees because it’s less painful than firing them?"
Indeed it is. Firing someone is never easy, and it is particularly tough on physicians. But sometimes it is unavoidable to preserve the efficiency and morale of yourself and your other employees.
Before you do it, however, be sure that you have legitimate grounds, and assemble as much documentation as possible. Record all terminatable transgressions in the employee’s permanent record, and document all verbal and written warnings. This is essential; you must be prepared to prove that your reasons for termination were legal.
Former employees will sometimes charge that their civil rights were violated. For example, federal law prohibits you from firing anyone because of race, gender, national origin, disability, religion, or age. You cannot fire a woman because she is pregnant, or recently gave birth. Other illegal reasons include assertion of antidiscrimination rights, refusing to take a lie detector test, and reporting OSHA (Occupational Safety and Health Administration) violations.
You also can’t terminate someone for refusing to commit an illegal act, such as filing false insurance claims; or for exercising a legal right, such as voting or participating in a political demonstration.
And you cannot fire an alcohol abuser unless he or she is caught drinking at work; but many forms of illegal drug use are legitimate cause for termination. Other laws may apply, depending on where you live. When in doubt, contact your state labor department or fair employment office.
If a fired employee alleges that he or she was fired for any of these illegal reasons, and you do not have convincing documentation to counter the charge, you may find yourself defending your actions in court.
As I’ve mentioned in the past, consider adding employment practices liability insurance (EPLI) to your umbrella policy, since a wrongful termination lawsuit is always a possibility despite your best efforts to prevent it.
Once you have all your legal ducks in a row, don’t procrastinate. Get it over with, first thing on Monday morning. If you wait until Friday afternoon you will worry about the dreaded task all week long, and the fired employee will stew about it all weekend.
Explain the performance you have expected, the steps you have taken to help correct the problems you have seen, and the fact that the problems persist. Try to limit the conversation to a minute or two, have the final paycheck ready, and make it clear that the decision has already been made, so begging and pleading will not change anything.
I’ve been asked to share exactly what I say; so for what it’s worth, here it is: "I have called you in to discuss a difficult issue. You know that we have not been happy with your performance. We are still not happy with it, despite all the discussions we have had, and we feel that you can do better elsewhere. So today we will part company, and I wish you the best of luck in your future endeavors. Here is your severance check. I hope there are no hard feelings."
There will, of course be hard feelings, but that cannot be helped. The point is to be quick, firm, and decisive. Get it over with and allow everyone to move on.
Be sure to get all your office keys back – or change the locks if you cannot. Back up all important computer files, and change all your passwords. Most employees know more of them than you would ever suspect.
Finally, call the staff together and explain what you have done. They should hear the story from you, not a distorted version through the rumor mill. You don’t have to explain your reasoning or divulge every detail, but do explain how the termination will affect everyone else. Responsibilities will need to be shifted until a replacement can be hired, and all employees should understand that.
If you are asked in the future to give a reference or write a letter of recommendation for the terminated employee, be sure that everything you say is truthful and well documented.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
Impact of the Supreme Court Decision
Now that the Supreme Court has upheld the constitutionality of most of the Affordable Care Act, it behooves us to take a closer look at that law’s potential impact on physicians.
Last year I wrote that most physicians would see few changes in the near term, largely because the essential changes sought by physicians – tort reform, and revision of the ill-conceived Medicare compensation rules that threaten to cut payments by 25% every few months – were never addressed.
That said, many of the law’s provisions did favor physicians in the short term. As of last year, insurers could no longer cancel policies already issued, nor could they exclude applicants who were previously uninsurable because of chronic ailments. This provision indirectly triggered the Supreme Court’s involvement, since insurers cannot afford to cover patients with existing conditions without a mandate that all individuals purchase coverage. (Without that, healthy people would have no reason to buy insurance until they got sick, the equivalent of waiting to buy fire insurance until your house was aflame.) The case before the court centered on the constitutionality of the individual mandate, which was upheld.
Other highlights of the Affordable Care Act include prohibition of lifetime coverage limits and guaranteed coverage of dependents on their parents’ policies until they are 26 years old. Early retirees do not have to risk going uninsured until they qualify for Medicare, and Medicare’s infamous "doughnut hole" is gradually closing. Small businesses now receive tax-credit incentives to insure their workers.
All of this adds up to more paying patients, with better insurance. However, as additional provisions come online this year, the long-range potential impact on private practitioners becomes more uncertain, and more ominous.
"Physician payment reforms" will begin to appear. Although no one yet knows exactly what that means, the law mandates the formation of "accountable care organizations" to "improve quality and efficiency of care." The buzzword will be outcomes – the better your measurable results, the higher your reimbursements. This is supposed to reward quality of care over volume of procedures, but the result could be exactly the opposite if less-motivated providers cherry pick the quick, easy, least-risky cases and refer anything time consuming or complex to tertiary centers.
In 2013, Medicare will introduce a national program of payment bundling. A single hospital admission, for example, will be paid with a single bundled payment that will have to be divided among the hospital and treating physicians. The idea, ostensibly, is to encourage physicians and hospitals to work together to "better coordinate patient care," but arguments over how to divide the pie could, once again, have the opposite effect.
And it won’t take long for hospitals to figure out that they can keep the whole pie if the partnering physicians are their employees. So look for more private offices to be absorbed by hospitals, which already employ almost a third of all physicians.
By 2014, states will have to set up "SHOP Exchanges" (Small Business Health Options Programs), allowing small businesses (defined as 100 employees or less) to pool their resources to buy health insurance. Most people will, by then, be required to have health insurance coverage or pay a fine if they don’t. Employers not offering coverage will face fines and other penalties, and health insurance companies will begin paying a fee based on their market share, which will no doubt be passed along to those they insure, nullifying some of the savings garnered by the SHOP Exchanges, which are already predicted to be marginal.
The big Medicaid expansion will be in place by 2014 as well, but few physicians are likely to accept more Medicaid patients unless compensation increases. That is unlikely to happen without substantial reductions in the states’ woeful budget deficits – and probably not even then, since state governments already complain about their Medicaid budgets. Hospitals, with their deeper pockets, will get most of the new Medicaid patients and will hire even more physicians away from private practice to treat them.
If this sounds like a potential problem for private practice as we know it, it is. Then again, it’s too early for reliable predictions: The recent Supreme Court decision notwithstanding, there is a lot of potential leeway in the new law’s future specifications; and a lot can happen between now and full implementation, from modifications and amendments to outright repeal. Only time will tell.
Dr. Joseph S. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. To respond to this column, email him at our editorial offices at [email protected].
Now that the Supreme Court has upheld the constitutionality of most of the Affordable Care Act, it behooves us to take a closer look at that law’s potential impact on physicians.
Last year I wrote that most physicians would see few changes in the near term, largely because the essential changes sought by physicians – tort reform, and revision of the ill-conceived Medicare compensation rules that threaten to cut payments by 25% every few months – were never addressed.
That said, many of the law’s provisions did favor physicians in the short term. As of last year, insurers could no longer cancel policies already issued, nor could they exclude applicants who were previously uninsurable because of chronic ailments. This provision indirectly triggered the Supreme Court’s involvement, since insurers cannot afford to cover patients with existing conditions without a mandate that all individuals purchase coverage. (Without that, healthy people would have no reason to buy insurance until they got sick, the equivalent of waiting to buy fire insurance until your house was aflame.) The case before the court centered on the constitutionality of the individual mandate, which was upheld.
Other highlights of the Affordable Care Act include prohibition of lifetime coverage limits and guaranteed coverage of dependents on their parents’ policies until they are 26 years old. Early retirees do not have to risk going uninsured until they qualify for Medicare, and Medicare’s infamous "doughnut hole" is gradually closing. Small businesses now receive tax-credit incentives to insure their workers.
All of this adds up to more paying patients, with better insurance. However, as additional provisions come online this year, the long-range potential impact on private practitioners becomes more uncertain, and more ominous.
"Physician payment reforms" will begin to appear. Although no one yet knows exactly what that means, the law mandates the formation of "accountable care organizations" to "improve quality and efficiency of care." The buzzword will be outcomes – the better your measurable results, the higher your reimbursements. This is supposed to reward quality of care over volume of procedures, but the result could be exactly the opposite if less-motivated providers cherry pick the quick, easy, least-risky cases and refer anything time consuming or complex to tertiary centers.
In 2013, Medicare will introduce a national program of payment bundling. A single hospital admission, for example, will be paid with a single bundled payment that will have to be divided among the hospital and treating physicians. The idea, ostensibly, is to encourage physicians and hospitals to work together to "better coordinate patient care," but arguments over how to divide the pie could, once again, have the opposite effect.
And it won’t take long for hospitals to figure out that they can keep the whole pie if the partnering physicians are their employees. So look for more private offices to be absorbed by hospitals, which already employ almost a third of all physicians.
By 2014, states will have to set up "SHOP Exchanges" (Small Business Health Options Programs), allowing small businesses (defined as 100 employees or less) to pool their resources to buy health insurance. Most people will, by then, be required to have health insurance coverage or pay a fine if they don’t. Employers not offering coverage will face fines and other penalties, and health insurance companies will begin paying a fee based on their market share, which will no doubt be passed along to those they insure, nullifying some of the savings garnered by the SHOP Exchanges, which are already predicted to be marginal.
The big Medicaid expansion will be in place by 2014 as well, but few physicians are likely to accept more Medicaid patients unless compensation increases. That is unlikely to happen without substantial reductions in the states’ woeful budget deficits – and probably not even then, since state governments already complain about their Medicaid budgets. Hospitals, with their deeper pockets, will get most of the new Medicaid patients and will hire even more physicians away from private practice to treat them.
If this sounds like a potential problem for private practice as we know it, it is. Then again, it’s too early for reliable predictions: The recent Supreme Court decision notwithstanding, there is a lot of potential leeway in the new law’s future specifications; and a lot can happen between now and full implementation, from modifications and amendments to outright repeal. Only time will tell.
Dr. Joseph S. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. To respond to this column, email him at our editorial offices at [email protected].
Now that the Supreme Court has upheld the constitutionality of most of the Affordable Care Act, it behooves us to take a closer look at that law’s potential impact on physicians.
Last year I wrote that most physicians would see few changes in the near term, largely because the essential changes sought by physicians – tort reform, and revision of the ill-conceived Medicare compensation rules that threaten to cut payments by 25% every few months – were never addressed.
That said, many of the law’s provisions did favor physicians in the short term. As of last year, insurers could no longer cancel policies already issued, nor could they exclude applicants who were previously uninsurable because of chronic ailments. This provision indirectly triggered the Supreme Court’s involvement, since insurers cannot afford to cover patients with existing conditions without a mandate that all individuals purchase coverage. (Without that, healthy people would have no reason to buy insurance until they got sick, the equivalent of waiting to buy fire insurance until your house was aflame.) The case before the court centered on the constitutionality of the individual mandate, which was upheld.
Other highlights of the Affordable Care Act include prohibition of lifetime coverage limits and guaranteed coverage of dependents on their parents’ policies until they are 26 years old. Early retirees do not have to risk going uninsured until they qualify for Medicare, and Medicare’s infamous "doughnut hole" is gradually closing. Small businesses now receive tax-credit incentives to insure their workers.
All of this adds up to more paying patients, with better insurance. However, as additional provisions come online this year, the long-range potential impact on private practitioners becomes more uncertain, and more ominous.
"Physician payment reforms" will begin to appear. Although no one yet knows exactly what that means, the law mandates the formation of "accountable care organizations" to "improve quality and efficiency of care." The buzzword will be outcomes – the better your measurable results, the higher your reimbursements. This is supposed to reward quality of care over volume of procedures, but the result could be exactly the opposite if less-motivated providers cherry pick the quick, easy, least-risky cases and refer anything time consuming or complex to tertiary centers.
In 2013, Medicare will introduce a national program of payment bundling. A single hospital admission, for example, will be paid with a single bundled payment that will have to be divided among the hospital and treating physicians. The idea, ostensibly, is to encourage physicians and hospitals to work together to "better coordinate patient care," but arguments over how to divide the pie could, once again, have the opposite effect.
And it won’t take long for hospitals to figure out that they can keep the whole pie if the partnering physicians are their employees. So look for more private offices to be absorbed by hospitals, which already employ almost a third of all physicians.
By 2014, states will have to set up "SHOP Exchanges" (Small Business Health Options Programs), allowing small businesses (defined as 100 employees or less) to pool their resources to buy health insurance. Most people will, by then, be required to have health insurance coverage or pay a fine if they don’t. Employers not offering coverage will face fines and other penalties, and health insurance companies will begin paying a fee based on their market share, which will no doubt be passed along to those they insure, nullifying some of the savings garnered by the SHOP Exchanges, which are already predicted to be marginal.
The big Medicaid expansion will be in place by 2014 as well, but few physicians are likely to accept more Medicaid patients unless compensation increases. That is unlikely to happen without substantial reductions in the states’ woeful budget deficits – and probably not even then, since state governments already complain about their Medicaid budgets. Hospitals, with their deeper pockets, will get most of the new Medicaid patients and will hire even more physicians away from private practice to treat them.
If this sounds like a potential problem for private practice as we know it, it is. Then again, it’s too early for reliable predictions: The recent Supreme Court decision notwithstanding, there is a lot of potential leeway in the new law’s future specifications; and a lot can happen between now and full implementation, from modifications and amendments to outright repeal. Only time will tell.
Dr. Joseph S. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. To respond to this column, email him at our editorial offices at [email protected].
Hiring the Right Employees
As I write this, the government’s "new jobs" figures are at last turning a bit optimistic. This is consistent with the growing number of questions I’m receiving on a subject that hasn’t come up for awhile: hiring new employees. So although we probably haven’t seen the end of the Great Recession just yet, now might be a good time to review the basic rules in preparation for getting your office back to full speed.
Many of the personnel questions I receive concern the dreaded "marginal employee": the person who has done neither anything heinous enough to merit firing, nor anything special to merit continued employment. I always advise getting rid of such people, and then changing the hiring criteria that all too often result in poor hires.
Most bad hires come about because the employer does not have a clear vision of the kind of employee he or she wants. Many office manuals do not contain detailed job descriptions. If you don’t know exactly what you are looking for, your entire selection process will be inadequate, from your initial screening of applicants through your assessments of their skills and personalities. Many physicians compound the problem with poor interview techniques and inadequate checking of references.
So now – before a job vacancy occurs – is the time to reevaluate your entire hiring process. Take a hard look at your job descriptions, or start compiling them if you don’t have any. A good description lists the major responsibilities of the position, with the relative importance of each duty and the critical knowledge, skills, and education levels necessary for each function. In other words, it describes (accurately and in detail) exactly what you expect from the employee you will hire to perform that job.
Once you have a clear job description in mind (and in print), take all the time you need to find the best possible match. This is not a place to cut corners. Screen your candidates carefully, and avoid lowering your expectations. This is the point at which it might be tempting to settle for a marginal candidate, just to get the process over with.
It is also sometimes tempting to hire the candidate that you have the "best feeling" about, even though he or she is a poor match for the job, and then try to mold the job to that person. Every doctor knows that hunches are no substitute for hard data.
Be alert for red flags in resumes: significant time gaps between jobs; positions at companies that are no longer in business, or are otherwise impossible to verify; job titles that don’t make sense, given the applicant’s qualifications.
Background checks are a dicey subject, but publicly available information can be found, cheaply or free, on multiple websites created for that purpose. Be sure to tell applicants that you will be verifying facts in their resumes; it’s usually wise to get their written consent to do so.
Many employers skip the essential step of calling references; many applicants know that. Some old bosses will be reluctant to tell you anything substantive; I always ask, "Would you hire this person again?" You can interpret a lot from the answer – or lack of.
Interviews often get short shrift as well. Many doctors tend to do all the talking; as I’ve observed numerous times, listening is not our strong suit, as a general rule. The purpose of an interview is to allow you to size up the prospective employee, not to deliver a lecture on the sterling attributes of your office. Important interview topics include educational background, skills, experience, and unrelated job history.
By law, you cannot ask an applicant’s age, date of birth, gender, creed, color, religion, or national origin. Other forbidden subjects include disabilities, marital status, military record, number of children (or who cares for them), addiction history, citizenship, criminal record, psychiatric history, absenteeism, or workers’ compensation.
But there are acceptable alternatives to some of those questions: You can ask if an applicant has ever gone by another name (for your background check), for example. You can ask if he or she is legally authorized to work in this country, and whether he or she will be physically able to perform the duties specified in the job description. Although past addictions are off limits, you do have a right to know about current addictions to illegal substances.
Once you have hired people whose skills and personalities best fit your needs, train them well, and then give them the opportunity to succeed. "The best executive," wrote Theodore Roosevelt, "is the one who has sense enough to pick good people to do what he [or she] wants done, and self-restraint enough to keep from meddling with them while they do it."
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
As I write this, the government’s "new jobs" figures are at last turning a bit optimistic. This is consistent with the growing number of questions I’m receiving on a subject that hasn’t come up for awhile: hiring new employees. So although we probably haven’t seen the end of the Great Recession just yet, now might be a good time to review the basic rules in preparation for getting your office back to full speed.
Many of the personnel questions I receive concern the dreaded "marginal employee": the person who has done neither anything heinous enough to merit firing, nor anything special to merit continued employment. I always advise getting rid of such people, and then changing the hiring criteria that all too often result in poor hires.
Most bad hires come about because the employer does not have a clear vision of the kind of employee he or she wants. Many office manuals do not contain detailed job descriptions. If you don’t know exactly what you are looking for, your entire selection process will be inadequate, from your initial screening of applicants through your assessments of their skills and personalities. Many physicians compound the problem with poor interview techniques and inadequate checking of references.
So now – before a job vacancy occurs – is the time to reevaluate your entire hiring process. Take a hard look at your job descriptions, or start compiling them if you don’t have any. A good description lists the major responsibilities of the position, with the relative importance of each duty and the critical knowledge, skills, and education levels necessary for each function. In other words, it describes (accurately and in detail) exactly what you expect from the employee you will hire to perform that job.
Once you have a clear job description in mind (and in print), take all the time you need to find the best possible match. This is not a place to cut corners. Screen your candidates carefully, and avoid lowering your expectations. This is the point at which it might be tempting to settle for a marginal candidate, just to get the process over with.
It is also sometimes tempting to hire the candidate that you have the "best feeling" about, even though he or she is a poor match for the job, and then try to mold the job to that person. Every doctor knows that hunches are no substitute for hard data.
Be alert for red flags in resumes: significant time gaps between jobs; positions at companies that are no longer in business, or are otherwise impossible to verify; job titles that don’t make sense, given the applicant’s qualifications.
Background checks are a dicey subject, but publicly available information can be found, cheaply or free, on multiple websites created for that purpose. Be sure to tell applicants that you will be verifying facts in their resumes; it’s usually wise to get their written consent to do so.
Many employers skip the essential step of calling references; many applicants know that. Some old bosses will be reluctant to tell you anything substantive; I always ask, "Would you hire this person again?" You can interpret a lot from the answer – or lack of.
Interviews often get short shrift as well. Many doctors tend to do all the talking; as I’ve observed numerous times, listening is not our strong suit, as a general rule. The purpose of an interview is to allow you to size up the prospective employee, not to deliver a lecture on the sterling attributes of your office. Important interview topics include educational background, skills, experience, and unrelated job history.
By law, you cannot ask an applicant’s age, date of birth, gender, creed, color, religion, or national origin. Other forbidden subjects include disabilities, marital status, military record, number of children (or who cares for them), addiction history, citizenship, criminal record, psychiatric history, absenteeism, or workers’ compensation.
But there are acceptable alternatives to some of those questions: You can ask if an applicant has ever gone by another name (for your background check), for example. You can ask if he or she is legally authorized to work in this country, and whether he or she will be physically able to perform the duties specified in the job description. Although past addictions are off limits, you do have a right to know about current addictions to illegal substances.
Once you have hired people whose skills and personalities best fit your needs, train them well, and then give them the opportunity to succeed. "The best executive," wrote Theodore Roosevelt, "is the one who has sense enough to pick good people to do what he [or she] wants done, and self-restraint enough to keep from meddling with them while they do it."
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
As I write this, the government’s "new jobs" figures are at last turning a bit optimistic. This is consistent with the growing number of questions I’m receiving on a subject that hasn’t come up for awhile: hiring new employees. So although we probably haven’t seen the end of the Great Recession just yet, now might be a good time to review the basic rules in preparation for getting your office back to full speed.
Many of the personnel questions I receive concern the dreaded "marginal employee": the person who has done neither anything heinous enough to merit firing, nor anything special to merit continued employment. I always advise getting rid of such people, and then changing the hiring criteria that all too often result in poor hires.
Most bad hires come about because the employer does not have a clear vision of the kind of employee he or she wants. Many office manuals do not contain detailed job descriptions. If you don’t know exactly what you are looking for, your entire selection process will be inadequate, from your initial screening of applicants through your assessments of their skills and personalities. Many physicians compound the problem with poor interview techniques and inadequate checking of references.
So now – before a job vacancy occurs – is the time to reevaluate your entire hiring process. Take a hard look at your job descriptions, or start compiling them if you don’t have any. A good description lists the major responsibilities of the position, with the relative importance of each duty and the critical knowledge, skills, and education levels necessary for each function. In other words, it describes (accurately and in detail) exactly what you expect from the employee you will hire to perform that job.
Once you have a clear job description in mind (and in print), take all the time you need to find the best possible match. This is not a place to cut corners. Screen your candidates carefully, and avoid lowering your expectations. This is the point at which it might be tempting to settle for a marginal candidate, just to get the process over with.
It is also sometimes tempting to hire the candidate that you have the "best feeling" about, even though he or she is a poor match for the job, and then try to mold the job to that person. Every doctor knows that hunches are no substitute for hard data.
Be alert for red flags in resumes: significant time gaps between jobs; positions at companies that are no longer in business, or are otherwise impossible to verify; job titles that don’t make sense, given the applicant’s qualifications.
Background checks are a dicey subject, but publicly available information can be found, cheaply or free, on multiple websites created for that purpose. Be sure to tell applicants that you will be verifying facts in their resumes; it’s usually wise to get their written consent to do so.
Many employers skip the essential step of calling references; many applicants know that. Some old bosses will be reluctant to tell you anything substantive; I always ask, "Would you hire this person again?" You can interpret a lot from the answer – or lack of.
Interviews often get short shrift as well. Many doctors tend to do all the talking; as I’ve observed numerous times, listening is not our strong suit, as a general rule. The purpose of an interview is to allow you to size up the prospective employee, not to deliver a lecture on the sterling attributes of your office. Important interview topics include educational background, skills, experience, and unrelated job history.
By law, you cannot ask an applicant’s age, date of birth, gender, creed, color, religion, or national origin. Other forbidden subjects include disabilities, marital status, military record, number of children (or who cares for them), addiction history, citizenship, criminal record, psychiatric history, absenteeism, or workers’ compensation.
But there are acceptable alternatives to some of those questions: You can ask if an applicant has ever gone by another name (for your background check), for example. You can ask if he or she is legally authorized to work in this country, and whether he or she will be physically able to perform the duties specified in the job description. Although past addictions are off limits, you do have a right to know about current addictions to illegal substances.
Once you have hired people whose skills and personalities best fit your needs, train them well, and then give them the opportunity to succeed. "The best executive," wrote Theodore Roosevelt, "is the one who has sense enough to pick good people to do what he [or she] wants done, and self-restraint enough to keep from meddling with them while they do it."
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
Managing Your Dermatology Practice: Work Less
Year’s end is a good time to do your annual maintenance evaluation. Check all of your equipment for malfunctions. Have your curettes and scissors resharpened. Back up your computer files and upgrade software as necessary. And above all, take a good look at the status of your most important asset: yourself.
I write this reminder every couple of years because it’s so easy to lose sight of the big picture among the pressures of our daily routines. Sooner or later, no matter how dedicated we are, the grind gets to all of us, leading to fatigue, irritability, and a progressive decline in motivation. And we are too busy to sit down and think about what we might do to break that vicious cycle. This is detrimental to our own well-being, as well as that of our patients.
There are many ways to maintain your intellectual and emotional health, but here’s how I do it: I work less. Yes, less. I take individual days off (average of one a month) to catch up on journals, take a CME course, or to try something new – something I’ve been thinking about doing "someday, when there is time" – such as a piano or sailing lessons, or a long weekend away with my wife. And I take no less than 4 weeks’ vacation per year.
I know how some of you feel about "wasting" a workday. Vacations are even worse because patients might go elsewhere while you’re gone, and every day the office is idle, we "lose money."
That whole paradigm is wrong. Stop thinking day to day; think year to year instead. You bring in a given amount of revenue per year – more on some days, less on others, and none on weekends and vacation days. It all averages out in the end.
Besides, this is much more important than money. This is breaking the routine, clearing the cobwebs, living your life. And trust me, your practice will still be there when you return.
I am writing this month’s column from Greece. Yesterday, my wife and I, and two of my kids, hiked to the top of the Byzantine ruins of Mystra on the Peloponnese Peninsula; tomorrow we will climb the sanctuary at Delfi. As I huff and puff up the trails, I don’t have the time – or the slightest inclination – to worry about the office. After these 10 days, I will return ready to take on the world, and my practice, anew.
And I will have jotted down some great ideas – practical, medical, and literary. Original thoughts are hard to come by during the daily grind, but they often appear, unannounced, in a new and refreshing environment.
Creative people have long recognized the value of working less. A classic example is the oft-told story of Swiss research scientists Alex Müller and J. Georg Bednorz. In 1986 they reached a major impasse in their superconductivity research; it appeared two decades of work might be for naught. The harder they pressed, the more elusive the answer became. So Müller decided to take time off, put aside his troubles, and research a subject that had always interested him: ceramics.
Nothing could have been further from his research field, of course, since ceramics are among the poorest conductors known. Yet as he relaxed, it occurred to Müller that a unique property of ceramics might apply to their project. Back in the lab, the team created a ceramic compound that became the first successful "high-temperature" superconductor.
The rest, as they say, is history; Müller and Bednorz won a Nobel Prize and triggered an explosion of research leading to breakthroughs in computing, electricity transmission, magnetically-elevated trains, and many other applications that are still being realized.
By working less, you may not change the world, but you will change you; any nudge out of your comfort zone will give you fresh ideas and help you look at the same old problems in completely new ways.
And to those who still can’t bear the thought of taking time off, remember Eastern’s Second Law: Your last words will NOT be, "I wish I had spent more time in the office!"
Year’s end is a good time to do your annual maintenance evaluation. Check all of your equipment for malfunctions. Have your curettes and scissors resharpened. Back up your computer files and upgrade software as necessary. And above all, take a good look at the status of your most important asset: yourself.
I write this reminder every couple of years because it’s so easy to lose sight of the big picture among the pressures of our daily routines. Sooner or later, no matter how dedicated we are, the grind gets to all of us, leading to fatigue, irritability, and a progressive decline in motivation. And we are too busy to sit down and think about what we might do to break that vicious cycle. This is detrimental to our own well-being, as well as that of our patients.
There are many ways to maintain your intellectual and emotional health, but here’s how I do it: I work less. Yes, less. I take individual days off (average of one a month) to catch up on journals, take a CME course, or to try something new – something I’ve been thinking about doing "someday, when there is time" – such as a piano or sailing lessons, or a long weekend away with my wife. And I take no less than 4 weeks’ vacation per year.
I know how some of you feel about "wasting" a workday. Vacations are even worse because patients might go elsewhere while you’re gone, and every day the office is idle, we "lose money."
That whole paradigm is wrong. Stop thinking day to day; think year to year instead. You bring in a given amount of revenue per year – more on some days, less on others, and none on weekends and vacation days. It all averages out in the end.
Besides, this is much more important than money. This is breaking the routine, clearing the cobwebs, living your life. And trust me, your practice will still be there when you return.
I am writing this month’s column from Greece. Yesterday, my wife and I, and two of my kids, hiked to the top of the Byzantine ruins of Mystra on the Peloponnese Peninsula; tomorrow we will climb the sanctuary at Delfi. As I huff and puff up the trails, I don’t have the time – or the slightest inclination – to worry about the office. After these 10 days, I will return ready to take on the world, and my practice, anew.
And I will have jotted down some great ideas – practical, medical, and literary. Original thoughts are hard to come by during the daily grind, but they often appear, unannounced, in a new and refreshing environment.
Creative people have long recognized the value of working less. A classic example is the oft-told story of Swiss research scientists Alex Müller and J. Georg Bednorz. In 1986 they reached a major impasse in their superconductivity research; it appeared two decades of work might be for naught. The harder they pressed, the more elusive the answer became. So Müller decided to take time off, put aside his troubles, and research a subject that had always interested him: ceramics.
Nothing could have been further from his research field, of course, since ceramics are among the poorest conductors known. Yet as he relaxed, it occurred to Müller that a unique property of ceramics might apply to their project. Back in the lab, the team created a ceramic compound that became the first successful "high-temperature" superconductor.
The rest, as they say, is history; Müller and Bednorz won a Nobel Prize and triggered an explosion of research leading to breakthroughs in computing, electricity transmission, magnetically-elevated trains, and many other applications that are still being realized.
By working less, you may not change the world, but you will change you; any nudge out of your comfort zone will give you fresh ideas and help you look at the same old problems in completely new ways.
And to those who still can’t bear the thought of taking time off, remember Eastern’s Second Law: Your last words will NOT be, "I wish I had spent more time in the office!"
Year’s end is a good time to do your annual maintenance evaluation. Check all of your equipment for malfunctions. Have your curettes and scissors resharpened. Back up your computer files and upgrade software as necessary. And above all, take a good look at the status of your most important asset: yourself.
I write this reminder every couple of years because it’s so easy to lose sight of the big picture among the pressures of our daily routines. Sooner or later, no matter how dedicated we are, the grind gets to all of us, leading to fatigue, irritability, and a progressive decline in motivation. And we are too busy to sit down and think about what we might do to break that vicious cycle. This is detrimental to our own well-being, as well as that of our patients.
There are many ways to maintain your intellectual and emotional health, but here’s how I do it: I work less. Yes, less. I take individual days off (average of one a month) to catch up on journals, take a CME course, or to try something new – something I’ve been thinking about doing "someday, when there is time" – such as a piano or sailing lessons, or a long weekend away with my wife. And I take no less than 4 weeks’ vacation per year.
I know how some of you feel about "wasting" a workday. Vacations are even worse because patients might go elsewhere while you’re gone, and every day the office is idle, we "lose money."
That whole paradigm is wrong. Stop thinking day to day; think year to year instead. You bring in a given amount of revenue per year – more on some days, less on others, and none on weekends and vacation days. It all averages out in the end.
Besides, this is much more important than money. This is breaking the routine, clearing the cobwebs, living your life. And trust me, your practice will still be there when you return.
I am writing this month’s column from Greece. Yesterday, my wife and I, and two of my kids, hiked to the top of the Byzantine ruins of Mystra on the Peloponnese Peninsula; tomorrow we will climb the sanctuary at Delfi. As I huff and puff up the trails, I don’t have the time – or the slightest inclination – to worry about the office. After these 10 days, I will return ready to take on the world, and my practice, anew.
And I will have jotted down some great ideas – practical, medical, and literary. Original thoughts are hard to come by during the daily grind, but they often appear, unannounced, in a new and refreshing environment.
Creative people have long recognized the value of working less. A classic example is the oft-told story of Swiss research scientists Alex Müller and J. Georg Bednorz. In 1986 they reached a major impasse in their superconductivity research; it appeared two decades of work might be for naught. The harder they pressed, the more elusive the answer became. So Müller decided to take time off, put aside his troubles, and research a subject that had always interested him: ceramics.
Nothing could have been further from his research field, of course, since ceramics are among the poorest conductors known. Yet as he relaxed, it occurred to Müller that a unique property of ceramics might apply to their project. Back in the lab, the team created a ceramic compound that became the first successful "high-temperature" superconductor.
The rest, as they say, is history; Müller and Bednorz won a Nobel Prize and triggered an explosion of research leading to breakthroughs in computing, electricity transmission, magnetically-elevated trains, and many other applications that are still being realized.
By working less, you may not change the world, but you will change you; any nudge out of your comfort zone will give you fresh ideas and help you look at the same old problems in completely new ways.
And to those who still can’t bear the thought of taking time off, remember Eastern’s Second Law: Your last words will NOT be, "I wish I had spent more time in the office!"
Editorial: E-Prescribing Update
You’re probably tired of reading about electronic prescribing by now, and I really thought I was done writing about it for the year when I summarized the "final" 2011 rules.
Now, however, CMS has proposed further rule modifications in the spirit, they say, of working with physicians to encourage the wider use of e-prescribing technology.
In order to qualify for the 2011 incentive, the rules required you to send at least 10 electronic Medicare or Medicaid prescriptions by the end of June (and report them to CMS using the G8553 code by the end of July), followed by a minimum of 15 more by the end of the year.
So if you missed the June deadline, you are ineligible for the 2011 incentive no matter what you do in the second half of 2011. But you can use the remainder of the year to prepare for 2012, the first year that failing to e-prescribe will incur a 1% penalty against Medicare/Medicaid payments. (In 2013 the penalty increases to 1.5%, and then to 2% in 2014 and beyond.)
Practices in rural areas, those without high-speed Internet access, and those lacking a sufficient number of pharmacies equipped to accept electronic prescriptions may apply for exemptions.
Now, CMS has proposed additional exemption opportunities for practices that write very few prescriptions, and those that write large numbers of prescriptions for drugs that cannot, by law, be prescribed electronically (such as most narcotics).
Offices that see very few Medicare or Medicaid patients can still qualify for the incentive if at least 10% of their Medicare Part B claims involve an electronic prescription.
As I mentioned previously, many electronic health record systems do not satisfy e-prescribing requirements because the prescription software simply generates faxes that arrive, on paper, in the pharmacy’s fax machine.
Under the proposed new rules, however, any certified electronic health records (EHR) system would be considered a "qualified" e-prescribing system, even those that don’t send prescriptions electronically. (The government’s other major goal, after all, is to increase EHR usage.)
To be clear, manual faxing of prescriptions to pharmacies will still not qualify as e-prescribing, which remains, by definition, computer-to-computer (paperless) communication of prescriptions. If you don’t have a qualified EHR, you will still need to use a qualified stand-alone e-prescribing system.
Either way, the e-prescribing G-code must be submitted with a line-item charge of zero dollars ($0.00) at the time the associated covered service is billed. Those line items will be denied for payment, but are passed through the claims processing system to the National Claims History database (NCH), which will keep track of your e-prescribing usage.
Fortunately, a coalition of insurance and technology companies called the National e-Prescribing Patient Safety Initiative (NEPSI) has made it quite easy to acquire free qualified e-prescribing technology. Setup methods vary, but the concepts and requirements for each company are generally similar. In most cases, all you need to get started is an Internet-enabled computer with a high-speed connection and a database of patients.
NEPSI has also encouraged pharmacies to make themselves compatible, and about 75% of them can now handle electronic prescriptions.
Keep in mind that this will not be a complete transition; once you’re set up, you cannot throw away your paper prescription pads.
Beside the pharmacies not yet equipped for e-prescribing, the Drug Enforcement Administration strongly discourages sending controlled substance prescriptions electronically. (The DEA has, however, relaxed its rules somewhat on this issue in the past year.)
A nonprofit foundation called eHealth Initiative has released an excellent guide for physicians on e-prescribing.
A list of other companies currently offering e-prescribing software, along with links to their respective websites, can be found at eprescribing.info.
Next year will be pivotal for electronic prescribing: If you are a Medicare or Medicaid participator you will either have to take the plunge or incur a penalty. However, with the free NEPSI program and only 25 e-prescriptions required over the course of an entire year, you can try out the technology with minimal cost and inconvenience.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
You’re probably tired of reading about electronic prescribing by now, and I really thought I was done writing about it for the year when I summarized the "final" 2011 rules.
Now, however, CMS has proposed further rule modifications in the spirit, they say, of working with physicians to encourage the wider use of e-prescribing technology.
In order to qualify for the 2011 incentive, the rules required you to send at least 10 electronic Medicare or Medicaid prescriptions by the end of June (and report them to CMS using the G8553 code by the end of July), followed by a minimum of 15 more by the end of the year.
So if you missed the June deadline, you are ineligible for the 2011 incentive no matter what you do in the second half of 2011. But you can use the remainder of the year to prepare for 2012, the first year that failing to e-prescribe will incur a 1% penalty against Medicare/Medicaid payments. (In 2013 the penalty increases to 1.5%, and then to 2% in 2014 and beyond.)
Practices in rural areas, those without high-speed Internet access, and those lacking a sufficient number of pharmacies equipped to accept electronic prescriptions may apply for exemptions.
Now, CMS has proposed additional exemption opportunities for practices that write very few prescriptions, and those that write large numbers of prescriptions for drugs that cannot, by law, be prescribed electronically (such as most narcotics).
Offices that see very few Medicare or Medicaid patients can still qualify for the incentive if at least 10% of their Medicare Part B claims involve an electronic prescription.
As I mentioned previously, many electronic health record systems do not satisfy e-prescribing requirements because the prescription software simply generates faxes that arrive, on paper, in the pharmacy’s fax machine.
Under the proposed new rules, however, any certified electronic health records (EHR) system would be considered a "qualified" e-prescribing system, even those that don’t send prescriptions electronically. (The government’s other major goal, after all, is to increase EHR usage.)
To be clear, manual faxing of prescriptions to pharmacies will still not qualify as e-prescribing, which remains, by definition, computer-to-computer (paperless) communication of prescriptions. If you don’t have a qualified EHR, you will still need to use a qualified stand-alone e-prescribing system.
Either way, the e-prescribing G-code must be submitted with a line-item charge of zero dollars ($0.00) at the time the associated covered service is billed. Those line items will be denied for payment, but are passed through the claims processing system to the National Claims History database (NCH), which will keep track of your e-prescribing usage.
Fortunately, a coalition of insurance and technology companies called the National e-Prescribing Patient Safety Initiative (NEPSI) has made it quite easy to acquire free qualified e-prescribing technology. Setup methods vary, but the concepts and requirements for each company are generally similar. In most cases, all you need to get started is an Internet-enabled computer with a high-speed connection and a database of patients.
NEPSI has also encouraged pharmacies to make themselves compatible, and about 75% of them can now handle electronic prescriptions.
Keep in mind that this will not be a complete transition; once you’re set up, you cannot throw away your paper prescription pads.
Beside the pharmacies not yet equipped for e-prescribing, the Drug Enforcement Administration strongly discourages sending controlled substance prescriptions electronically. (The DEA has, however, relaxed its rules somewhat on this issue in the past year.)
A nonprofit foundation called eHealth Initiative has released an excellent guide for physicians on e-prescribing.
A list of other companies currently offering e-prescribing software, along with links to their respective websites, can be found at eprescribing.info.
Next year will be pivotal for electronic prescribing: If you are a Medicare or Medicaid participator you will either have to take the plunge or incur a penalty. However, with the free NEPSI program and only 25 e-prescriptions required over the course of an entire year, you can try out the technology with minimal cost and inconvenience.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
You’re probably tired of reading about electronic prescribing by now, and I really thought I was done writing about it for the year when I summarized the "final" 2011 rules.
Now, however, CMS has proposed further rule modifications in the spirit, they say, of working with physicians to encourage the wider use of e-prescribing technology.
In order to qualify for the 2011 incentive, the rules required you to send at least 10 electronic Medicare or Medicaid prescriptions by the end of June (and report them to CMS using the G8553 code by the end of July), followed by a minimum of 15 more by the end of the year.
So if you missed the June deadline, you are ineligible for the 2011 incentive no matter what you do in the second half of 2011. But you can use the remainder of the year to prepare for 2012, the first year that failing to e-prescribe will incur a 1% penalty against Medicare/Medicaid payments. (In 2013 the penalty increases to 1.5%, and then to 2% in 2014 and beyond.)
Practices in rural areas, those without high-speed Internet access, and those lacking a sufficient number of pharmacies equipped to accept electronic prescriptions may apply for exemptions.
Now, CMS has proposed additional exemption opportunities for practices that write very few prescriptions, and those that write large numbers of prescriptions for drugs that cannot, by law, be prescribed electronically (such as most narcotics).
Offices that see very few Medicare or Medicaid patients can still qualify for the incentive if at least 10% of their Medicare Part B claims involve an electronic prescription.
As I mentioned previously, many electronic health record systems do not satisfy e-prescribing requirements because the prescription software simply generates faxes that arrive, on paper, in the pharmacy’s fax machine.
Under the proposed new rules, however, any certified electronic health records (EHR) system would be considered a "qualified" e-prescribing system, even those that don’t send prescriptions electronically. (The government’s other major goal, after all, is to increase EHR usage.)
To be clear, manual faxing of prescriptions to pharmacies will still not qualify as e-prescribing, which remains, by definition, computer-to-computer (paperless) communication of prescriptions. If you don’t have a qualified EHR, you will still need to use a qualified stand-alone e-prescribing system.
Either way, the e-prescribing G-code must be submitted with a line-item charge of zero dollars ($0.00) at the time the associated covered service is billed. Those line items will be denied for payment, but are passed through the claims processing system to the National Claims History database (NCH), which will keep track of your e-prescribing usage.
Fortunately, a coalition of insurance and technology companies called the National e-Prescribing Patient Safety Initiative (NEPSI) has made it quite easy to acquire free qualified e-prescribing technology. Setup methods vary, but the concepts and requirements for each company are generally similar. In most cases, all you need to get started is an Internet-enabled computer with a high-speed connection and a database of patients.
NEPSI has also encouraged pharmacies to make themselves compatible, and about 75% of them can now handle electronic prescriptions.
Keep in mind that this will not be a complete transition; once you’re set up, you cannot throw away your paper prescription pads.
Beside the pharmacies not yet equipped for e-prescribing, the Drug Enforcement Administration strongly discourages sending controlled substance prescriptions electronically. (The DEA has, however, relaxed its rules somewhat on this issue in the past year.)
A nonprofit foundation called eHealth Initiative has released an excellent guide for physicians on e-prescribing.
A list of other companies currently offering e-prescribing software, along with links to their respective websites, can be found at eprescribing.info.
Next year will be pivotal for electronic prescribing: If you are a Medicare or Medicaid participator you will either have to take the plunge or incur a penalty. However, with the free NEPSI program and only 25 e-prescriptions required over the course of an entire year, you can try out the technology with minimal cost and inconvenience.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
E-Prescribing Update
About this time last year, I wrote about electronic prescribing and the incentives that had been put in place to encourage adoption. Apparently, most of you were unimpressed; a year later e-prescribing use has increased only marginally.
The Centers for Medicare and Medicaid Services thought it could turn the tide in 2009 by adding a financial incentive: a 2% bonus on Medicare Part B payments. That didn’t do the trick either; accessibility and cost issues remained, and the various "G" codes that had to be added to Medicare claims to document e-prescribing were confusing and annoying.
In 2010, CMS made it much easier to collect the incentive with minimum e-prescribing effort: If you could show that you were using a qualified e-prescribing program on only 25 Medicare claims over the course of the entire year, you got a 2% bonus on every Medicare Part B claim you filed over the entire year. They also replaced myriad confusing "G" codes with a single one, G8553.
If none of these incentives has swayed you, 2011 might be the year you are finally persuaded: CMS has not sweetened the deal. In fact, the bonus is reduced to 1% this year. But 2011 is the last year you can avoid going electronic without generating a penalty.
In 2012, physicians filing at least the minimum 25 Medicare claims will receive a 1% bonus, but those not doing so will incur a 1% penalty. In 2013, the incentive drops to 0.5%, and the penalty increases to 1.5%. In 2014, and beyond, there will be no incentive, but the penalty will rise to 2% and remain there.
To be clear (and I have been asked about this more than once), faxing a prescription to a pharmacy is not e-prescribing, which, by definition, is computer-to-computer (paperless) communication of prescriptions. Many electronic medical record users are under the erroneous impression that they are e-prescribing via their EMR, when the EMR is simply generating faxes that arrive, on paper, in the pharmacy’s fax machine. That is not considered e-prescribing by CMS, and it does not qualify for the incentive program.
A coalition of insurance and technology companies called the National ePrescribing Patient Safety Initiative (NEPSI) has provided $100 million in funding to offer free e-prescribing technology that qualifies for the program to physicians nationwide. NEPSI members include Allscripts, Surescripts, and NaviMedix, as well as Google, Dell, Cisco Systems, Fujitsu, Microsoft, Sprint Nextel, Aetna, Horizon Blue Cross Blue Shield, WellPoint, and Wolters Kluwer Health. (I have no financial interest in any company or product mentioned in this column.)
Thanks to the efforts of NEPSI and others, e-prescribing is now easy for most practices to set up and use. Pharmacies have already done most of the work to make themselves compatible; about 70% of U.S. pharmacies can now handle electronic prescriptions.
Setup methods vary, but the concepts and requirements for each company are generally similar. You can incorporate bona fide e-prescribing into many electronic health record systems, or set it up as a separate, stand-alone system. In most cases, all you need to get started is an Internet-enabled computer with a high-speed connection and a database of patients.
Keep in mind that this will not be a complete transition; once you’re set up, you cannot throw away your paper prescription pads. Besides the 30% of pharmacies not yet equipped for e-prescribing, the Drug Enforcement Administration strongly discourages sending controlled substance prescriptions electronically. (The DEA has, however, relaxed its rules somewhat on this issue in the past year.)
You can learn more about NEPSI, and sign up for their free, online-based prescribing software at www.nationalerx.com.
A list of other companies currently offering e-prescribing software, along with links to their respective Web sites, is offered by a nonprofit foundation called eHealth Initiative.
Details of the CMS incentive program are available from CMS.
Whether or not a mere 1% incentive impresses you, you’ll need to sign up this year or next to avoid a penalty; and with the free NEPSI program and only 25 e-prescriptions required to qualify, you will expend a minimum of cost and inconvenience in giving it a try.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
About this time last year, I wrote about electronic prescribing and the incentives that had been put in place to encourage adoption. Apparently, most of you were unimpressed; a year later e-prescribing use has increased only marginally.
The Centers for Medicare and Medicaid Services thought it could turn the tide in 2009 by adding a financial incentive: a 2% bonus on Medicare Part B payments. That didn’t do the trick either; accessibility and cost issues remained, and the various "G" codes that had to be added to Medicare claims to document e-prescribing were confusing and annoying.
In 2010, CMS made it much easier to collect the incentive with minimum e-prescribing effort: If you could show that you were using a qualified e-prescribing program on only 25 Medicare claims over the course of the entire year, you got a 2% bonus on every Medicare Part B claim you filed over the entire year. They also replaced myriad confusing "G" codes with a single one, G8553.
If none of these incentives has swayed you, 2011 might be the year you are finally persuaded: CMS has not sweetened the deal. In fact, the bonus is reduced to 1% this year. But 2011 is the last year you can avoid going electronic without generating a penalty.
In 2012, physicians filing at least the minimum 25 Medicare claims will receive a 1% bonus, but those not doing so will incur a 1% penalty. In 2013, the incentive drops to 0.5%, and the penalty increases to 1.5%. In 2014, and beyond, there will be no incentive, but the penalty will rise to 2% and remain there.
To be clear (and I have been asked about this more than once), faxing a prescription to a pharmacy is not e-prescribing, which, by definition, is computer-to-computer (paperless) communication of prescriptions. Many electronic medical record users are under the erroneous impression that they are e-prescribing via their EMR, when the EMR is simply generating faxes that arrive, on paper, in the pharmacy’s fax machine. That is not considered e-prescribing by CMS, and it does not qualify for the incentive program.
A coalition of insurance and technology companies called the National ePrescribing Patient Safety Initiative (NEPSI) has provided $100 million in funding to offer free e-prescribing technology that qualifies for the program to physicians nationwide. NEPSI members include Allscripts, Surescripts, and NaviMedix, as well as Google, Dell, Cisco Systems, Fujitsu, Microsoft, Sprint Nextel, Aetna, Horizon Blue Cross Blue Shield, WellPoint, and Wolters Kluwer Health. (I have no financial interest in any company or product mentioned in this column.)
Thanks to the efforts of NEPSI and others, e-prescribing is now easy for most practices to set up and use. Pharmacies have already done most of the work to make themselves compatible; about 70% of U.S. pharmacies can now handle electronic prescriptions.
Setup methods vary, but the concepts and requirements for each company are generally similar. You can incorporate bona fide e-prescribing into many electronic health record systems, or set it up as a separate, stand-alone system. In most cases, all you need to get started is an Internet-enabled computer with a high-speed connection and a database of patients.
Keep in mind that this will not be a complete transition; once you’re set up, you cannot throw away your paper prescription pads. Besides the 30% of pharmacies not yet equipped for e-prescribing, the Drug Enforcement Administration strongly discourages sending controlled substance prescriptions electronically. (The DEA has, however, relaxed its rules somewhat on this issue in the past year.)
You can learn more about NEPSI, and sign up for their free, online-based prescribing software at www.nationalerx.com.
A list of other companies currently offering e-prescribing software, along with links to their respective Web sites, is offered by a nonprofit foundation called eHealth Initiative.
Details of the CMS incentive program are available from CMS.
Whether or not a mere 1% incentive impresses you, you’ll need to sign up this year or next to avoid a penalty; and with the free NEPSI program and only 25 e-prescriptions required to qualify, you will expend a minimum of cost and inconvenience in giving it a try.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
About this time last year, I wrote about electronic prescribing and the incentives that had been put in place to encourage adoption. Apparently, most of you were unimpressed; a year later e-prescribing use has increased only marginally.
The Centers for Medicare and Medicaid Services thought it could turn the tide in 2009 by adding a financial incentive: a 2% bonus on Medicare Part B payments. That didn’t do the trick either; accessibility and cost issues remained, and the various "G" codes that had to be added to Medicare claims to document e-prescribing were confusing and annoying.
In 2010, CMS made it much easier to collect the incentive with minimum e-prescribing effort: If you could show that you were using a qualified e-prescribing program on only 25 Medicare claims over the course of the entire year, you got a 2% bonus on every Medicare Part B claim you filed over the entire year. They also replaced myriad confusing "G" codes with a single one, G8553.
If none of these incentives has swayed you, 2011 might be the year you are finally persuaded: CMS has not sweetened the deal. In fact, the bonus is reduced to 1% this year. But 2011 is the last year you can avoid going electronic without generating a penalty.
In 2012, physicians filing at least the minimum 25 Medicare claims will receive a 1% bonus, but those not doing so will incur a 1% penalty. In 2013, the incentive drops to 0.5%, and the penalty increases to 1.5%. In 2014, and beyond, there will be no incentive, but the penalty will rise to 2% and remain there.
To be clear (and I have been asked about this more than once), faxing a prescription to a pharmacy is not e-prescribing, which, by definition, is computer-to-computer (paperless) communication of prescriptions. Many electronic medical record users are under the erroneous impression that they are e-prescribing via their EMR, when the EMR is simply generating faxes that arrive, on paper, in the pharmacy’s fax machine. That is not considered e-prescribing by CMS, and it does not qualify for the incentive program.
A coalition of insurance and technology companies called the National ePrescribing Patient Safety Initiative (NEPSI) has provided $100 million in funding to offer free e-prescribing technology that qualifies for the program to physicians nationwide. NEPSI members include Allscripts, Surescripts, and NaviMedix, as well as Google, Dell, Cisco Systems, Fujitsu, Microsoft, Sprint Nextel, Aetna, Horizon Blue Cross Blue Shield, WellPoint, and Wolters Kluwer Health. (I have no financial interest in any company or product mentioned in this column.)
Thanks to the efforts of NEPSI and others, e-prescribing is now easy for most practices to set up and use. Pharmacies have already done most of the work to make themselves compatible; about 70% of U.S. pharmacies can now handle electronic prescriptions.
Setup methods vary, but the concepts and requirements for each company are generally similar. You can incorporate bona fide e-prescribing into many electronic health record systems, or set it up as a separate, stand-alone system. In most cases, all you need to get started is an Internet-enabled computer with a high-speed connection and a database of patients.
Keep in mind that this will not be a complete transition; once you’re set up, you cannot throw away your paper prescription pads. Besides the 30% of pharmacies not yet equipped for e-prescribing, the Drug Enforcement Administration strongly discourages sending controlled substance prescriptions electronically. (The DEA has, however, relaxed its rules somewhat on this issue in the past year.)
You can learn more about NEPSI, and sign up for their free, online-based prescribing software at www.nationalerx.com.
A list of other companies currently offering e-prescribing software, along with links to their respective Web sites, is offered by a nonprofit foundation called eHealth Initiative.
Details of the CMS incentive program are available from CMS.
Whether or not a mere 1% incentive impresses you, you’ll need to sign up this year or next to avoid a penalty; and with the free NEPSI program and only 25 e-prescriptions required to qualify, you will expend a minimum of cost and inconvenience in giving it a try.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
E-Prescribing Update
About this time last year, I wrote about electronic prescribing and the incentives that had been put in place to encourage adoption. Apparently, most of you were unimpressed; a year later e-prescribing use has increased only marginally.
The Centers for Medicare and Medicaid Services thought it could turn the tide in 2009 by adding a financial incentive: a 2% bonus on Medicare Part B payments. That didn’t do the trick either; accessibility and cost issues remained, and the various "G" codes that had to be added to Medicare claims to document e-prescribing were confusing and annoying.
In 2010, CMS made it much easier to collect the incentive with minimum e-prescribing effort: If you could show that you were using a qualified e-prescribing program on only 25 Medicare claims over the course of the entire year, you got a 2% bonus on every Medicare Part B claim you filed over the entire year. They also replaced myriad confusing "G" codes with a single one, G8553.
If none of these incentives has swayed you, 2011 might be the year you are finally persuaded: CMS has not sweetened the deal. In fact, the bonus is reduced to 1% this year. But 2011 is the last year you can avoid going electronic without generating a penalty.
In 2012, physicians filing at least the minimum 25 Medicare claims will receive a 1% bonus, but those not doing so will incur a 1% penalty. In 2013, the incentive drops to 0.5%, and the penalty increases to 1.5%. In 2014, and beyond, there will be no incentive, but the penalty will rise to 2% and remain there.
To be clear (and I have been asked about this more than once), faxing a prescription to a pharmacy is not e-prescribing, which, by definition, is computer-to-computer (paperless) communication of prescriptions. Many electronic medical record users are under the erroneous impression that they are e-prescribing via their EMR, when the EMR is simply generating faxes that arrive, on paper, in the pharmacy’s fax machine. That is not considered e-prescribing by CMS, and it does not qualify for the incentive program.
A coalition of insurance and technology companies called the National ePrescribing Patient Safety Initiative (NEPSI) has provided $100 million in funding to offer free e-prescribing technology that qualifies for the program to physicians nationwide. NEPSI members include Allscripts, Surescripts, and NaviMedix, as well as Google, Dell, Cisco Systems, Fujitsu, Microsoft, Sprint Nextel, Aetna, Horizon Blue Cross Blue Shield, WellPoint, and Wolters Kluwer Health. (I have no financial interest in any company or product mentioned in this column.)
Thanks to the efforts of NEPSI and others, e-prescribing is now easy for most practices to set up and use. Pharmacies have already done most of the work to make themselves compatible; about 70% of U.S. pharmacies can now handle electronic prescriptions.
Setup methods vary, but the concepts and requirements for each company are generally similar. You can incorporate bona fide e-prescribing into many electronic health record systems, or set it up as a separate, stand-alone system. In most cases, all you need to get started is an Internet-enabled computer with a high-speed connection and a database of patients.
Keep in mind that this will not be a complete transition; once you’re set up, you cannot throw away your paper prescription pads. Besides the 30% of pharmacies not yet equipped for e-prescribing, the Drug Enforcement Administration strongly discourages sending controlled substance prescriptions electronically. (The DEA has, however, relaxed its rules somewhat on this issue in the past year.)
You can learn more about NEPSI, and sign up for their free, online-based prescribing software at www.nationalerx.com.
A list of other companies currently offering e-prescribing software, along with links to their respective Web sites, is offered by a nonprofit foundation called eHealth Initiative.
Details of the CMS incentive program are available from CMS.
Whether or not a mere 1% incentive impresses you, you’ll need to sign up this year or next to avoid a penalty; and with the free NEPSI program and only 25 e-prescriptions required to qualify, you will expend a minimum of cost and inconvenience in giving it a try.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
About this time last year, I wrote about electronic prescribing and the incentives that had been put in place to encourage adoption. Apparently, most of you were unimpressed; a year later e-prescribing use has increased only marginally.
The Centers for Medicare and Medicaid Services thought it could turn the tide in 2009 by adding a financial incentive: a 2% bonus on Medicare Part B payments. That didn’t do the trick either; accessibility and cost issues remained, and the various "G" codes that had to be added to Medicare claims to document e-prescribing were confusing and annoying.
In 2010, CMS made it much easier to collect the incentive with minimum e-prescribing effort: If you could show that you were using a qualified e-prescribing program on only 25 Medicare claims over the course of the entire year, you got a 2% bonus on every Medicare Part B claim you filed over the entire year. They also replaced myriad confusing "G" codes with a single one, G8553.
If none of these incentives has swayed you, 2011 might be the year you are finally persuaded: CMS has not sweetened the deal. In fact, the bonus is reduced to 1% this year. But 2011 is the last year you can avoid going electronic without generating a penalty.
In 2012, physicians filing at least the minimum 25 Medicare claims will receive a 1% bonus, but those not doing so will incur a 1% penalty. In 2013, the incentive drops to 0.5%, and the penalty increases to 1.5%. In 2014, and beyond, there will be no incentive, but the penalty will rise to 2% and remain there.
To be clear (and I have been asked about this more than once), faxing a prescription to a pharmacy is not e-prescribing, which, by definition, is computer-to-computer (paperless) communication of prescriptions. Many electronic medical record users are under the erroneous impression that they are e-prescribing via their EMR, when the EMR is simply generating faxes that arrive, on paper, in the pharmacy’s fax machine. That is not considered e-prescribing by CMS, and it does not qualify for the incentive program.
A coalition of insurance and technology companies called the National ePrescribing Patient Safety Initiative (NEPSI) has provided $100 million in funding to offer free e-prescribing technology that qualifies for the program to physicians nationwide. NEPSI members include Allscripts, Surescripts, and NaviMedix, as well as Google, Dell, Cisco Systems, Fujitsu, Microsoft, Sprint Nextel, Aetna, Horizon Blue Cross Blue Shield, WellPoint, and Wolters Kluwer Health. (I have no financial interest in any company or product mentioned in this column.)
Thanks to the efforts of NEPSI and others, e-prescribing is now easy for most practices to set up and use. Pharmacies have already done most of the work to make themselves compatible; about 70% of U.S. pharmacies can now handle electronic prescriptions.
Setup methods vary, but the concepts and requirements for each company are generally similar. You can incorporate bona fide e-prescribing into many electronic health record systems, or set it up as a separate, stand-alone system. In most cases, all you need to get started is an Internet-enabled computer with a high-speed connection and a database of patients.
Keep in mind that this will not be a complete transition; once you’re set up, you cannot throw away your paper prescription pads. Besides the 30% of pharmacies not yet equipped for e-prescribing, the Drug Enforcement Administration strongly discourages sending controlled substance prescriptions electronically. (The DEA has, however, relaxed its rules somewhat on this issue in the past year.)
You can learn more about NEPSI, and sign up for their free, online-based prescribing software at www.nationalerx.com.
A list of other companies currently offering e-prescribing software, along with links to their respective Web sites, is offered by a nonprofit foundation called eHealth Initiative.
Details of the CMS incentive program are available from CMS.
Whether or not a mere 1% incentive impresses you, you’ll need to sign up this year or next to avoid a penalty; and with the free NEPSI program and only 25 e-prescriptions required to qualify, you will expend a minimum of cost and inconvenience in giving it a try.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
About this time last year, I wrote about electronic prescribing and the incentives that had been put in place to encourage adoption. Apparently, most of you were unimpressed; a year later e-prescribing use has increased only marginally.
The Centers for Medicare and Medicaid Services thought it could turn the tide in 2009 by adding a financial incentive: a 2% bonus on Medicare Part B payments. That didn’t do the trick either; accessibility and cost issues remained, and the various "G" codes that had to be added to Medicare claims to document e-prescribing were confusing and annoying.
In 2010, CMS made it much easier to collect the incentive with minimum e-prescribing effort: If you could show that you were using a qualified e-prescribing program on only 25 Medicare claims over the course of the entire year, you got a 2% bonus on every Medicare Part B claim you filed over the entire year. They also replaced myriad confusing "G" codes with a single one, G8553.
If none of these incentives has swayed you, 2011 might be the year you are finally persuaded: CMS has not sweetened the deal. In fact, the bonus is reduced to 1% this year. But 2011 is the last year you can avoid going electronic without generating a penalty.
In 2012, physicians filing at least the minimum 25 Medicare claims will receive a 1% bonus, but those not doing so will incur a 1% penalty. In 2013, the incentive drops to 0.5%, and the penalty increases to 1.5%. In 2014, and beyond, there will be no incentive, but the penalty will rise to 2% and remain there.
To be clear (and I have been asked about this more than once), faxing a prescription to a pharmacy is not e-prescribing, which, by definition, is computer-to-computer (paperless) communication of prescriptions. Many electronic medical record users are under the erroneous impression that they are e-prescribing via their EMR, when the EMR is simply generating faxes that arrive, on paper, in the pharmacy’s fax machine. That is not considered e-prescribing by CMS, and it does not qualify for the incentive program.
A coalition of insurance and technology companies called the National ePrescribing Patient Safety Initiative (NEPSI) has provided $100 million in funding to offer free e-prescribing technology that qualifies for the program to physicians nationwide. NEPSI members include Allscripts, Surescripts, and NaviMedix, as well as Google, Dell, Cisco Systems, Fujitsu, Microsoft, Sprint Nextel, Aetna, Horizon Blue Cross Blue Shield, WellPoint, and Wolters Kluwer Health. (I have no financial interest in any company or product mentioned in this column.)
Thanks to the efforts of NEPSI and others, e-prescribing is now easy for most practices to set up and use. Pharmacies have already done most of the work to make themselves compatible; about 70% of U.S. pharmacies can now handle electronic prescriptions.
Setup methods vary, but the concepts and requirements for each company are generally similar. You can incorporate bona fide e-prescribing into many electronic health record systems, or set it up as a separate, stand-alone system. In most cases, all you need to get started is an Internet-enabled computer with a high-speed connection and a database of patients.
Keep in mind that this will not be a complete transition; once you’re set up, you cannot throw away your paper prescription pads. Besides the 30% of pharmacies not yet equipped for e-prescribing, the Drug Enforcement Administration strongly discourages sending controlled substance prescriptions electronically. (The DEA has, however, relaxed its rules somewhat on this issue in the past year.)
You can learn more about NEPSI, and sign up for their free, online-based prescribing software at www.nationalerx.com.
A list of other companies currently offering e-prescribing software, along with links to their respective Web sites, is offered by a nonprofit foundation called eHealth Initiative.
Details of the CMS incentive program are available from CMS.
Whether or not a mere 1% incentive impresses you, you’ll need to sign up this year or next to avoid a penalty; and with the free NEPSI program and only 25 e-prescriptions required to qualify, you will expend a minimum of cost and inconvenience in giving it a try.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
E-Prescribing Update
About this time last year, I wrote about electronic prescribing and the incentives that had been put in place to encourage adoption. Apparently, most of you were unimpressed; a year later e-prescribing use has increased only marginally.
The Centers for Medicare and Medicaid Services thought it could turn the tide in 2009 by adding a financial incentive: a 2% bonus on Medicare Part B payments. That didn’t do the trick either; accessibility and cost issues remained, and the various "G" codes that had to be added to Medicare claims to document e-prescribing were confusing and annoying.
In 2010, CMS made it much easier to collect the incentive with minimum e-prescribing effort: If you could show that you were using a qualified e-prescribing program on only 25 Medicare claims over the course of the entire year, you got a 2% bonus on every Medicare Part B claim you filed over the entire year. They also replaced myriad confusing "G" codes with a single one, G8553.
If none of these incentives has swayed you, 2011 might be the year you are finally persuaded: CMS has not sweetened the deal. In fact, the bonus is reduced to 1% this year. But 2011 is the last year you can avoid going electronic without generating a penalty.
In 2012, physicians filing at least the minimum 25 Medicare claims will receive a 1% bonus, but those not doing so will incur a 1% penalty. In 2013, the incentive drops to 0.5%, and the penalty increases to 1.5%. In 2014, and beyond, there will be no incentive, but the penalty will rise to 2% and remain there.
To be clear (and I have been asked about this more than once), faxing a prescription to a pharmacy is not e-prescribing, which, by definition, is computer-to-computer (paperless) communication of prescriptions. Many electronic medical record users are under the erroneous impression that they are e-prescribing via their EMR, when the EMR is simply generating faxes that arrive, on paper, in the pharmacy’s fax machine. That is not considered e-prescribing by CMS, and it does not qualify for the incentive program.
A coalition of insurance and technology companies called the National ePrescribing Patient Safety Initiative (NEPSI) has provided $100 million in funding to offer free e-prescribing technology that qualifies for the program to physicians nationwide. NEPSI members include Allscripts, Surescripts, and NaviMedix, as well as Google, Dell, Cisco Systems, Fujitsu, Microsoft, Sprint Nextel, Aetna, Horizon Blue Cross Blue Shield, WellPoint, and Wolters Kluwer Health. (I have no financial interest in any company or product mentioned in this column.)
Thanks to the efforts of NEPSI and others, e-prescribing is now easy for most practices to set up and use. Pharmacies have already done most of the work to make themselves compatible; about 70% of U.S. pharmacies can now handle electronic prescriptions.
Setup methods vary, but the concepts and requirements for each company are generally similar. You can incorporate bona fide e-prescribing into many electronic health record systems, or set it up as a separate, stand-alone system. In most cases, all you need to get started is an Internet-enabled computer with a high-speed connection and a database of patients.
Keep in mind that this will not be a complete transition; once you’re set up, you cannot throw away your paper prescription pads. Besides the 30% of pharmacies not yet equipped for e-prescribing, the Drug Enforcement Administration strongly discourages sending controlled substance prescriptions electronically. (The DEA has, however, relaxed its rules somewhat on this issue in the past year.)
You can learn more about NEPSI, and sign up for their free, online-based prescribing software at www.nationalerx.com.
A list of other companies currently offering e-prescribing software, along with links to their respective Web sites, is offered by a nonprofit foundation called eHealth Initiative.
Details of the CMS incentive program are available from CMS.
Whether or not a mere 1% incentive impresses you, you’ll need to sign up this year or next to avoid a penalty; and with the free NEPSI program and only 25 e-prescriptions required to qualify, you will expend a minimum of cost and inconvenience in giving it a try.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
About this time last year, I wrote about electronic prescribing and the incentives that had been put in place to encourage adoption. Apparently, most of you were unimpressed; a year later e-prescribing use has increased only marginally.
The Centers for Medicare and Medicaid Services thought it could turn the tide in 2009 by adding a financial incentive: a 2% bonus on Medicare Part B payments. That didn’t do the trick either; accessibility and cost issues remained, and the various "G" codes that had to be added to Medicare claims to document e-prescribing were confusing and annoying.
In 2010, CMS made it much easier to collect the incentive with minimum e-prescribing effort: If you could show that you were using a qualified e-prescribing program on only 25 Medicare claims over the course of the entire year, you got a 2% bonus on every Medicare Part B claim you filed over the entire year. They also replaced myriad confusing "G" codes with a single one, G8553.
If none of these incentives has swayed you, 2011 might be the year you are finally persuaded: CMS has not sweetened the deal. In fact, the bonus is reduced to 1% this year. But 2011 is the last year you can avoid going electronic without generating a penalty.
In 2012, physicians filing at least the minimum 25 Medicare claims will receive a 1% bonus, but those not doing so will incur a 1% penalty. In 2013, the incentive drops to 0.5%, and the penalty increases to 1.5%. In 2014, and beyond, there will be no incentive, but the penalty will rise to 2% and remain there.
To be clear (and I have been asked about this more than once), faxing a prescription to a pharmacy is not e-prescribing, which, by definition, is computer-to-computer (paperless) communication of prescriptions. Many electronic medical record users are under the erroneous impression that they are e-prescribing via their EMR, when the EMR is simply generating faxes that arrive, on paper, in the pharmacy’s fax machine. That is not considered e-prescribing by CMS, and it does not qualify for the incentive program.
A coalition of insurance and technology companies called the National ePrescribing Patient Safety Initiative (NEPSI) has provided $100 million in funding to offer free e-prescribing technology that qualifies for the program to physicians nationwide. NEPSI members include Allscripts, Surescripts, and NaviMedix, as well as Google, Dell, Cisco Systems, Fujitsu, Microsoft, Sprint Nextel, Aetna, Horizon Blue Cross Blue Shield, WellPoint, and Wolters Kluwer Health. (I have no financial interest in any company or product mentioned in this column.)
Thanks to the efforts of NEPSI and others, e-prescribing is now easy for most practices to set up and use. Pharmacies have already done most of the work to make themselves compatible; about 70% of U.S. pharmacies can now handle electronic prescriptions.
Setup methods vary, but the concepts and requirements for each company are generally similar. You can incorporate bona fide e-prescribing into many electronic health record systems, or set it up as a separate, stand-alone system. In most cases, all you need to get started is an Internet-enabled computer with a high-speed connection and a database of patients.
Keep in mind that this will not be a complete transition; once you’re set up, you cannot throw away your paper prescription pads. Besides the 30% of pharmacies not yet equipped for e-prescribing, the Drug Enforcement Administration strongly discourages sending controlled substance prescriptions electronically. (The DEA has, however, relaxed its rules somewhat on this issue in the past year.)
You can learn more about NEPSI, and sign up for their free, online-based prescribing software at www.nationalerx.com.
A list of other companies currently offering e-prescribing software, along with links to their respective Web sites, is offered by a nonprofit foundation called eHealth Initiative.
Details of the CMS incentive program are available from CMS.
Whether or not a mere 1% incentive impresses you, you’ll need to sign up this year or next to avoid a penalty; and with the free NEPSI program and only 25 e-prescriptions required to qualify, you will expend a minimum of cost and inconvenience in giving it a try.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
About this time last year, I wrote about electronic prescribing and the incentives that had been put in place to encourage adoption. Apparently, most of you were unimpressed; a year later e-prescribing use has increased only marginally.
The Centers for Medicare and Medicaid Services thought it could turn the tide in 2009 by adding a financial incentive: a 2% bonus on Medicare Part B payments. That didn’t do the trick either; accessibility and cost issues remained, and the various "G" codes that had to be added to Medicare claims to document e-prescribing were confusing and annoying.
In 2010, CMS made it much easier to collect the incentive with minimum e-prescribing effort: If you could show that you were using a qualified e-prescribing program on only 25 Medicare claims over the course of the entire year, you got a 2% bonus on every Medicare Part B claim you filed over the entire year. They also replaced myriad confusing "G" codes with a single one, G8553.
If none of these incentives has swayed you, 2011 might be the year you are finally persuaded: CMS has not sweetened the deal. In fact, the bonus is reduced to 1% this year. But 2011 is the last year you can avoid going electronic without generating a penalty.
In 2012, physicians filing at least the minimum 25 Medicare claims will receive a 1% bonus, but those not doing so will incur a 1% penalty. In 2013, the incentive drops to 0.5%, and the penalty increases to 1.5%. In 2014, and beyond, there will be no incentive, but the penalty will rise to 2% and remain there.
To be clear (and I have been asked about this more than once), faxing a prescription to a pharmacy is not e-prescribing, which, by definition, is computer-to-computer (paperless) communication of prescriptions. Many electronic medical record users are under the erroneous impression that they are e-prescribing via their EMR, when the EMR is simply generating faxes that arrive, on paper, in the pharmacy’s fax machine. That is not considered e-prescribing by CMS, and it does not qualify for the incentive program.
A coalition of insurance and technology companies called the National ePrescribing Patient Safety Initiative (NEPSI) has provided $100 million in funding to offer free e-prescribing technology that qualifies for the program to physicians nationwide. NEPSI members include Allscripts, Surescripts, and NaviMedix, as well as Google, Dell, Cisco Systems, Fujitsu, Microsoft, Sprint Nextel, Aetna, Horizon Blue Cross Blue Shield, WellPoint, and Wolters Kluwer Health. (I have no financial interest in any company or product mentioned in this column.)
Thanks to the efforts of NEPSI and others, e-prescribing is now easy for most practices to set up and use. Pharmacies have already done most of the work to make themselves compatible; about 70% of U.S. pharmacies can now handle electronic prescriptions.
Setup methods vary, but the concepts and requirements for each company are generally similar. You can incorporate bona fide e-prescribing into many electronic health record systems, or set it up as a separate, stand-alone system. In most cases, all you need to get started is an Internet-enabled computer with a high-speed connection and a database of patients.
Keep in mind that this will not be a complete transition; once you’re set up, you cannot throw away your paper prescription pads. Besides the 30% of pharmacies not yet equipped for e-prescribing, the Drug Enforcement Administration strongly discourages sending controlled substance prescriptions electronically. (The DEA has, however, relaxed its rules somewhat on this issue in the past year.)
You can learn more about NEPSI, and sign up for their free, online-based prescribing software at www.nationalerx.com.
A list of other companies currently offering e-prescribing software, along with links to their respective Web sites, is offered by a nonprofit foundation called eHealth Initiative.
Details of the CMS incentive program are available from CMS.
Whether or not a mere 1% incentive impresses you, you’ll need to sign up this year or next to avoid a penalty; and with the free NEPSI program and only 25 e-prescriptions required to qualify, you will expend a minimum of cost and inconvenience in giving it a try.
Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.
Designing Your Web Site
Is a Web site essential to the success of your practice? No, not really, despite everything those spammers tell you.
About 20% of private medical practices have a Web site, and the rest seem to be doing fine without one. The reality is that most users of medical care are older folk; and most older folk still find their doctors the old-fashioned ways: through referrals from primary practitioners, and by word-of-mouth from family and friends.
By the time the youngsters who use the Internet to find everything reach the age where medical care is a priority, almost every private practice will certainly have a Web presence. (But by then, of course, something way cooler will have come along to replace the Web!)
That said, aggressive cosmetic practices in highly competitive areas clearly seem to benefit from Web exposure; and for the rest of us, although a well-designed Web site is not a necessity, it can certainly make life easier for doctors, staff, and patients.
The key phrase, of course, is "well-designed." A badly designed site will do far more harm than good, so this is one project to leave to the professionals. Doing it yourself might sound like fun, but good site design is a lot harder than it looks. And if you resort to a standard template, as most amateurs do, you won’t like the result.
Almost every generic, template-based Web site I’ve seen looks shabby and amateurish. Broken links, misspelled text, stock snapshot-quality photos – exactly the opposite of the professional image you want to project.
In addition, template-based sites tend to be overlooked by search engines. What’s the point of having a Web site if patients can’t find it? A buzz phrase among professional Web designers is "search engine optimization" (SEO) – a pro will give you a professional look and a Web presence that is readily visible to search engine users.
On the other hand, don’t let your designer get carried away with fancy gimmicks and expensive effects. A big turnoff for me, on any Web site, is anything blocking fast, easy navigation. Anytime I find myself waiting for a fancy flash introduction to load, for example, I’m gone. Tell your designer to stick with simple, interactive, user-friendly Java scripts.
Once patients have found your site, they had better find it easy to navigate, or they will be gone, too. Make clear immediately what you want visitors to do. Advertising professionals call this the "call to action." If potential patients don’t know what to do within seconds of landing on your site, they will usually click the back button and go to the next hit on the search engine. Communication links ("Contact Us," "Make an Appointment," "Call for Consultation") should be readily available. Don’t expect patients to sift through the site to find them.
Don’t let your patients get lost, either. Well-organized Web sites have hyperlinked paths on each page that allow users to determine immediately where they are. For example, "Home > Services > Fillers" means a patient is on the Fillers page of the Services section, with an easy path back to the Home page. (Designers call this "breadcrumbing.")
Leave design and navigation to the pros, but don’t delegate content. Only you know what you want to say on your site and as the captain of the ship, you are responsible for all the facts and opinions on it.
Decide what you want your site to say before any design begins, and write it out, in plain English. Once the designer has your content to work with, he or she can create a unique framework to complement it.
Good photographs are vital to a good practice site. Patients should be able to see that your office is an attractive place, staffed with compassionate and cheerful professionals. A professional photographer can convey that message and make your site distinctive. Photos are often the most prominent elements of a Web site. They should send a warm and professional first impression.
Contact information must be front and center, and on every page. Patients don’t want to hunt for a way to contact you. Post contact information prominently, in large, easy-to-read fonts.
Contact forms should be simple, with a few basic fields. If you make patients work too hard to contact you by having them complete a complex form and a string of scary questions, you will lose them.
And don’t just rely on online contact; give them other options as well. Some people – particularly the elderly – still prefer to pick up the phone!
This column, "Managing Your Dermatology Practice," appears regularly in Skin and Allergy News, an Elsevier publication and website. Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. To respond to this column, e-mail him at our editorial offices.
Is a Web site essential to the success of your practice? No, not really, despite everything those spammers tell you.
About 20% of private medical practices have a Web site, and the rest seem to be doing fine without one. The reality is that most users of medical care are older folk; and most older folk still find their doctors the old-fashioned ways: through referrals from primary practitioners, and by word-of-mouth from family and friends.
By the time the youngsters who use the Internet to find everything reach the age where medical care is a priority, almost every private practice will certainly have a Web presence. (But by then, of course, something way cooler will have come along to replace the Web!)
That said, aggressive cosmetic practices in highly competitive areas clearly seem to benefit from Web exposure; and for the rest of us, although a well-designed Web site is not a necessity, it can certainly make life easier for doctors, staff, and patients.
The key phrase, of course, is "well-designed." A badly designed site will do far more harm than good, so this is one project to leave to the professionals. Doing it yourself might sound like fun, but good site design is a lot harder than it looks. And if you resort to a standard template, as most amateurs do, you won’t like the result.
Almost every generic, template-based Web site I’ve seen looks shabby and amateurish. Broken links, misspelled text, stock snapshot-quality photos – exactly the opposite of the professional image you want to project.
In addition, template-based sites tend to be overlooked by search engines. What’s the point of having a Web site if patients can’t find it? A buzz phrase among professional Web designers is "search engine optimization" (SEO) – a pro will give you a professional look and a Web presence that is readily visible to search engine users.
On the other hand, don’t let your designer get carried away with fancy gimmicks and expensive effects. A big turnoff for me, on any Web site, is anything blocking fast, easy navigation. Anytime I find myself waiting for a fancy flash introduction to load, for example, I’m gone. Tell your designer to stick with simple, interactive, user-friendly Java scripts.
Once patients have found your site, they had better find it easy to navigate, or they will be gone, too. Make clear immediately what you want visitors to do. Advertising professionals call this the "call to action." If potential patients don’t know what to do within seconds of landing on your site, they will usually click the back button and go to the next hit on the search engine. Communication links ("Contact Us," "Make an Appointment," "Call for Consultation") should be readily available. Don’t expect patients to sift through the site to find them.
Don’t let your patients get lost, either. Well-organized Web sites have hyperlinked paths on each page that allow users to determine immediately where they are. For example, "Home > Services > Fillers" means a patient is on the Fillers page of the Services section, with an easy path back to the Home page. (Designers call this "breadcrumbing.")
Leave design and navigation to the pros, but don’t delegate content. Only you know what you want to say on your site and as the captain of the ship, you are responsible for all the facts and opinions on it.
Decide what you want your site to say before any design begins, and write it out, in plain English. Once the designer has your content to work with, he or she can create a unique framework to complement it.
Good photographs are vital to a good practice site. Patients should be able to see that your office is an attractive place, staffed with compassionate and cheerful professionals. A professional photographer can convey that message and make your site distinctive. Photos are often the most prominent elements of a Web site. They should send a warm and professional first impression.
Contact information must be front and center, and on every page. Patients don’t want to hunt for a way to contact you. Post contact information prominently, in large, easy-to-read fonts.
Contact forms should be simple, with a few basic fields. If you make patients work too hard to contact you by having them complete a complex form and a string of scary questions, you will lose them.
And don’t just rely on online contact; give them other options as well. Some people – particularly the elderly – still prefer to pick up the phone!
This column, "Managing Your Dermatology Practice," appears regularly in Skin and Allergy News, an Elsevier publication and website. Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. To respond to this column, e-mail him at our editorial offices.
Is a Web site essential to the success of your practice? No, not really, despite everything those spammers tell you.
About 20% of private medical practices have a Web site, and the rest seem to be doing fine without one. The reality is that most users of medical care are older folk; and most older folk still find their doctors the old-fashioned ways: through referrals from primary practitioners, and by word-of-mouth from family and friends.
By the time the youngsters who use the Internet to find everything reach the age where medical care is a priority, almost every private practice will certainly have a Web presence. (But by then, of course, something way cooler will have come along to replace the Web!)
That said, aggressive cosmetic practices in highly competitive areas clearly seem to benefit from Web exposure; and for the rest of us, although a well-designed Web site is not a necessity, it can certainly make life easier for doctors, staff, and patients.
The key phrase, of course, is "well-designed." A badly designed site will do far more harm than good, so this is one project to leave to the professionals. Doing it yourself might sound like fun, but good site design is a lot harder than it looks. And if you resort to a standard template, as most amateurs do, you won’t like the result.
Almost every generic, template-based Web site I’ve seen looks shabby and amateurish. Broken links, misspelled text, stock snapshot-quality photos – exactly the opposite of the professional image you want to project.
In addition, template-based sites tend to be overlooked by search engines. What’s the point of having a Web site if patients can’t find it? A buzz phrase among professional Web designers is "search engine optimization" (SEO) – a pro will give you a professional look and a Web presence that is readily visible to search engine users.
On the other hand, don’t let your designer get carried away with fancy gimmicks and expensive effects. A big turnoff for me, on any Web site, is anything blocking fast, easy navigation. Anytime I find myself waiting for a fancy flash introduction to load, for example, I’m gone. Tell your designer to stick with simple, interactive, user-friendly Java scripts.
Once patients have found your site, they had better find it easy to navigate, or they will be gone, too. Make clear immediately what you want visitors to do. Advertising professionals call this the "call to action." If potential patients don’t know what to do within seconds of landing on your site, they will usually click the back button and go to the next hit on the search engine. Communication links ("Contact Us," "Make an Appointment," "Call for Consultation") should be readily available. Don’t expect patients to sift through the site to find them.
Don’t let your patients get lost, either. Well-organized Web sites have hyperlinked paths on each page that allow users to determine immediately where they are. For example, "Home > Services > Fillers" means a patient is on the Fillers page of the Services section, with an easy path back to the Home page. (Designers call this "breadcrumbing.")
Leave design and navigation to the pros, but don’t delegate content. Only you know what you want to say on your site and as the captain of the ship, you are responsible for all the facts and opinions on it.
Decide what you want your site to say before any design begins, and write it out, in plain English. Once the designer has your content to work with, he or she can create a unique framework to complement it.
Good photographs are vital to a good practice site. Patients should be able to see that your office is an attractive place, staffed with compassionate and cheerful professionals. A professional photographer can convey that message and make your site distinctive. Photos are often the most prominent elements of a Web site. They should send a warm and professional first impression.
Contact information must be front and center, and on every page. Patients don’t want to hunt for a way to contact you. Post contact information prominently, in large, easy-to-read fonts.
Contact forms should be simple, with a few basic fields. If you make patients work too hard to contact you by having them complete a complex form and a string of scary questions, you will lose them.
And don’t just rely on online contact; give them other options as well. Some people – particularly the elderly – still prefer to pick up the phone!
This column, "Managing Your Dermatology Practice," appears regularly in Skin and Allergy News, an Elsevier publication and website. Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. To respond to this column, e-mail him at our editorial offices.