Best Financial Advisers for Doctors

83 Pages·2014·31.9 MB·English

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86 NOVEMBER 10, 2014 THE 86th ANNUAL
TH AN VOL. 91 NO. 21
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G YO PRODUCTIVITY Patient visits drop as doctors face growing burdens Page 15
U
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RA PRACTICE FINANCES Why practices are falling behind
C Page 20
T
IC
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’S P ICD-10 Why so many physicians are not ready
A Page 25
T
IE
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FLO MALPRACTICE How practice size dictates premiums Page 30
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mbcyyelaaallcgonkewnta ES517288_ME111014_cv1.pgs 10.20.2014 21:28 ADV
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MedicalEconomics.com Medical econoMics ❚ NOvEMBER 10, 2014
mbcyyelaaallcgonkewnta ES517214_ME111014_003.pgs 10.20.2014 19:46 ADV
Referenced in MedLine®
Volume 91
NOVEMBER 10, 2014 Issue 21
86TH ANNUAL
IN DEPTH COLUMNS
PHYSICIAN
PAGE
SPECIAL REPORT 33
15 PRODUCTIVITY FALLS
REPORT FINANCIAL
Why primary care physicians are STRATEGIES
seeing fewer patients despite f ood
of newly insured.
20 PRACTICE FINANCIAL 12 Joel Greenwald
PROGRESS STALLS STARTS How to determine
your retirement number
Salaries remain f at as physician ON PAGE
practices face lower reimbursements,
rising costs and challenging market
forces.
PAGE
25 ICD-10 READINESS 43
Why the delay and burden on
practices is making it dif cult for PRACTICAL
physicians to get ready. MATTERS
30 MALPRACTICE
INSURANCE Judy Capko
Premiums remain mostly unchanged Don’t let peak demand
from a year ago as physicians wait COVER STORY | SPECIAL REPORT sabotage your schedule
for impacts from healthcare reform.
How administrative burdens are
33 PHYSICIAN RETIREMENT keeping physicians away from 6 ME ONLINE
How much money is enough for a 7 EDITORIAL BOARD
their patients
secure retirement?
8 FROM THE TRENCHES
starts on page 12 9 VITALS

48 ADVERTISER INDEX
34 CANCER CARE’S ❚ Exploring productivity 49 THE LAST WORD
NEW PATH
Recently released government data
impacts
A new payer program focuses on shows mixed performance
evidence-based medicine. in f rst two years for Pioneer ACOs.
❚ ICD-10 readiness examined

❚ A look at the f nancial state MISSION STATEMENT
40 IMPROVING THE FLOW of physician practices Medical Economics is the leading business
OF YOUR PRACTICE resource for of ce-based physicians,
5 ways to improve the patient providing the expert advice and shared
experience. experiences doctors need to successfully
43 PRACTICAL MATTERS meet today’s challenges in practice
How to deal with peak demand. management, patient relations, malpractice,
electronic health records, career, and personal
f nance. Medical Economics provides the

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Medical econoMics ❚ November 10, 2014 MedicalEconomics.com
mbcyyelaaallcgonkewnta ES517442_ME111014_006.pgs 10.21.2014 00:35 ADV
Advisers
the
The board members and consultants contribute expertise and analysis that help shape the content of Medical Economics.
EDITORIAL
PAGE 33
CONSULTANTS
With planning and sound
PRACTICE MANAGEMENT
advice, physicians reach Judy Bee
www.ppgconsulting.com
their retirement goals” La Jolla, CA
Keith Borglum, CHBC
—Joel Greenwald, CFP FINANCIAL PLANNER Professional Management and Marketing
Santa Rosa, CA
Kenneth Bowden, CHBC
Berkshire Professional Management
Pittsf eld, MA
Michael D. Brown, CHBC
EDITORIAL BOARD Health Care Economics Indianapolis, IN
Frank Cohen, MPA
www.frankcohengroup.com
Clearwater, FL
Virginia Martin, CMA, CPC, CHCO, CHBC
Mary Ann Bauman, MD Elizabeth A. Pector, MD Healthcare Consulting Associates
of N.W. Ohio Inc. Waterville, OH
Internal Medicine Family Medicine Rosemarie Nelson
Oklahoma City, OK Naperville, IL MGMA Healthcare Consultant Syracuse, NY
Mark D. Scroggins, CPA, CHBC
Clayton L. Scroggins Associates Inc.
Cincinnati, OH
Gray Tuttle Jr., CHBC
John L. Bender, MD Patricia J. Roy, DO The Rehmann Group Lansing, MI
Michael J. Wiley, CHBC
Family Medicine Family Medicine Healthcare Management
Ft. Collins, CO Muskegon, MI and Consulting Services Bay Shore, NY
H. Christopher Zaenger, CHBC
Z Management Group Barrington, IL
Karen Zupko
Karen Zupko & Associates Chicago, IL
Maria Y. Chandler, MD, MBA Joseph E. Scherger, MD
TAXES & PERSONAL FINANCE
Business of Medicine, Pediatrics Family Medicine Lewis J. Altfest, CFP, CPA
Irvine, CA La Quinta, CA Altfest Personal Wealth Management
New York City
Robert G. Baldassari, CPA
Matthews, Carter and Boyce Fairfax, VA
Todd D. Bramson, CFP
George G. Ellis Jr., MD Salvatore S. Volpe, MD North Star Resource Group Madison, WI
Glenn S. Daily, CFP
Internal Medicine Internal Medicine-Pediatrics Insurance consultant New York City
Youngstown, OH Staten Island, NY Barry Oliver, CPA, PFS
Thomas, Wirig, Doll & Co.
Capital Performance Advisors
Walnut Creek, CA
Gary H. Schatsky, JD
David C. Judge, MD Craig M. Wax, DO IFC Personal Money Managers New York City
David J. Schiller, JD
Internal Medicine Family Medicine Schiller Law Associates Norristown, PA
Cambridge, MA Mullica Hill, NJ
Edward A. Slott, CPA
E. Slott & Co. Rockville Centre, NY
HEALTH LAW & MALPRACTICE
Barry B. Cepelewicz, MD, JD
Jeffrey M. Kagan, MD Garfunkel Wild, PC Stamford, CT
John M. Fitzpatrick, JD
Internal Medicine
Wheeler Trigg Kennedy, LLP Denver, CO
Newington, CT
Alice G. Gosfi eld, JD
Alice G. Gosf eld and Associates
Philadelphia, PA
James Lewis Griffi th Sr., JD
Fox Rothschild Philadelphia, PA
Lee J. Johnson, JD
ask us Mount Kisco, NY
Lawrence W. Vernaglia, JD, MPH
Have a question for our advisers? Email your question to [email protected]. Foley & Lardner, LLP Boston, MA
7
MedicalEconomics.com MEDICAL ECONOMICS ❚ NOVEMBER 10, 2014
mbcyyelaaallcgonkewnta ES517218_ME111014_007.pgs 10.20.2014 19:47 ADV
Trenches
from the
Gevitz has been the preeminent historian of the osteopathic
profession for 30 years. His concerns...are troubling, and
require extreme caution if the AOA pursues this merger. His
apprehensions...spell possible disaster for the osteopathic graduate
education system, osteopathic medical school, and the profession’s
independence. Craig M. Wax, DO, Mullica Hill, New Jersey
merger with acgme
suing this for a decade without addressing
TELL US could doom osteopathic
his work concerns and members’ concerns,
medical education
such as mine. Again, this is an example of the
[email protected]
Tanks for publishing Shannon Scott, DO’s AOA’s top-down management style rather
opinions on the Accreditation Council for than bottom-up parliamentary rule as is ex-
Or mail to:
Graduate Medical Education and Osteo- pressed in their bylaws and mission.
Letters Editor,
pathic Graduate Medical Education merger 2. Gevitz’s detailed report spells out the
Medical Economics,
(“DOs will beneft from unifed GME system,” domino efect that could result from the
24950 Country Club
September 10, 2014). ACGME merger of the course. Tis may
Boulevard, Suite 200, North
Certainly there are many issues and vari- result in the loss of osteopathic OGME pro-
Olmsted, Ohio 44070.
ables to be considered. Te concerns I raised grams and input in future ACGME programs,
Include your address and
about the merger are primarily based in fact and the loss of the profession at large.
daytime phone number.
on the report of Norman Gevitz, PhD, “Te 3. Te AOA steadfastly refuses to publish
Unintended Consequences of the ACGME any editorials or papers that difer from the
Letters may be edited for length and
Merger.” (Available at bit.ly/1sR73KH) AOAs ofcial policy in “Te D.O.” and “Te
style. Unless you specify otherwise, we’ll
Gevitz has been the preeminent research- JAOA.” Further, the AOA administration has
assume your letter is for publication.
Submission of a letter or e-mail er and historian of the osteopathic profession inappropriately tried to withdraw motions
constitutes permission for Medical for 30 years. His concerns, as detailed in his and pervert parliamentary procedures at
Economics, its licensees, and its assignees report of April 2013, are troubling and require house of delegates business meetings to
to use it in the journal’s various print and extreme caution if the AOA pursues this subvert DO member resolutions and ac-
electronic publications and in collections, merger. His assertions and apprehensions, tions.
revisions, and any other form of media. based on the history and actions of the osteo- Te osteopathic profession began in 1874
pathic profession at large, spell possible loss when A.T. Still, MD became frustrated with
and disaster for the osteopathic graduate ed- the current state of medicine and healthcare.
ucation system, osteopathic medical schools, His thoughts, actions, persistence and cour-
and the profession’s independence. By 2021, age to pursue a novel school of medical care
ACGME will be in control of the osteopathic are legendary and paramount. We must not
graduate medical education system and will allow government and its arbitrary funding
be free to fre all DOs and reject their philoso- goals to determine our profession’s course or
phy in formerly DO training programs. the care of our patients.
My concerns are threefold:
Craig M. Wax, DO
1. I am concerned that the AOA (Ameri-
can Osteopathic Association) has been pur- Mullica Hill, New Jersey
8
Medical econoMics ❚ November 10, 2014 MedicalEconomics.com
mbcyyelaaallcgonkewnta ES517293_ME111014_008.pgs 10.20.2014 21:52 ADV
Vitals
the
Examining the News Affecting
the Business of Medicine
MEDICARE
PART B
AMA stUDY
PREMIUMS,
DEDUCTIBLES
Most Metro AreAs LAcK
TO STAY FLAT
PAYer coMPetItIon
The costs of premiums
and deductibles for
Medicare Part B, which
covers physician services, A new annual study by the American Medical
will not change in Association (AMA) has found that 72% of U.S.
2015, according to an
metropolitan areas studied lack signif cant
announcement from the
competition for health insurance, and most were
Centers for Medicare and
Medicaid Services (CMS). highly concentrated.
Premiums for the
T e study - Competition in Health Insurance: A Comprehensive Study of U.S.
nearly 49 million
Markets - looked for evidence of highly concentrated areas because they can lead
recipients will stay at
to insurers exercising “market power” including controlling price.
$104.90 and deductibles
T e study found that 17 states have a single health insurer with a commercial
will remain $147.
market share of 50% or more, and 45 states have two health insurers with
This is the second
a combined commercial market share of 50% or more. In 90% percent of
year that the cost of
metropolitan areas, just one insurer holds at least a 30% share of the commercial
Medicare Part B has not
health insurance market.
increased for seniors, and
“T e dominant market power of big health insurers increases the risk of anti-
CMS says it’s proof that
competitive behavior that harms patients and physicians,” said AMA president
the Af ordable Care Act
Robert M. Wah, MD, in a statement.
is working to improve
access to care and slowing
hea“lTthhcea srtea cboilsitzsa.tion t o p 1 0
Least commercial payer competition
of Part B premiums is STATES
another example of how
we are containing health
care costs to provide WA NH
a more sustainable MT ND VT ME
and af ordable health 1. Alabama OR ID SD MN WI NY MRAI
delivery system,” CMS 2. Hawaii WY MI
ATadvmeninniestrr saatiodr iMn aar ilyn 34.. MDeiclahwigaarne CA NV UT CO NKES IAMO IL INKYOH WVPVAA NCTJ
setvaetne mgreenatt.e “rT fh nisa mnceiaaln asn d 5. Louisiana AZ NM OK AR TN SCNC MDED
6. South Carolina
health security for our MS AL GA DC
seniors next year as their 7. Alaska TX LA
premiums will remain 8. Illinois FL
unchanged.” 9. Nebraska AK
CMS says Medicare 10. North Dakota
spending growth has
been f at for four years. Source: AMA HI
9
MedicalEconomics.com Medical econoMics ❚ November 10, 2014
mbcyyelaaallcgonkewnta ES517294_ME111014_009.pgs 10.20.2014 21:52 ADV
Vitals
the
Primary care can kill
Medicare fines
record nuMber
fee-for-service with
of hospitals over
readMissions
diverse payment models
A record number of
hospitals are being

fned via Medicare It’s no secret that from the fee-for-service approximately equal
reimbursement cuts primary care is becoming reimbursement model,” the numbers of physician and
for having too many more important to the report states. non-physician providers,”
readmissions, according healthcare landscape. Efcient and easy-to- according to the report.
to an analysis by Kaiser Provisions of the Afordable fnd primary care services Reimbursement
Health News. Care Act (ACA) are also contribute to the models would have to be
The $428 million in expected to add 25 million decrease in emergency reconfgured to incentivize
fnes were levied against primary care appointments department visits. practices to use NPs and
2,610 hospitals, with annually. In order to lower Nearly 70% of emergency PAs for less-complex
39 receiving the largest costs and make primary department visits by patients. “A signifcant
penalty allowed. care more accessible insured patients are for barrier to achieving
Penalties are assessed as more people seek non-emergency issues, more dramatic and rapid
when the number of healthcare, UnitedHealth according to the report. progress is payment policy.
Medicaid patients who Center for Health Reform & Te report suggests Medicare and Medicaid
are readmitted within Modernization and Optum policies and regulations generally reimburse less for
30 days of discharge Labs released a report that increase roles for services delivered by NPs
exceeds a national recommending that states nurse practitioners (NPs) and PAs than for the same
benchmark. The latest the solution lies in phasing and physician assistants services when performed
penalties are based on out fee-for-service models (PAs), thereby making by physicians.”
readmissions from July and incorporating multiple primary care services Ofering diferent types
2010 through June 2013, healthcare teams, diverse more attainable and of services tailored to
notes the analysis. pay models and technology. afordable for people living patients’ needs also will
This is the third year “As much as half of in medically underserved help primary care practices
that the U.S. Centers for wasteful health care communities. “In the 10% transition to value-
Medicare and Medicaid spending results from of local markets with the based payment models
Services (CMS) has levied failures of care delivery lowest concentration of and increase patient
the penalties. They frst and care coordination, primary care physicians, satisfaction.
went into efect in 2012 as well as overtreatment the concentration Te report fnds that
following establishment — all of which could be of NPs and PAs was too many barriers remain
of the Hospital improved by moving away highest, and there were in healthcare technology
Readmissions Reduction to allow primary care
Program (HRRP) as part The study’s suggestions for primary care physicians to use it to
of the Afordable Care their advantage. Lack of
Act. Of hospitals subject interoperability between
1
to HRRP, 75% are being Retail- or urgent care-structured services ofered after EHR systems, training,
penalized, says the hours to cut emergency department visits. maintenance costs and
analysis. loss of productivity all
CMS uses a 2 House calls to patients to evaluate social and make utilizing technology
complex formula to environmental factors that can afect health; difcult. “Investments
determine acceptable in the deployment and
readmissionss for each 3 impactful use of HIT
Group visits with private exams and collective
hospital, but their require signifcant time
educational classes.
methodology has come commitments and upfront
under fre, with critics costs that will pose
4
noting that hospitals Focus on healthcare’s “super-users,” the 5% of the difculty for some primary
have to hit a rate lower population who account for 50% of healthcare costs. care practices,” the report
than the overall industry. says.
10
Medical econoMics ❚ November 10, 2014 MedicalEconomics.com
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