Posts Tagged regulatory

What Are Some Common Challenges and Solutions for Medical Practices?

What Are Some Common Challenges and Solutions for Medical Practices?

Regulatory compliance and technology are changing the landscape of the health care industry. New technologies, revenue cycles resolution and changes in leadership can all have a positive impact on your practice. Are you prepared to take on these new opportunities? In this article, Tammie Lunceford answers a few questions about how the landscape is changing and how facing these changes can help breathe new life into your practice.

Question: What are some of the common challenges you have seen in medical practices recently?

Answer: I often see revenue cycle problems. It is more difficult now than ever to get paid by the carriers and by the patient. As you know, we’ve had a shift from the carrier paying all of the health claims to now the patient has more responsibility over the costs, and it can be difficult to ask patients for money. Physicians are there to serve the patient and many feel uncomfortable asking the patient for money. I also see problems with adopting new technologies that are available, and problems where too much responsibility is on the front office…having them answer the phone and also deal face-to-face with the patient, which can be challenging. We also have seen a lot of highly qualified managers (Baby Boomers) leaving the market, which can lead to issues with changing leadership.

Question: Can you describe a couple of examples you’ve seen in medical practices where, with a few small changes, you saw a big impact.

Answer: I work with both large and small practices, and I have a couple of stories that I could share. One from this year was a Practice Assessment for a new client. The manager was overwhelmed because the practice had doubled in size over a four-year period. The physicians were overwhelmed because they were finding themselves making decisions for a large practice when they had been a small practice for so many years. Their revenue cycle manager, who had been very loyal to the practice, was not qualified to handle the new load, and were having some financial issues. MACRA was approaching as a big project and that they had no idea how to attempt that undertaking. Plus, throughout their growth, they had failed to build the appropriate infrastructure to adequately support the practice, like hiring a mid-level manager or supervisory staff to assist the manager in staying highly effective. So, after I identified these problems during the assessment, I worked closely with the group and over a short period of time we recruited and hired a revenue cycle manager who was effective and innovative. The practice’s profitability has increased, they relieved the front desk staff from answering the phones and allowed them to focus on the patients standing in front of them. Through coaching the group and the manager, they have been able to work more cohesively and make better decisions. They’ve identified some team leaders to lead other areas, and they are doing great. They are approaching projects more on their own now, but I’m still their advisor and have built a long-term relationship and I know we will continue working with that practice.

We also work with smaller practices. We received a call from a physician who was leaving a large practice and going out on her own to form a “boutique practice.” I assisted her early in her practice. She couldn’t afford a high-level manager to help her make decisions, so I became her advisor. I continued this over a five-year period and we have taken her from being too small to hire a manager to hiring a manager, to hiring to mid-level providers, and now we are about to hire a partner for her. I love forming these lasting relationships with managers and providers.

Question: What new changes are we seeing in healthcare as we move forward into the next few years?

Answer: Because we’ve seen a decline in reimbursement and collections over the last few years, it can be difficult for us to get physicians to invest in their practice because many are afraid. They want to hang on to their money rather than investing in their practice. They really don’t know where we are going in the future of healthcare, there are changes in the payment models, administrative burdens are at their highest, and manager and physician burnout is at its highest. There has never been a time where I’ve seen practices need advisory services more than now. I think with technology growing as quickly as it is, we will need to guide these physicians on what technologies they should incorporate and invest in to keep their practice vital.

Article contributed by Tammie Lunceford, Healthcare and Dental Consultant, Warren Averett Healthcare Consulting Group. Warren Averett is an official Gold Partner with the Medical Association.

Posted in: Management

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HHS Seeks Comments on Easing Stark Law Burdens

HHS Seeks Comments on Easing Stark Law Burdens

The Centers for Medicare & Medicaid Services has requested public input on how the physician self-referral law, or Stark Law, may be interfering with care coordination. To help accelerate the transformation to a value-based system that includes care coordination, HHS has launched a Regulatory Sprint to Coordinated Care. The Regulatory Sprint is focused on identifying regulatory requirements or prohibitions that may act as barriers to coordinated care, assessing whether those regulatory provisions are unnecessary obstacles to coordinated care, and issuing guidance or revising regulations to address such obstacles and, as appropriate, encouraging and incentivizing coordinated care.

On June 25, 2018, HHS published in the Federal Register a Request for Information seeking comments on the structure of arrangements between parties that participate in alternative payment models or other novel financial arrangements and the need to revise or expand exceptions to the Stark Law. CMS states “CMS is aware of the effect the physician self-referral law may have on parties participating or considering participation in integrated delivery models, alternative payment models, and arrangements to incent improvements in outcomes and reductions in cost.” CMS has also engaged stakeholders through comment solicitations in several recent rulemakings. In 2017, through the annual payment rules, CMS asked for comments on improvements that can be made to the health care delivery system that reduce unnecessary burdens for clinicians, other providers, and patients and their families.

CMS is interested in the public’s thoughts on issues that include the structure of arrangements between parties that participate in alternative payment models or other novel financial arrangements, the need for revisions or additions to exceptions to the physician self-referral law, and terminology related to alternative payment models and the physician self-referral law. Specifically, CMS requested stakeholders’ thoughts on important definitions and/or concepts such as defining “commercial reasonableness,” “fair market value” and “take into account the volume or value of referrals” by a physician.

While the Request for Information does not mean HHS will make any changes to Stark, it is encouraging that CMS recognizes the many roadblocks Stark causes to legitimate arrangements involving physicians.

The Request of Information is available online at

Jim Hoover is a partner at Burr & Forman LLP practicing exclusively in the firm’s Health Care Industry Group. Burr & Forman LLP is a partner with the Medical Association.

Posted in: Legal Watch

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