« June 2009 | Main | August 2009 »

23 posts from July 2009

July 31, 2009

Current Physician Recruiting Trends

The following comes from Jeffrey Sisk, President/CEO of PhysicianWork.com

I have had the opportunity to talk with a large number of physician recruiters over the last few weeks about the state of the physician recruiting industry as a whole. These recruiters are from hospitals, health systems, medical practices, permanent placement firms and locum tenens companies, and some of their feedback has been very insightful. I thought I’d share some of this information with you because it is thought provoking and gives each of us a clearer picture of the current physician recruiting environment. I think it is important to share this type of information with the physician recruiters in our network.

If you are recruiting permanent physicians, this is one of the more difficult recruiting environments we have ever seen. Many physicians are afraid to consider changing jobs for a variety of reasons that are all related to the current economic state of our country. Some of the specific reasons mentioned to me recently are: It is very difficult to sell your home in the current real estate market at a fair price. Home values are way down and it’s a buyer’s market. If you are lucky and can sell your home you will have difficulties getting a new home loan because banks aren’t lending money; especially for jumbo home loans on larger homes and physicians typically purchase a home in this category. Also, physicians, just like many Americans, have seen their savings and retirement accounts shrink considerably because of the drop in stock prices so they feel that their financial “safety net” is no longer there. Overall, there is a lot of uncertainty about the future, so even if a physician isn’t happy in his or her current job, they are more likely to stick it out in their present position until things get better.

Additionally, many physicians (especially primary care and non hospital based specialties) are reporting drops in the number of patients scheduling office visits and elective procedures. Consumers have slowed down routine medical care and are seeking treatment only when they are sick. Consequently, many medical practices have stopped growing and therefore do not need to recruit additional physicians. In some cases, practices already have “one physician too many” in the practice. There is apparently a stable demand for hospital based specialties at the present time because hospitals treat sick patients, so recruiting needs in these areas should continue to be strong.

The shining star in the current market would be for the locum tenens physician, and locum tenens companies. Facilities that are desperate to recruit a permanent physician are turning to locums to fill the gaps in their recruiting needs until they can find a more permanent solution. My advice to any physician who loses his or her job in this economic climate would be to work locums for a while until things improve. These jobs will be easier to find, you don’t have to sell your home to work locums (they will put you up in a hotel and provide a rental car in most cases), and the locum tenens company is picking up your malpractice costs.  If you are a medical practice, hospital or health system with critical recruiting needs, you may want to consider utilizing locum tenens physicians to fill your needs for the near future. In some cases you may find a permanent hire and this is a good way to find out if a physician is “a good fit” with your practice because you get to see them in action before you hire them permanently. Keep in mind though that many locums physicians are working locums because they are not interested in a permanent job, so they may only be a temporary solution for you until the economy recovers.

This is the bottom line for physician recruiters based on the information coming in to us here at PhysicianWork: The current candidate pool of physicians is greatly reduced as compared to previous years. In this economic climate you’re not going to be covered up with stacks of CV’s from any recruitment advertising resource you are using. Candidate response rates will be low or moderate for most specialties and you will have to be patient with your advertising programs. The key here would be to use as many recruiting resources as possible, and do not have unreal expectations of these resources. In other words, if you are using a known national physician recruiting resource, you shouldn’t terminate these ad programs because you aren’t getting the large number of candidate responses that you have in the past. Stay diligent with these programs because they are the ones most likely to produce viable candidates for your company. If you stop using good national resources that you know have traditionally produced results, then you will further isolate your company’s visibility to an already reduced candidate pool. Most of the good national physician recruiting resources will produce results, but it takes more time and you have to be patient.

So, where is the market headed? At the present time, not even “the experts” can tell us when things will turn around with our economy, the real estate and financial markets. So, physician recruitment will continue to be more difficult in the near term than it has been in the past.


July 30, 2009

Red flag rule postponed again

As you have probably already heard, the FTC is delaying enforcement of the Red Flags Rule until November 1, 2009 to give “small business[es] and other entities more time to develop and implement written identity theft prevention programs.”

The FTC also announced that it will “redouble its efforts” to educate small businesses and other entities about compliance with the Red Flags Rule. The FTC anticipates creating a special link on the FTC website for small and low-risk entities, with guidance and direction regarding compliance with the Red Flags Rule. See www.FTC.gov/redflagsrule. This response from the FTC is a result of the House Appropriation Committee’s request that the FTC defer enforcement for health care providers and small businesses that have a low risk of identity theft problems.

By the way, don't forget to vist my micro blog on Twitter: www.twitter.com/rtacpa.


July 27, 2009

Monitor your answering service to ensure good customer service

Keep in mind that patients perceive your answering service as an extension of your staff. Stay personally aware of your service's reliability and courtesy by regularly telephoning it yourself. Portray various situations, ranging from emergency to casual inquiry. Consider these points:

  • Was your call answered promptly or on the tenth ring?
  • Was it handled with proper manners and respect?
  • Was the important information relayed to you properly?

Tell your answering service that you will make such test calls. Additionally, notify the service's owner or manager of the specifics of any shortcomings. Make the complaint in writing as well as by phone so it drives home both your concern and your surveillance. And, just like your own staff, if you discover a particular operator who provides excellent service every time, compliment him or her to the service supervisor.

July 24, 2009

What You Can Learn From Michael Jackson

Simple - A very important lesson on estate planning. I saw this article by Neal Frankle, CFP in the AICPA Wealth Management Insider newsletter and thought it might interest the readership. Estate planning is something that always seems to get put on the “back burner”:

If you take the right steps you can do yourself a big favor. Just like Michael Jackson did. I live in Los Angeles. A few days ago, the city shut down to pay tribute to the controversial Mr. Jackson — but maybe — for the wrong reason.

The media are in frenzy and the tabloids are full of wild stories. They tease us by suggesting they know who is going to get what portion of Jackson's assets. And more important – who isn't going to get anything. Of course the media are lying to us because they need to sell their magazines.

The truth is they don't know anything about Jackson's estate. Very few people know that Jackson created a living trust in 2002.

Michael, wherever you are, ya done some good estate planning.

You can, and probably should, consider doing the same thing for yourself and your clients.

Living Trusts

A living trust is different from a will. If you use a will, it will get "interpreted" by the courts once you pass away and it will be argued about by the attorneys. This is probate. As you already know, it is a very costly, lengthy and public process — at least in California.

A living trust can help your clients avoid the cost, time delays and publicity associated with a will.

"Wait just a minute" you say … "Michael Jackson had a will!"

That's true. He did. But he, like most everyone who has a trust, created a "pour over will." Its only purpose is to provide for any assets that were mistakenly left out of the trust he created.

So when you read the tabloids' claim that so-and-so was left out of Jackson's will … they may be right but it doesn't necessarily mean that same person was left out of the estate. The trust could still award that person a great deal of money. The only difference is … we'll never know about it.

Benefits of Living Trusts

So a trust provides much greater privacy than a will. What other benefits does a trust offer?

Any assets you put into the trust go to the beneficiaries that you name. No lawyer or judge gets involved. Because of that, it's much less expensive and takes a lot less time to wind up an estate that has a trust versus an estate that doesn't. In some cases, a trust can be used to save big bucks on estate taxes but we're not going to get into that subject right now.

Another very important benefit of having a trust is that it usually includes setting up a health power of attorney. This gives legal authority to another human being to make medical decisions for you in the event that you are unable to do so. Keep in mind that you don't have to set up a trust to get such a document in place. You can usually get your local hospital to give you a blank health power of attorney form and just fill it out. I strongly recommend you consider getting such a document in place — whether or not you set up a trust.

Problems with Trusts

First, you have to actually create a trust. While that could cost you anywhere between a few hundred dollars to a few thousand dollars, it's well worth it. You have worked all of your life to build up assets. Doesn't it make sense to spend some money to protect those assets?

Next, you have to move assets into the trust. Keep in mind that a trust is only a shell. It creates the opportunity for you to have the benefits of the trust. In order to realize those benefits you have to rename their assets so that the trust is the owner of the assets. The renaming process is not difficult or costly.

Now, before you get into a big fuss, keep in mind that you don't have to give up control of the assets. By naming yourself the trustee of the trust, you can still call the shots. You don't have to give up anything. You can invest the money, sell the house … do anything you want. Nothing changes.

Another issue can be children. Some people say that a trust can't guarantee what happens to minor children if both parents pass away. That is true. But a will doesn't solve this problem either. As far as I know, there is no written document that you can create that will guarantee what happens to minor kids. You can make their wishes known by expressing them in the trust or will and the court usually carries that out.


The last lesson we learn from the Michael Jackson School of Estate Planning is that it's never too soon to take care of this issue. Nobody knows when his or her time is up. If you are responsible for other people or have assets you’d like your family to inherit without wasting lots of time and even more money, you should consider looking into setting up a living trust.

To subscribe to the newsletter, go to:



July 23, 2009

Working patient pay accounts

As a practice administrator, you should make a point every 4 months or so to work patient balance accounts.  This allows you a chance to speak personally with patients and find out certain things that happen in your processes that might help your collection efforts in the future.  It’s also a good checks and balances on your collectors. I know you have better things to do, but you should find this exercise very informative.

July 22, 2009

FTC Commissioner Gives Speech on Clinical Integration

From the American Health Lawyers Association; to join, go to www.healthlawyers.org:

On April 27, 2009, Federal Trade Commissioner (FTC) Commissioner Pamela Jones Harbour gave a speech on clinical integration at an annual meeting of the American Hospital Association (AHA). The speech, entitled "Clinical Integration: The Changing Policy Climate and What it Means for Care Coordination," provides the Commissioner's views on the FTC's policy on clinical integration and how that policy might be affected by the Obama Administration's healthcare reform plans. The Commissioner emphasized that the FTC's continuing approach to clinical integration will be a "flexible, case-by-case approach," and that the FTC staff is always willing to work with providers to resolve any antitrust concerns surrounding clinical integration plans.

In her speech before the AHA, the Commissioner commented on a number of themes relevant to clinical integration that were part of the Obama/Biden campaign health plan. First, the Commissioner said it is clear that the Obama Administration regards competition as an important element of the American healthcare system. For example, President Obama has suggested that any government-sponsored insurance plan should compete with private health insurers. Additionally, the Obama Administration has emphasized better coordination of care at all levels of the healthcare system, which the Administration notes can be partially accomplished through improved health information technology (HIT) measures and by linking physician compensation to the value of care provided. The goal is a quality-based, pay-for-performance model combined with changes in reimbursement methodology for doctors and their patients. The Commissioner noted that HIT could serve as a "hub for effective coordination-of-care efforts" and is "completely consistent with procompetitive clinical integration," but she emphasized that the FTC's and the Obama Administration's real focus should be quality of coordination and improved efficiency.

The Commissioner next explained that the FTC would not be issuing bright-line rules on clinical integration, but rather would continue to employ a flexible, case-by-case approach when analyzing clinical integration programs. Reacting to past criticism that the federal antitrust agencies have not been providing sufficient guidance to healthcare providers, the Commissioner said that the criticism was in effect a request for clinical integration safe harbors. She pointed to the thirty-seven-page advisory opinion recently issued by the Commission to TriState Health Partners as evidence that antitrust analysis of clinical integration programs is a highly fact-specific endeavor, and she emphasized that bright-line rules would stifle innovation in the development of such programs. The Commissioner also called for more empirical studies analyzing the clinical integration's overall effectiveness.

At the conclusion of her remarks, the Commissioner noted that the FTC had offered more guidance on clinical integration than on any other area within its competition jurisdiction. She emphasized that the doors were always open to speak to the FTC staff about any clinical integration plans, and that ultimately innovation and creative thinking would be what would most benefit the healthcare industry.

July 21, 2009

What it takes to successfully implement EMR

A large part of success/failure is that someone of authority in the practice has to take accountability to direct all the physicians that EMR is either go/no go for the entire group. This is not to say that leading physicians through the buy in process is not vitally important, only that the organization cannot be divided once an implementation decision has been reached. The single most important factor leading to dissatisfaction is allowing physicians to dictate when they will or will not join their peers in adopting EMR within the same practice. A physician champion is needed to make it happen but everyone has to hold hands and jump into the cold water at the same time.


When done right, meaning a complete reengineering of internal processes concurrent with the installation, not just forcing the EMR to mimic "the way we've always done things in the past "goes a long way to realizing acceptable advantages. The monetary challenges and ramp up time will, however, still remain difficult for most.

July 20, 2009

Tips to Get Your Business Associates to Comply with HIPAA

Reproduced from [name of publication] © 2008 HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945. 781/639-1872. www.hcpro.com. Used with permission.

Your business associates (BAs) must comply with the HIPAA Security Rule beginning February 18, 2010. That mandate is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, signed into law by President on Obama February 17, 2009. If complying with the HIPAA Security Rule sounds like a large task for, say, a small billing and coding company, well, that's because it is. Encryption. Destruction. Firewall protection. There's a lot to it.

And their problem is your problem. After all, it's your patients' information at stake. If your BA is good, you're good. If they're bad, well…just picture the front page of your local newspaper with your facility's name next to the word "breach" in a headline. So where do your BAs begin? Hopefully, they've already started.

Here are eight tips you can share with your BAs to get them ahead of the HIPAA compliance deadline next February:

1. Perform a risk assessment.

Determine your primary vulnerabilities. Find what your biggest threats to the security of your PHI are. You need to know where you are before you begin to form your policies and procedures. Check on the last time you had a security assessment, if ever, and start from there.

2. Make your own way.

As a BA, you must understand that you are responsible for your own compliance program, regardless of contract terms with a covered entity. You need to be responsible for your own security program with HIPAA. Do not simply accept what is thrown your way - Your program should be built based upon your organization's own unique risks. That's what your risk assessment will reveal.

3. Run a gap analysis on covered entity contracts.

HITECH is new, and existing contracts will probably leave gaps. We haven't been in this world before; Find your gaps and what you will do about them. You may want to wait for further regulations before you finalize your contracts. However, start by consulting your legal team. You may need to provide a contract in the future, but the onus now is only on the covered entity, according to current law.

4. Don't rewrite the entire contract.

The changes to the BA contracts should be minimal. Include a new short statement or paragraph indicating that the BA must now comply with the HIPAA security rule and the use and disclosure provisions of the privacy rule.

5. Add breach notification language to BA contracts.

The language should require the BA to notify the covered entity within five days of a breach. Also add language requiring that the BA pay the cost of notification, which could get rather expensive if the breach includes a significant number of individuals.

6. Add language about the Red Flags Rule.

Covered entities (primarily providers) should consider adding additional language to the BA contract requiring that certain BAs implement identity theft management programs. The Red Flags Rule requires covered entities considered to be creditors by FTC standards to adopt an identity theft prevention program by August 1.

7. Build your breach notification processes.

This is perhaps the biggest change for BAs. BAs must put a policy in writing per the HITECH Act. You need to be able to coordinate this by fall [of 2009] at the latest - This is going to be a big issue for a lot of BAs.

8. Train, train, train.

I’ve seen horrible training in the BA community. Make sure your policies document the need for regular training, along with ongoing awareness communications, and then use effective training content. Just throwing words in front of your personnel is not training.

Get your hands on HIPAA resources, such as training books, e-learning courses, and webinars. Check with your covered entities to see what they have done.

July 19, 2009

Reminder: Support Your Auto Expenses

Auto expenses are a very common deduction for business owners and employees who must travel. Often the taxpayer does not know the exact amounts necessary to calculate the proper deduction and the tax preparer must estimate the mileage, business percentage, and ultimate auto deduction with the client’s help. You need to have proper substantiation or, if the IRS examines your tax return, the deduction will more than likely be denied.

If the substantiation is lost or stolen, the IRS will generally deny the deduction because the Cohan rule (which allows a court to estimate deductible amounts of unsubstantiated expenses) cannot be applied for certain expenses, including automobile expenses (IRC § 274(d)(4)). In the case of a lost or stolen substantiation, combined with the nonavailability of contemporaneous records, substitute records may be provided, but they must include sufficient information to support the deduction (Temp. Treas. Reg. § 1.274-5T(c)).

Back in September of last year, the Tax Court in a summary decision upheld the Service’s disallowance of an auto expense deduction of a traveling salesperson due to lack of substantiation (Niyitegyeka, T.C. Summ. 2008-129). It was obvious that the taxpayer traveled for business and would ordinarily be entitled to a deduction, but the submitted evidence was too weak to allow it.

For a complete overview of the case, go to:


July 18, 2009

Make sure getting off call schedule is addressed

Make sure your physician employment agreements address when a physician can request to be removed from the call schedule and any related reductions to his or her compensation. Most groups I see either require a length of service requirement to get off call or when a physician reaches a certain age. The penalty for coming off call is usually a 20-30% reduction in compensation, depending of course on the medical specialty and the intensity of getting called out after hours. Any reduction in compensation is divided equally among the physicians who remain on the call schedule.