Obamacare led to an increase in ER visits

A recent study has shown a 5.6% increase in ER visits. The study by the Colorado Hospital Association included 450 hospitals in 25 states and demonstrated the increase is specifically due to the expansion in Medicaid. Moreover, the increase was three times higher than for hospitals in states that did not expand Medicaid. Additionally, the study implies that the newly insured Medicaid patients are sicker.

The Obama administration’s response? They claim they will educate these patients on how to obtain the right care, at the right place and time. I wouldn’t hold your breath on that.

Healthcare coverage was expanded and indeed that was a good thing for at least now those sick patients are going in to receive medical care. The problem is of course that the hospitals will have to figure out how to survive on Medicaid payments. Perhaps a time will come years down the road where patients will seek more preventative care via their primary care physician. In the meantime, however, hospitals are going to need to retool their operations and take a very hard look at their budgeting processes going forward.


Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

Patients’ Financial Responsibilities are Destroying Practices

The argument that patients’ deductibles will rise as a result of Obamacare is over as we have all seen it time and again in every state. What is now going to start making headlines is not only the damaging effect it has on personal finances but also the impact this change has on medical and dental practices, as well as hospitals. Here’s a quick look at the numbers:

  • 41% of employees who get health coverage at work have deductibles of at least $1,000; in 2006, only 10% of employees had such a deductible – Kaiser Family Foundation
  • The average deductible for the 7 million new Obamacare enrollees is $2,267 (for the most popular silver tier) – Robert Wood Johnson Foundation
  • 86% of insured Americans do not understand what is meant by “copays”, “deductibles”, “out of pocket maximums”, and “coinsurance” – Journal of Health Economics
  • 44% of U.S. households have less than 3 months of savings – Corporation for Enterprise Development

These statistics are staggering as they clearly show . . . Americans’ health insurance responsibility is rising, most (86%) do not understand what that means, and many will not be able to pay their medical and dental bills going forward. After we get through the politics of this upcoming November 2014 election, I predict that this impact on medical providers will start to become public knowledge. Combined with Americans paying their taxes the first part of next year, I believe 2015 will be a very heated year for the discussion of the impacts of healthcare reform that have now hit our society.


Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

Recruiting for your Medical/Dental Office Manager

Undoubtedly a talented manager will help to ensure a medical/dental practice operates efficiently, is profitable, and has great employees. Finding such a manager, however, can sometimes be challenging since your practice is not the only one attempting to recruit that stellar candidate. So, if you like gambling in casinos and/or have plenty of time to spend interviewing countless candidates, then you should put an advertisement in your local paper or online. Otherwise, your time and money would be better spent using a recruiter to find an experienced manager/administrator who you will value for years to come.

A good recruiter will weed through the candidates and give you just a few (no more than three) who appear to be a good fit for you and your practice. Of course, when it comes time to interview, there are several items you need to ensure are covered.

Top Characteristics

Here a few things that you should ensure the candidates have when you are conducting your interview:

• Appropriate education level (Do they need a high school diploma? Specific type of college degree? Master’s degree?)
• Business acumen (This is your business person, so don’t skimp on this criteria. You are not hiring them to perform surgery; you are hiring them to keep the practice in order.)
• Leadership capabilities (Are they motivating? Can they delegate?)
• Healthcare administrator qualities (Do they communicate well? Are they empathetic? Do they have a sense of attention to detail?)

Warning Characteristics

Recruiters should be interviewing candidates in great detail before they ever send them your way. It is their job to be acute and to have a thorough selective process. Even the best of recruiters may miss something when they screen candidates, so here are a few red flags you should be on the lookout for when conducting your interviews:

• Did the candidate ask about salary upfront? (Actually, when using a recruiter, the candidate should not even bring it up since the recruiter should have already covered the salary range, benefits, etc.)
• Did the candidate ask about long hours?
• Did the candidate slam their former co-workers?
• Does the candidate appear to have poor people skills?
• Does the candidate appear to miss the point about patient care? (This can sometimes be the case if this will be the first job they have in a medical/dental practice. Obviously, patient care is a priority. The candidate that does not get that, will not do a job well since they will be unable to relate to the tasks the clinical staff perform on a daily basis. The manager does NOT have to have clinical experience to do a great job as an administrator.)

This position is crucial member of your staff and critical to the success of your practice. Finding the right manager is not easy, but being open about your needs to a recruiter can help to facilitate the search for a perfect fit.

We work with several great recruiters. Please let us know if you need help finding one. Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

Physician Barometer

The Physicians Foundation produced yet another survey and the results are quite interesting. This survey (conducted by Merritt Hawkins on behalf of Physicians Foundation) regarding Practice Patterns and Perspectives is conducted every two years and recently garnered 20,000 responses from physicians across the country. The 2014 survey covers a whole host of issues including reimbursement, morale, physician shortages, electronic medical records, etc. Here are some highlights of the survey’s findings:

81% are over-extended or at full capacity
44% are planning to reduce their patient load
56% stated their morale is somewhat to very negative
85% have implemented electronic medical records (“EMR”), but:
47% stated EMR detracts from patient care
76% stated EMR did not improve efficiency
68% stated EMR did not improve the quality of care
50% expect ICD-10 will cause their practices to experience severe administrative problems
56% are not positive about the current state of the medical profession
39% plan to accelerate retirement plans due to Obamacare
69% stated their clinical autonomy is often compromised
46% graded Obamacare as a D or F
87% do not believe ACOs will decrease costs or enhance quality

On average, physicians stated they:
• spend 20% of their time on non-clinical paperwork
• work approximately 53 hours per week

Regarding Medicare/Medicaid patients:
• physicians stated 49% of their patients are enrolled in Medicare or Medicaid
• 24% do not see or limit the number of Medicare patients
• 38% do not see or limit the number or Medicaid patients


Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

If you build it, they may not come

With the changes and incentives (often misaligned incentives) in play as a result of Obamacare, many hospitals and provider groups are hedging their bets that bigger is better. To that extent, some are attempting to leverage their brand outside of their catchment area in an attempt to secure more patients. The pitch to those communities receiving the new facility is often the same: “we bring an unparalleled level of expertise”, “extending the benefits of an academic institution”, “to better serve the residents”. The problem is that the community often becomes confused and questions what sort of care they have been receiving for decades before this new entity decided to ride in on their white horse and save us all. Equally important, the entire medical community is often upset for the same reasons, with physicians stating “So, I have been providing substandard care to my patients?”

Although this has not stopped hospitals and provider groups from expanding their arena in the past, it was not as widespread as it has been in the past few years. This is due to the Obamacare push to have fewer players in the healthcare sector, essentially easing into socialized medicine as some would declare. Either way, it is certainly an “in your face” push to shut down the solo and small group medical practices that have longstanding roots in their communities.

Last year, a university physician’s group in Florida entered a market nearly two hours away to offer specialty care such as cardiology, gynecology, and orthopedics. In just 6 months, they walked away from their $4 million investment. The center was tracking to be $2 million in the red during its first year, but the university is conflicted. On one hand, they are not happy about the loss, to which they acknowledged “due diligence could have been better.” On the other hand, they are still eager to jump into that remote community due to the population health initiatives being driven by healthcare reform.

In Indiana, a proton therapy center is closing after being in operation for 10 years. This Indiana center, which had a $3.5 million operating loss last year, cited several reasons for closing including changes in new payment models like bundled payments. The point here is not this center’s closing but rather the plethora of other proton centers still being built and planned for around the country. There are 13 such centers in operation, but 12 more are currently being developed. Perhaps there is going to be a demand to justify doubling the number of proton therapy centers in the U.S. And perhaps, clinical studies and payment reforms will be in favor of all this growth. Time will tell.

There is no crystal ball as to how U.S. healthcare reform will shake out. I believe that our entrepreneurial society which includes outstanding physicians and great business leaders will prevail and patients will be the benefactors, providing all continue to put the patient first. Nevertheless, examples abound in the healthcare industry that show us . . . If you build it, they may not come.


Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

Laws Targeting Physician Behavior

Indeed there are many federal and state laws on the books that target physician behavior. Examples of some key federal laws include Stark, Anti-Kickback, and False Claims. In Florida, there are several additional regulations such as the Patient Self Referral Act and the Patient Brokering Statute. With all the changes going on within the U.S. healthcare industry, I thought I would provide a quick snapshot of healthcare fraud and abuse over the past 4 years.

Obamacare Initiative
Healthcare fraud and abuse is a big undertaking for the U.S. government, but governmental agencies have received help recently. In 2010, Obamacare gave CMS (Centers for Medicare and Medicaid Services) greater authority to battle fraud and abuse and the war has had substantial achievements. From 2010 to 2013, $19.2 billion was collected under the Health Care Fraud and Abuse Control Program.

In 2011, fraud charges were filed against some 1,430 defendants. That same year also saw 743 criminal convictions, 977 new investigations of civil health care fraud and the recovery of $4.1 billion.

Some of the actions have been quite newsworthy. For example, you may recall the raids in May 2012 of 7 U.S. cities which resulted in the arrests of 107 physicians and nurses.

And the Beat Goes On
Approximately 70% of recovery in 2013 from civil fraud, arose from matters involving healthcare fraud. In the first half of 2013, 1,500 individuals were excluded from participation in federal health care programs and 240 civil actions were undertaken by the OIG (Office of Inspector General). Last year saw 638 new prosecutions and the OIG recovered $4.3 billion.

By the end of 2013, new investigations opened involving 1,910 individuals and some 3,500 people were listed in pending investigations. The average prison term for individuals convicted in 2013 of Medicare fraud . . . 52 months!

Local Education

Some groups are taking a proactive stance to educate healthcare providers and managers. The Tampa chapter of PAHCOM (Professional Association of Health Care Office Management) is up and running and helping its members tremendously with a wealth of education from informative speakers. Recently, they received a presentation by Rachel Goodman, a healthcare attorney with Shumaker, Loop & Kendrick. The topic was Health Law 101 and she covered the basics that office managers need to know in order to help protect their physicians’ licenses and the practice as a whole.

Ignorance of the law is no excuse and you should call your attorney with any questions before the OIG comes knocking at your door. If you need help for your medical or dental practice, seek out a consultant experienced with practice operations.


Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

Stress Attacks Physicians and Practice Managers

Last week I attended a meeting of the Pinellas Park Medical District. The speaker, Dr. Colette Cseszko, presented a topic entitled “How to Eliminate the Harmful Effects of Stress”. This subject is indeed applicable to the medical community where physicians and their practice managers are being inundated with stress-causing issues today.

Obamacare. What does it mean? Am I ready to meet the requirements of the law for my patients? Am I ready to meet the requirements of the law for my staff as a business? How will this affect my livelihood?

Reimbursement Challenges. How can I better forecast financial profitability? How deep will the reimbursement cuts be next year? What impact will Obamacare have on reimbursement? With the changes in the economy, will my practice be seeing more Medicaid patients? As more baby boomers retire, will my patient demographics switch from commercial insurance to Medicare?

Rising Costs. Do I need to cut staff to survive? Will I be able to budget for staff pay increases? Has anyone reviewed the various service contracts and agreements that the practice has? Is there the ability to negotiate with vendors for better rates? Do I have the time to tackle these important issues?

Competition. How can I better compete for more patients? What should I focus on regarding marketing? Do I have a competitive strategy for my practice? Do I have time to spend on refining a strategy and implementing it?

Social Media. Is it really that important for my practice? What do I need to focus on? How do we get started? Who is going to keep the content fresh? Do I need to hire staff for this? What is it going to cost the practice?

Indeed, there are countless issues physicians and practice managers face. These challenges accumulate to the point that they can lead to frustration, burnout, and depression (in addition to other health-related issues as explained by Dr. Cseszko).


Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

Obamacare Open Enrollment

Believe it or not, it is almost that time of year already for open enrollment. This year, however, Obamacare enrollment could add new issues that have yet come to light. For the program itself, some of the challenges are the length and timing. The open enrollment season this year will be half as long as last year’s sign-up period. Additionally, the season (Nov 15 — Feb 15) overlaps with the holiday season.

But the larger implications are for those already enrolled. For starters, when you signed up last year the system set you up for automatic renewal. That fine print could turn out to be a bad thing because you may miss out on lower premium options and consequently be stuck with an outdated and possibly incorrect government subsidy.

Additionally, if you received tax credits to help pay your premium, you will have to file new forms with your 2014 tax return to prove you received the correct amount. A large majority (approximately 84%) of Obamacare enrollees fall into this category. The subsidies are tied to income, thus your tax filings will definitely be impacted in one way or another.

And for those who remained uninsured for this past year? Well, this is where you reap the well-published “gift” of Obamacare. For those of you in this category, you will receive a tax penalty (unless you can somehow secure an exemption).

So why all of these tax issues and penalties? Remember that, in short, the Supreme Court upheld the constitutionality of Obamacare only because the new healthcare law is . . . a TAX.


Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

The Truth Behind Medicare Spending

As usual, there is much spin regarding the topic of Medicare spending. The only common denominator behind all comments is that everyone admits there will be an end to Medicare as we know it.

So what’s the spin? Well, some people are trying to dissuade the public by stating that per capita Medicare spending is down and equating it to the U.S. getting a hold of total Medicare spending. This, my friends, is a complete falsehood.

The reality is that the baby boomer generation is entering the Medicare program and in the long term that is a huge problem for the Medicare budget. Simply put, there will be a surge in the number of people that Medicare will have to support. However, in the short term Medicare’s per capita spending numbers are skewed. Why? It’s actually quite simple. With a large number of “younger” baby boomers entering Medicare, the group is skewed toward a younger, healthier population. As previously stated, however, when this surge of people in Medicare ages (and needs more medical care), Medicare spending (in total and per capita) will soar and program will crumble.

So don’t get caught up in whatever the current hype is. Rather, continue to believe in what everyone has said for years . . . . Medicare as we know it will eventually come to an end.


Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.