It Took A Pandemic To Push Thru Stark Law Changes

On March 30, 2020, the CMS issued the Stark Blanket Waiver in response to the COVID-19 pandemic in order to facilitate Coronavirus related medical services. Retroactive to March 1, 2020, the circumstances and conditions under which the waivers apply are strictly and narrowly described as relating to the physician self-referral law (Stark Law).

Although temporary (at this time), health care providers, physicians and clinicians have a unique opportunity to take advantage of the Stark Blanket Waiver as it will protect financial relationships, remuneration and referrals (and the claims submitted as a result thereof) that are related to a broadly defined set of “COVID-19 Purposes.”

The blanket waivers define “COVID-19 Purposes” broadly to include the following:

• “Diagnosis or medically necessary treatment of COVID-19 for any patient or individual, whether or not the patient or individual is diagnosed with a confirmed case of COVID-19;

• Securing the services of physicians and other health care practitioners and professionals to furnish medically necessary patient care services, including services not related to the diagnosis and treatment of COVID-19, in response to the COVID-19 outbreak in the United States;

• Ensuring the ability of health care providers to address patient and community needs due to the COVID-19 outbreak;

• Expanding the capacity of health care providers to address patient and community needs due to the COVID-19 outbreak;

• Shifting the diagnosis and care of patients to appropriate alternative settings due to the COVID-19 outbreak; or

• Addressing medical practice or business interruption due to the COVID-19 outbreak in the United States in order to maintain the availability of medical care and related services for patients and the community.”

The CMS provided the following examples of how the Stark Blanket Waiver will enable flexibility for physicians and DHS entities:

• Non-Fair Market Value (FMV) Compensation. Hospitals and other providers may pay physicians above or below fair market value to rent equipment or receive services from physicians (or vice versa). Hospitals may rent space in a physician office related to COVID-19 patients below FMV or free of charge.

• Flexible Financial Support. A physician owner of a hospital may make a personal loan to the hospital without charging interest at FMV so that the hospital can make payroll or pay vendors.

• Medical Staff Benefits. Hospitals can provide benefits to medical staff, such as daily meals, laundry service or child care services.

• Non-monetary Compensation. Certain items and services that are related to the COVID-19 Purposes may be provided to physicians (e.g., continuing medical education regarding latest care protocols for COVID-19) without exceeding the annual non-monetary compensation cap.

• Hospital Capacity. Physician-owned hospitals may temporarily increase the number of licensed beds, operating rooms and procedure rooms, even if such increases would otherwise be prohibited under the Stark Law.

• Group Practice-Home Care. Any physician in a group practice may order medically necessary DHS that furnished to a patient by a technician or nurse in the patient’s home contemporaneously with a physician service that is furnished via telehealth by the physician who ordered the DHS.

• Relaxation of In-Office Requirement. Group practices can furnish medically necessary MRIs, CT scans or clinical laboratory services from locations such as mobile vans in parking lots that the group practice rents on a part-time basis. Physicians may provide clinical lab services related to Coronavirus detection and treatment because requirements that the DHS be provided in the same building as the physician office are waived; and financial relationship limitations between the physician (or family member) and the DHS provider are also waived.

These examples are merely illustrative, and each arrangement should be reviewed to ensure that it does not run afoul of other applicable state and federal laws including, specifically, applicable fraud, waste and abuse laws. Finally, although DHS entities and physician do not need to notify CMS to utilize the Stark Blanket Waiver, they “must make records relating to the use of the blanket waivers available to” CMS upon request.

We cannot stress strongly enough that the blanket waivers apply only if:

• Providers are acting in good faith to provide care in response to the COVID-19 pandemic;
• Financial relationships or referrals are protected by one of CMS’ 18 permitted relationships; and
• Financial relationships do not create fraud and abuse concerns.

Check out the more than 60 specific waivers and other changes announced in the Emergency Declaration: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf.   

Healthcare providers, including DHS entities and physicians, should continue to monitor the CMS Coronavirus Waivers & Flexibilities website for any further developments in responding to the COVID-19 pandemic: https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers.

REACH OUT TO US: These blanket waivers only temporarily permit payments and referrals between physicians and DHS entities if the relationship falls into one of CMS’ stated categories during the COVID-19 pandemic, even if such an arrangement would not meet a Stark Law exception. For now, the CMS is giving providers more freedom and flexibility as the COVID-19 pandemic continues, but keep in mind these blanket waivers will terminate at the end of the public health emergency. In the meantime we urge all physicians to examine their referral relationships, telemedicine practices, and hospital/surgery center connections for opportunities. Keep in mind, the Stark Law Waivers have no impact in the presence of fraud or abuse. We can assist with cash flow, liquidity, loans, insurance, restructuring, Tax credits and much more to get you through this crisis.


TFG Health Physician Telemedicine Toolkit

Telemedicine and virtual care have quickly become important tools in caring for your patients while keeping yourself and your staff safe as the COVID-19 pandemic evolves. It is a shame that a crisis like the Coronavirus is what it took to make telemedicine mainstream for most of the medical profession. Prior to the pandemic, telemedicine was not the success story it hoped to be.

Fortunately, the CMS reacted and has loosened the regulations for telemedicine in response to the emergency. Telehealth services may now be delivered to Medicare beneficiaries by phone as long as video capability is available. Wondering how to get reimbursed? Have questions about what technology to use? Download these helpful resources:

AAFP: https://www.aafp.org/patient-care/emergency/2019-coronavirus/telehealth.html

CMS General Provider Telehealth and Telemedicine Tool Kit: https://www.cms.gov/files/document/general-telemedicine-toolkit.pdf

AMA Telemedicine Quick Set-up Guide: https://www.ama-assn.org/practice-management/digital/ama-quick-guide-telemedicine-practice

Expansion of Telehealth and Licensing Waivers During Pandemic: http://connectwithcare.org/state-telehealth-and-licensure-expansion-covid-19-chart/

CONTACT US: Remember, we are here to help you keep your practice healthy during the pandemic! Telemedicine is a financial and economic opportunity. It might just be here to stay as both you and your patients will become accustomed to the convenience. Reach out to us with questions about the financial health of your practice


Modern Healthcare Meets Its Match With Coronavirus

A State of Emergency exists across the nation due to COVID-19. Many medical practices have been told to cut non-emergency services and elective procedures. Many states have now issued orders to dental offices to only respond to emergencies, and chiropractors have been ordered to shut their doors. Optometrists and ophthalmologists may be next along with therapists. Providers are concerned just like other businesses about paying rent, making payroll, and eventually forking over taxes. Those that are still open are concerned about their workers contracting the virus, lack of protocols, lack of safety equipment, and lack of a plan by state and federal legislators.

There are a few important topics we wish to address on behalf of our physician practices and medical groups regarding the pandemic COVID-19.

1. Many of our clients participate in ACOs. ACOs that participate in the Medicare Shared Savings Program are concerned they will be on the hook for penalties and won’t receive shared savings this performance year because of Coronavirus cases. The COVID-19 outbreak may drive up Medicare beneficiary spending this year, affecting the benchmark used to determine savings and losses in the program. The benchmark uses historical Medicare spending in addition to current performance year spending.

• According to a CMS spokesman, “The Medicare Shared Savings Program has policies in place to account for unexpected rises in Medicare beneficiary spending that have historically been used for natural disasters. The CMS can mitigate shared losses and calculate quality scores differently for ACOs affected with such issues. The agency implemented such policies for ACOs affected in performance year 2017 by Hurricanes, as well as the California wildfires.” The CMS spokesman also said it’s important to note healthcare providers in ACOs are part of the Medicare fee-for-service program, which has made special coverage considerations for Coronavirus such as testing.

• CMS recently announced relief for clinicians, providers, hospitals and facilities participating in quality reporting programs in response to COVID-19: Due to COVID-19, the Centers for Medicare & Medicaid Services is implementing additional extreme and uncontrollable circumstances policy exceptions and extensions for upcoming quality measure reporting and data submission deadlines for the following CMS programs:

MIPS/ACOs (Provider Programs)

1. 2019 data submission deadline has been extended from March 31, 2020 to April 30, 2020.
2. MIPS eligible clinicians who have not submitted any MIPS data by April 30, 2020 will qualify for the automatic extreme and uncontrollable circumstances policy and will receive a neutral payment adjustment for the 2021 MIPS payment year. 

1. At this time CMS is evaluation options for relief around participation and data submission for 2020 

Post-Acute Care (PAC) Programs: 

1. 2019 data submission for Oct. 1, 2019 – Dec. 31, 2019 (Q4) is optional.
2. If Q4 is submitted, it will be used to calculate the 2019 performance and payment (where appropriate).

1. Data from Jan. 1, 2020 – June 30, 2020 (Q1 – Q2) DOES NOT need to be submitted to CMS.
2. Home Health and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data from Jan. 1, 2020 – Sept. 30, 2020 (Q1 – Q3) DOES NOT need to be submitted to CMS.

2. President Trump has declared COVID-19 a national emergency. Hospitals have activated there emergency response plans – have you and your physician practice? What protocols have you put in place? Accommodations for staff and patients? You must demonstrate some level of due diligence in assessing patient health and ensuring the safety of patients in your waiting room or you may be liable for not doing anything to protect your patients!

See recommendations below from the PBCMS in the event a patient with suspected COVID-19 seeks care:

a) Follow the CDC’s patient assessment protocol for early disease detection. If a patient calls to schedule an appointment for an acute respiratory illness (e.g., fever, cough, and difficulty breathing), he or she should be screened appropriately for COVID-19. The CDC strongly recommends that practices do not turn patients away simply because a patient presents with acute respiratory symptoms.

b) Practices should consider developing front-door and office signage that informs patients who are exhibiting any of the PUI evaluation criteria (e.g., presenting symptoms, recent contacts, and/or travel history) to notify facility personnel. Consider giving a quick questionnaire to patients upon check in, and include this information on the practice website, also.

c) In some communities with the potential for community spread, the CDC recommends exploring alternatives to face-to-face triage during visits if screening can take place over the phone or via telemedicine.

d) If presenting symptoms, travel history, or patient contacts are suspicious, immediately isolate patients coming into the office in a designated exam room with dedicated patient care equipment. A back entrance may be utilized, if available. Since most medical offices don’t have negative pressure airflow, a spare bathroom with negative exhaust fans may be an option in the medical office setting instead of a regular exam room. The CDC provides guidelines for environmental infection control in healthcare facilities

e) Once suspected patients are inside the facility, instruct them to put on a face mask, utilize tissues, practice good hand hygiene, and dispose properly of any contaminated protective equipment/tissues in a designated waste receptacle.

f) Follow Standard, Contact, and Airborne precautions including gloves, gowns, protective eyewear, and NIOSH-certified N95 respirators that have been properly fit-tested. This applies to all healthcare staff interacting with patients.

g) Limit staff exposure to suspected patients, with the exam room door kept closed. Maintain records of staff-patient contact, i.e., who was assigned to work with the patient, either in a log or in the medical record. Any unprotected occupational exposure by staff members should be assessed and monitored.

h) When there is a reasonable presumption that a patient may have been exposed to COVID-19, contact the local or state health department regarding patient testing, and for locations designated to triage suspected patients so exposure is limited in general medical offices. Suspected cases must be reported to applicable local and state health departments.

i) Once the patient exits the room, conduct surface disinfection while staff continues to wear personal protective equipment (PPE).

j) Provide information on the virus to the patient and close contacts, including how to follow infection-control practices at home, such as in-home isolation, hand hygiene, cough etiquette, waste disposal, and the use of face masks.

3. Healthcare providers are concerned about the scarcity of PPE, testing kits, protective gear, medications, prescription delays, and COVID-19 copay issues, among other concerns. New York has been one of the states hit the hardest by the Coronavirus outbreak, yet suppliers are struggling to make testing for the virus widely available, with local officials estimating it could take weeks more to reach peak testing capacity. Cases in New York continue to climb as they do around the country. The Defense Production Act will help with marshaling critical supplies, as will the $2 Trillion dollar stimulus package that would inject several billion into the hospital system just passed by Congress. Dr. William Valenti, Chair of MSSNY’s Infectious Diseases Committee, discusses the current Coronavirus outbreak in a March 11th podcast here: https://www.buzzsprout.com/51522/2982079.

An unidentified flaw in test kits distributed by the federal government in February, which gave some false results, has set the country back; boosting testing is crucial disease experts say, to assess the scope of the U.S. outbreak and identify where it is spreading most rapidly. 1.5 million test kits were to already be available by the end of last week, but progress has been slow due to regulatory hurdles at the federal and state level (even thought the FDA is now granting regulatory authority to the states), as well as logistical and technical challenges, and supply chain issues. There is a critical shortage of the physical components needed to carry out tests: extraction kits to isolate viral RNA from specimens, reagents that determine whether Covid19 is present in the sample, and a lack of test swabs.

Click here for a Clinician Screening Tool for Identifying Persons with Coronavirus Disease: https://pbcms.memberclicks.net/assets/docs/nCoVProviderAlgorithmCHD2020-02-28.pdf

4. Have you considered implementing telehealth if you haven’t already? What about offering immunity enhancing services or products, vitamin infusions etc.? With respect to telehealth services, The AMA has made recommendations to the CMS for provisions that were included in the first supplemental spending bill passed by Congress. “We have urged CMS to substantially expand its coverage of patient-physician telephone conversations. Telehealth services should also be extended to ongoing care needs unrelated to COVID-19 during this time of “social distancing,” which is particularly relevant to elderly Medicare beneficiaries who are most at risk of severe complications from exposure to the virus. In addition, we have recommended a solution to CMS about currently inadequate ICD-10 diagnosis coding for COVID-19.”

This week the Trump administration announced it will temporarily expand telehealth services under Medicare to cover such interactions at the same rate as in-person visits and allow the suspension of certain HIPAA requirements so doctors can provide services with their personal phones. A range of providers will be able to deliver telehealth services, including doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers. Visits using the telehealth services will be considered the same as in-person visits and will be paid as if the patient were seen in the office. This expansion of Medicare telehealth services will continue for the duration of the COVID-19 public health emergency.

5. In the midst of the crisis Florida lawmakers passed sweeping legislation to expand the roles that pharmacists play in the state’s health-care system, including allowing pharmacists to test and treat patients for the flu and strep throat and treat people with chronic medical conditions, including arthritis, asthma, chronic obstructive pulmonary diseases, Type 2 diabetes, HIV, AIDS, obesity, or “any other chronic condition” adopted in rules. This may be helpful as the healthcare system continues to become more and more overwhelmed with COVID-19.

Concurrently the Florida Senate and House backed a bill that allows advanced practice registered nurses to provide primary care independently of physicians and for certified nurse midwives to work autonomously. The final version of the Advanced Nurses Bill was something of a compromise between the House and Senate. For instance, the bill doesn’t include independent practice for physician assistants or certified registered nurse anesthetists.

6. Additionally, the IRS advised that high-deductible health plans (HDHPs) can be used to pay for 2019 Novel Coronavirus (COVID-19)-related testing and treatment, without jeopardizing their status. This also means that an individual with an HDHP that covers these costs may continue to contribute to a health savings account (HSA). As stated in Notice 2020-15, health plans that otherwise qualify as HDHPs will not lose that status merely because they cover the cost of testing or treatment of COVID-19 before plan deductibles have been met. As in the past, any vaccination costs continue to count as preventive care and can be paid for by an HDHP.

Contact Us: Does your medical practice need a check-up for Coronavirus? We can help keep your practice healthy during the economic downturn due to Coronavirus. We can discuss the short- and long-term impacts on your business operations and the right steps to take now to minimize your risk. Do you have business interruption insurance? We have ideas how you can be proactive and revise your original 2020 business plan.


TFG Client Spotlight – Marciano Family Optometric

Our November client in the spotlight is Marciano Family Optometric and owners Drs. Mark and Brandee Marciano. Both are board certified optometric physicians who met during their fourth-year externship, and made a dream come true when they married and then built an optometric practice together that is now the leading provider of optometry services and vision care products in the greater West Palm Beach area.

“We believe life is all about your vision,” has been their motto since opening their doors in 2005. Dr. Mark Marciano has been practicing since 1999 and performs comprehensive eye exams and specializes in the management of ocular disease; including, cataract, glaucoma and refractive surgeries. Dr. Brandee Owens Marciano has also been practicing since 1999 and has extensive training in the co-management of refractive surgery and in pediatric eye care. She performs comprehensive eye exams and specializes in contact lenses, vision therapy and ocular disease management.

Marciano Family Optometric offers vision examinations to families from the young through the young at heart and specializes in the diagnosis and treatment of a wide array of eye diseases, conditions, and problems. It is their mission to provide the best eye care services possible, using only the most advanced, state-of-the-art diagnostic technology and eye care products available. They and their entire staff are committed to educating patients and providing high-quality, personalized eye care. The office is located at 1788 North Jog Road, West Palm Beach, Florida. Appointments can be made by calling 561-242-1200. More information on products, services, and staff, can be found at www.drmarciano.com.

Marciano Family Optometric has some exciting news to share, the addition of their new second location “Marciano Family Vision Associates” is on the way! Mark and Brandee purchased the practice of Dr. Michael Haugen located at 11380 Prosperity Farms Rd., in Palm Beach Gardens. Renovations are almost complete, state-of-the-art diagnostic equipment is being installed, and they anticipate opening Marciano Family Vision Associates in early December.

You may recognize Mark from his photo because he also serves as a Palm Beach Gardens City Councilman. Mark is also a Senior Trustee to the Florida Optometric Association. Both doctors are very involved in their community and the Society of Optometrists, they have both served as Past President of the Palm Beach County Optometric Association. Mark and Brandee live in Palm Beach Gardens where they are raising their two sons.

TFG is proud to provide Drs. Mark and Brandee Marciano, and Marciano Family Optometric, with a customized range of accounting services as part of our “new financial dialogue.” Become a part of the Fuoco Group and TFG Health client family, and enjoy the benefits of our expertise. We are more than just accountants, we are trusted business advisors that will beat your expectations.


Why Financial Planning Is A Challenge For Physicians

Like everyone else, doctors are concerned they are not saving enough money to retire on. However, there are many factors that set physicians apart from the average American trying to plan for their retirement. First, due to their grueling schedules doctors have less time than the average individual for financial planning.

Second, the cost of regulation and compliance is growing and that is increasing business expenses and disrupting cash flow. Third, reimbursements are decreasing and that negatively impacts income. What else distinguishes doctors from other folks hoping to safeguard their financial future? Plenty! Here is why healthcare professionals and clinicians need more than the general investment advice found on Google and in newspaper and magazine articles:

It takes more time to establish their healthcare practice. Medical school, residency, and fellowships – a doctor’s career takes longer to get started, and it takes longer for their medical practice to become established. Add to that early retirement due to burnout and the staggering amount of student loan debt, it’s no wonder there is less time to save what’s needed for retirement.

Higher income may require more complex investments. Tax efficient investing is a priority for physicians who traditionally make higher incomes, and often juggle brokerage accounts, Roth IRAs, life insurance and annuities, and outside retirement plans. It is important to consider tax-advantaged and tax-exempt investments and know how to access funds in the most efficient way during retirement.

An asset protection plan is needed. Medical malpractice lawsuits loom large and doctors in every profession need to plan ahead for the possibility of an adverse event as well as for disability. Income and retirement savings need protection, and long term care must be considered. A risk assessment is needed and an insurance audit for yourself and your family as well as for your practice.

A long term exit strategy is essential. Transition models can include selling your practice and all related assets outright or a partial sale of the practice assets only while retaining ownership of hard assets, such as the building and land, which can generate ongoing income.

Job security is a myth. Group contracts are not always renewed by facilities, and some physicians are being replaced by mid-level providers to contain costs. Leverage that physicians once had as a unique and powerful brand is fading. Even a doctor who is the head of a department or a key faculty member is subject to the whims of a large bureaucracy or big corporation just as much as the rest of us these days. And as the economy goes (or the insurance provider) – so goes the elective surgeries. Medicine is not recession proof.

Spending habits are hard to break. Lifestyle choices can be difficult, but budgets work for a reason. Financial goals need to be aligned with spending and financial habits like saving.

Financial planning for physicians is a specialized area of practice that requires an understanding of the unique financial challenges facing doctors today. Healthcare practitioners need to take a wellness approach to their financial health and that includes an annual financial check-up! Do you have access to adequate resources for emergencies or opportunities? A comprehensive financial plan for a physician from residency to retirement would include:

•    Financial Statements,
•    Income Tax Planning,
•    Insurance and Asset Protection,
•    Debt Analysis and Management,
•    Budget and Cash Flow Management,
•    Tax Efficient Investment Planning,
•    Business Loan Procurement,
•    Employee Benefits Planning,
•    Retirement Planning, and
•    Estate Planning

Contact the healthcare experts at TFG – we are more than just accountants and tax experts, we are medical practice consultants and business advisors. We understand your struggles with variable income, compliance issues, payors, and the changing landscape of medicine. Take advantage of our 20+ years of experience whether you are a physician, surgeon, chiropractor, dermatologist, dentist, podiatrist, pharmacist or other niche healthcare provider.


So You Became A Partner In A Medical Practice – Now What?

Becoming a partner in a physician practice or dental group is a dream come true and comes as the result of goals setting, sacrifice and an investment of time and self. It can also be a cauldron of financial complexity.

Be prepared. Although partnership can give you a voice in how the medical group is run, job security, and additional income, it comes with complications. Partners assume the risk in the practice, but those who are entrepreneurial and productive can realize success, even in a smaller partnership. There is no silver bullet or one size fits all approach, but here are the major landmines to be mindful of:

1.    The Buy In: Some groups have you buy in with dollars, other have you buy in with time served. The difference between what you earn and what you’re paid goes toward your equity share in the group. That might include part of a building, some medical equipment, goodwill, and a share of the accounts receivable. Negotiate your partnership contract. Have built in compensation increases for reaching revenue goals or cost-saving benchmarks, as well as increases to keep pace with inflation, etc.

2.    The Additional Expenses: A step up the ladder comes at a price – now you will be responsible for the personal expenses that the practice paid on your behalf prior to partnership including health insurance, malpractice insurance, Social Security and Medicare taxes. Set up an HSA to pay medical bills and contribute to it as a retirement vehicle, it is triple tax free. You won’t have withholding, so consider making quarterly estimated tax payments. You may get paid on a K-1.

3.    Shared Business Costs: Be aware that as a partner, you will now share in costs of running the practice whether administrative, operational, or related to insurance, taxes and financial fees, etc. Some of the practice expenses will be variable and some fixed, some will fluctuate based on how many patients you see and how much revenue is generated. This also means your income will variable.

4.    Financial Complexity: The more you make, the more you pay in taxes. Tax minimization strategies still exist and there are business structuring options available – tax reform legislation now provides a deduction of up to 20% for pass-through entities on qualified business income.

5.    Retirement options: Often there are additional retirement savings options and investment plans available to partners, now is the time to consider contributing up to the annual limit. Whether early retirement is on your mind or not, you need to plan now to exit the practice later. Estate planning alone will not protect your family, but Business Exit Planning will protect your financial future.

Contact Us: Making partner is a significant life event! It is a great time to review your financial situation. Make a budget, look at your insurance, plan your investments, and put together an asset protection plan as well as an estate plan. As mentioned in the article It is also a good time to have a review of business structure and tax situation with your Fuoco Group CPA. Congratulations! Becoming a partner can bring financial complexity, but your TFG professionals are here to help you reap the rewards.


Physician Wellness – The TFG Fast Five To Thrive

Dealing with physician burnout – why is it so prevalent for so many practitioners in medicine in this new millennium?

Being a physician is a demanding job with serious responsibilities. Add to that the fact that patients are often chronically ill, sometimes treatment doesn’t work, and occasionally patients die — that is a heavy burden to bear in addition to a daily workload, rounds, running your practice. But what exactly is burnout, how prevalent is it, and why should the medical community be concerned?

Studies define burnout as “a syndrome consisting of emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment, which is primarily driven by workplace stressors.” Recent research shows nearly half of practicing physicians in the U.S. experience burnout at some point, with those at the front line of care reporting the highest rates.

Leading drivers of burnout include excessive workload, imbalance between job demands and skills, a lack of job control, and prolonged work stress. Not all of the reasons for burnout are work-related. A physician may have significant issues regarding his or her own health or their personal life. Generally, the three symptoms of physician burnout are exhaustion, cynicism and doubt. Exhaustion isn’t just physical, but can be mental, emotional, even spiritual. Cynicism, or depersonalization, is sometimes dubbed “compassion fatigue.” And doubt, of course, is wondering why you bother.

Burnout in physicians has been linked with lower work satisfaction, disrupted personal relationships, substance misuse, depression, and suicide.  Burnout can result in an increase in medical errors, reduced quality of patient care, and lower patient satisfaction. Burnout is responsible for reduced productivity, high job turnover, and early retirement.

Kevin MD reports that more than 51% of physicians attribute burnout to excessive administrative burdens and bureaucratic duties, among other things like long hours, a constantly shifting health care system, and dealing with a built-in level of failure.

A recent article in Medical Economics suggests that simple tweaks in day-to-day tasks, workflow shortcuts, and running your practice more efficiently can ease stress and create a more positive experience for both physicians and patients. There’s a bit more to it than that.

First, as a physician you have to admit that you have normal human needs, will occasionally display vulnerability, are not a machine, and have the right to say “NO” when workload becomes impossible. There should be no shame or stigma about needing help, never wait till you are overwhelmed, exhausted, and stressed, before reaching out for assistance. Don’t blame yourself or let cultural norms, chaotic office conditions and a broken hospital system lead to your burnout!

Second, remember depression and burnout aren’t necessarily the same thing — but they often overlap. Take steps to avoid burnout and, if you feel yourself slipping over into depression, get help.

Third, the solution entails more than getting some sleep, meditating, exercising regularly, learning to say no, and better time management skills. The ultimate answer might be fixing the broken health care system. Studies show that burnout is a problem of the whole health care organization, rather than individuals. It requires structural changes and an organizational approach like changes in schedule and reductions in the intensity of workload, improved teamwork and leadership, communication skills training, changes in work evaluation, enhanced job control, and increasing the physician level of participation in decision making.

With all of that in mind, here are Fuoco’s five to thrive, self-healing strategies to stave off burnout:

1.    Sometimes you just have to say “no.” It’s impossible to say yes to everything. Before answering, always ask yourself: Will it lead to more balance in my life or create unwanted imbalance? Will it take away from time with my family and friends? Will it enhance my career? What aspect of being a physician do you enjoy the most and feel you’re best at? Try to focus on that and say yes to more of what you enjoy doing.

2.    Accept that you have limitations just like everyone else. Physicians can’t always help or save every patient. It’s impossible to predict or anticipate every possible medical outcome. Sometimes you won’t get to finish every item on your to-do list because you are juggling so many balls (or patients) at once. Develop coping techniques that work for you so you can accept it, and move on.

3.    Develop a strong support system. Whether it’s a spouse, friend, colleague, or trusted business advisor, everybody needs someone who will listen. Work on building a team, and better communication and collaboration whether at the office, or in the hospital (even at home).

4.    Slow it down. The business plan might call for spending 15 minutes with a patient and moving on, but don’t stress about being so efficient. Slowing down, and taking a few extra minutes out of your schedule when needed to listen, will benefit not only the patient, but you too.

5.    Learn to be flexible. Adapting to change is tough and it seems the practice of medicine is changing dramatically every day. Balance is hard to achieve, and stress as well as busy schedules are part of any career. Maybe “survival of the fittest” means most able to adapt to change. Being open and receptive to new ideas and ways of doing things is a positive way to work and live.

Some helpful resources for our physician clients in New York and Florida include:

American Association Physician Wellness Program: https://www.ama-assn.org/physician-wellness-program

Florida Medical Association Resources: https://www.flmedical.org/florida/Florida_Public/Resources/Physician_Wellness/Physician_Wellness.aspx

Florida Resources for Physician Wellness from the Palm Beach County Medical Society: https://pbcms.memberclicks.net/physician-wellness-program

New York Resources from the Medical Society of the State of New York Committee for Physician Health:

As you work for the health of your patients, the professionals at Fuoco Group work for our physicians’ financial health. If you are worrying about cash flow, internal controls, staff and equipment issues, perhaps the prescription is customized accounting and financial services from a CPA firm well versed in physician medical practices. Our “New Financial Dialogue” includes a 360 degree business advisory program designed to take the burden off you and your physician partners because worrying about costs, reimbursement, margins, operations and finances shouldn’t be keeping you awake at night!

Contact us today – offices in New York, Long Island, and South Florida.


Is It Time For Your Medical Practice To Have A Check-Up?

Here’s our Rx to protect and enhance your bottom line so you can spend more time practicing medicine and taking care of patients:

1)    Hire Better – This will save you money in the long run as having to replace staff is expensive in many ways and bad employees can cost you patients. You wear a lot of hats in your practice, but remember that patients spend a great deal of time in front of your employees so make sure they are technically skilled, but also compassionate and personable. The more your staff can do, the less time you have to devote to tedious tasks, and you might just help your stress level as well as your financial statement.

2)    Don’t Be Afraid of Change – When your practice stagnates so does your bottom line. Embrace technology that streamlines daily tasks, billing, processes, patient intake and records, etc. In the end it saves time, and makes compliance and collections easier. On another note, be aware of tech trends that are changing the status quo such as telehealth and telemedicine – there may be financial opportunities there as well as a way to better serve patients!

3)    Look Beyond Reimbursement – What insurers and other payors, including the government, are willing to reimburse is not controlled by physicians, and we have already seen how $$$ for quality vs procedure has shifted the financial landscape. Focus instead on internal costs which you can control. Focus instead on proper coding and compliance to avoid penalties.

4)    Better Billing – Train staff to increase time for revenue producing activities, code and bill accordingly, and reward staff for opportunities seized to streamline activities and avoid waste/duplication.

5)    Toot Your Own Horn – You can easily grow your practice by figuring out what is special about your brand or medical niche and then marketing that. If you are not ready for a facebook page, at the very least make sure all your online profiles are accurate, and your website is visible and accessible. Join a local medical society or professional organization and network with other doctors or large employers in your area who can refer patients to you.

6)    Avoid Burnout – You are the practice leader as well as the healer. You can’t do either well when you are seriously fatigued. Remember exhaustion is mental, physical and emotional. Know your limits, when to slow down and when to ask for help. Communicate, build a team, re-evaluate scheduling and workload, delegate where possible, and accept your limitations.

CONTACT US: Perhaps it’s time to consider an accounting ally in the healthcare industry with single or multiple physician practice expertise whether internist, specialist, surgeon, chiropractor, podiatrist, dentist, etc. In addition to tax and accounting services, our new financial dialogue includes a 360 degree business advisory program. All designed to take the burden off you and your physician partners because worrying about costs, reimbursement, margins, operations and finances shouldn’t be keeping you awake at night!


Physicians Have Their Part To Play In Preventing Healthcare Fraud

Doctors face a variety of legal risks every day: malpractice, fraud, waste and abuse. These actually surpass the risk of malpractice and tax liability. But physicians participating in federal health care programs can and must minimize those risks, because failure to do so exposes them to severe criminal, civil and administrative penalties, as well as tarnishes their reputation and impact reimbursement. Here are some simple steps that can help you take control:

1)    Review the red flags for fraud:

•    Billing for services not rendered.
•    Billing for a non-covered service as a covered service.
•    Misrepresenting dates of service.
•    Misrepresenting locations of service.
•    Misrepresenting provider of service.
•    Waiving of deductibles and/or co-payments.
•    Incorrect reporting of diagnoses or procedures (includes unbundling).
•    Over-utilization of services.
•    Corruption (kickbacks and bribery).
•    False or unnecessary issuance of prescription drugs.

Disputes often occur due to concerns about the adequacy of a provider’s documentation or the level of supervision over a service. Generally the provider is a repeat offender! Unfortunately it is assumed that physicians and their staff know all the statutes, regulations, and CPT codes, memorize the manuals, national and local coverage determinations, bulletins and fee schedules applicable to their claims. When participating in federal health care programs and government money is at stake, ignorance is not a defense. So what else can you do?

 2)    Create a culture of compliance. Be committed to compliance with education and training, random auditing, and detailed documentation. Let violators in the office know they will be held accountable and let “whistle-blowers” know there won’t be retaliation. Getting compliance right is a competitive advantage for your bottom line.

3)    Pay attention to the OIG guidance. The U.S. Department of Health & Human Services, Office of Inspector General, publishes voluntary compliance guidance documents for physician group practices, find it here: http://oig.hhs.gov/compliance/compliance-guidance/index.asp

4)    Attend to problems quickly.  Compliance problems not detected or those ignored for a lengthy period of time will attract government attention and lead to large penalties.

5)    Budget for compliance. Providers should ensure that adequate resources and time are devoted to compliance activities. Legal or consulting advice may be beneficial in developing a compliance plan and procedures, doing an audit or investigating non-compliance issues.

6)    Use benchmarking. Do not be in denial, big data is being mined by interested parties to find offenders. Be proactive and compare your billing data to similar providers in your area to be sure you are not under- or over-charging or incorrectly coding and providing the proper level of care. Abuse involves substandard, negligent or medically unnecessary practices that increase the cost of health care. Abusive practices often indicate fraud.

Keep in mind that health care fraud and abuse control programs are designed to prevent, identify and prosecute unlawful billings by health care providers and insurers. Health care fraud is a misrepresentation or failure to disclose pertinent information. A false claim involves an intentional false representation that causes the government to pay more than is allowable and might land you with more than a slap on the wrist!

Contact our healthcare team for assistance with this or any other accounting and operational needs. We have a depth and breadth of experience in the healthcare industry whether servicing hospitals, physicians, MSOs, dentists and DSOs, concierge medicine providers, chiropractors and podiatrists, etc. Whether in New York or Florida, call toll free 855-534-2727.


Revenue Cycle Management

Staying on budget and managing cash flow can be difficult when juggling expenses, collections and reimbursements. A lack an understanding of revenue cycle management can cause internal billing and coding errors, a failure to prioritize patient collections, not properly educating patients about payment policies or not verifying insurance for every patient.

Revenue cycle management is a complex interaction of services, billing codes, benefit analysis, and successful invoicing. Now that high-deductible health plans are more common, reimbursement patterns started shifting and doctors must develop good ways of interacting with patients to encourage payment of their bills. TFG Health Professionals can help you put a financial policy in place. We can design an audit process to help you track delinquent accounts prior to patient visit, and have our accountants analyze financial reports at month end to identify problems. Help and a more profitable practice is just a phone call away.

Is it time for your healthcare practice to have a check-up?

We have solutions to help you protect and enhance your bottom line so you can spend more time practicing medicine and taking care of patients.

Look to TFG Health for advice on: new payment models and care paradigms, revenue builders, cutting expenses, insurance planning, buy/sell agreements, new hiring physicians and mid-level providers properly, maximizing patient collections, preventing fraud in your practice, adding new products and services like telemedicine to increase profitability, Stark Law updates, and more.