Is It Worth Being A Member Of The American Academy Of Pediatrics?

I asked a newly graduated pediatrician if she was going to renew her membership with the American Academy of Pediatrics.

Her response did not surprise me. She said, “…probably not. I see no point in being a member.”

As far as she was concerned, there wasn’t an upside ( or value ) to belong to the Academy. I knew what she meant because I share her feelings.

Screen Shot 2016-06-05 at 10.48.49 AMRecently I came across an email that challenged my stance regarding the value the American Academy Of Pediatrics provides to pediatricians.

I wanted to share the email just as I read it. Below are the unedited comments from Dr. Suzanne Berman and Dr. Christoph Diasio regarding the meeting.

I had the privilege of attending the 3rd Immunization Congress in Washington DC with some of your favorite SOAPM types: Rich Lander, Geoff Simon, Christoph Diasio, Drew Hertz, Joel Bradley and uber-awesome AAP staffers Lou Terranova and Elizabeth Sobcyzk.

We had an opportunity to describe what works and doesn’t work with pediatric vaccinations, and lessons that can be applied in the adult world (where they do not vaccinate like we do).

Rich Lander spoke eloquently about the need for calling it PAYMENT not REIMBURSEMENT and people listened!

He presented the business case for vaccines. For the whole rest of the time, people would start to say “reimbursement” and then caught themselves and said: I should call it payment! I need to update my slides!

Geoff Simon and Drew Hertz spoke about some of the practical aspects of immunization delivery in large health systems and the implications of alternate payment models in vaccine delivery.

Geoff also talked about the challenges of providing vaccines across state lines (PA/DE).

Joel talked about the need for VFC to turn on 90461 and the need for local Medicaid and VFC programs not to do their little unsupervised strange things.

Suzanne Berman, MD

Dr. Diasio chimed in and added this:

There’s so much the AAP in general, and SOAPM, in particular, does quietly in the background- it is important to share this.

I am sure it will surprise none of you that I was continuing to beat the drum for removing the VFC flu vaccine delivery disparity.

Suzanne is humble- her talk on “the stupid things insurance companies/Medicaid agencies do re: vaccine payment” was terrific and included descriptions of dysfunction that I had never heard!

We touched on 2D barcoding uptake, but this was more related to trying to fix registries and increase communications.

We did discuss trying to create incentives/funding for EMR companies to support barcode readers

Christoph Diasio, MD

I have been particularly vocal about the Academy’s presumably disregard towards the numerous challenges pediatrician face in light of the AAP’s recommendations and children’s advocacy initiatives.

When I read this, the first thought that came to mind was, I think I am misinformed. Then I thought, so are numerous pediatricians, like the newly grad I mentioned.

I then thought to myself, the word needs to get out. Pediatricians need to know what the AAP and committees such as the Section on Administration and Practice Management (SOAPM) are doing on behalf of pediatricians, not just children.

Reached out

I immediately emailed Dr. Suzanne Berman and asked her permission to publish her email. I then spoke to Dr. Christoph Diasio – SOAPM Chairperson – and also asked him if I could add his commentary.

They responded with a resounding:

NO WAY. NOT IN A MILLION YEARS.

I am kidding, I am kidding. It was the opposite. They replied within minutes saying yes.

Times are indeed tough

I am preaching to the choir when I say that independent pediatricians are facing difficult challenges. However, it is reassuring to know that people are working behind the scenes advocating for children by advocating for those that provide for children.

It is my understanding that highly influential people attended the meeting. There were high ranking AAP representatives as well as influential people from the CDC.

Thanks

So, not only did I want to inform those that are not fully aware of what type of initiatives their AAP membership dollars go to support, but also wanted to give a big thanks to all that attended the meeting and all those that worked behind the scenes.

Thanks for looking out for us. And keep up the good work.

For the rest of you, go and renew your AAP Membership.

How Well Do Parents Know What You Do As a Pediatrician?

It’s hard to appreciate the value that pediatricians provide when one is not aware of exactly what it is that pediatricians do.

During the summer months, I posted on our practice’s Facebook page, a note encouraging parents, to schedule their children’s wellness visits.

Although the message was for our entire Facebook community, I wanted to catch the eye of parents with teenagers. Don’t know how well you manage teens in your office, but in our office, we have decent wellness visit numbers with younger patients. The teen population?

Not so much. Once the teen years kick in, we mostly see them when they are sick.Screen Shot 2016-02-26 at 11.48.51 AM

I wanted to encourage parents to make their wellness visits but also throw in a subtle nudge to parents with teens.To get their attention, I opened with this line: Did you know pediatricians are trained to treat children from birth to adolescence? Then I went on to talk about the importance of wellness visits etc.

Something interesting happened. The post outperformed other Facebook post. It received more likes that than the ordinary. But that the surprise me. What surprised me the most, were the comments from parents.

One mom said, “it’s good to know the pediatrician can see my teen.”

Another said, ” Timothy is going to be so happy when I tell him Dr. B can still see him.”

WHAT WAS THE LESSON?

It’s an age-old lesson. It’s a lesson on assumptions and what happens when we make them.

That simple, otherwise ordinary status update, got me thinking about how well (or not) we communicate what it is that we do as pediatricians. If so many people weren’t aware that pediatricians can treat teens and beyond (0-21), what else don’t they know? The irony is that our website is tagged with the line “Pediatric & Adolescent Medicine.”

OPPORTUNITY

We clearly have a communication problem. And I would argue that our lack of proper communication about what it is we do as pediatricians (more than runny noses and giving shots) is why many parents don’t see the distinction between a retail clinic and a pediatrician.


 

It’s hard to appreciate the value that pediatricians provide when one is not aware of exactly what it is that pediatricians do.

 


 

The good news is that there is a significant opportunity for pediatricians to cover a lot of ground. How so? By using social media channels to educate our community about all the great services we are trained to provide.

I also believe that leveraging this opportunity could aid your practice in differentiating itself from the competition.

WHAT IS YOUR COMMUNICATION STRATEGY?

Since I realized there was a chasm between our assumptions and the reality, I’ve been intentional about informing our community about the training, knowledge and expertise our pediatricians can address.

Some of it may seem too obvious for those of us that do this every day. Like explaining the importance of wellness visits.

But the truth is, some parents don’t know about yearly wellness visits. They assume that because the child no longer needs shots, they don’t need to go to the doctor.

Beyond promoting wellness visits, I use many of the things included in the Bright Futures guidelines as a way to highlight that a visit to the pediatricians is highly comprehensive.

And by educating our population, I’m also marketing our practice in a unique way. Instead of mentioning in a promotional piece that we accept most insurance plans, I may mention that how we can provide family support, safety and injury prevention, or mental health.

MARKETING STRATEGY

Not only is promoting and sharing this information relevant and valuable to parents, but I also think it is an excellent way to differentiate ourselves from the MinuteClinics or other medical services that overlap with pediatrics (i.e. Urgent Centers, Family Practice, Telemedicine).

YOUR CHALLENGE

Think about your medical practice’s communication strategy, or lack thereof. What is your practices unique selling proposition? What problems do you solve that others don’t? Then think about how best to communicate your message. Also, consider the channels you’ll be delivering your message. By channels I mean, traditional advertising, email campaigns, social media, etc.

Remember, each channel is unique, thus requires you to craft the message differently.

I’ll leave you with this… times are changing. That is certain. And we have two options, two paths to choose from. Disagree with how things are changing, or find ways to agree with the shifts in a way that benefits you and your practice.

Let’s Talk About What Happened In Vegas

My friends from the Pediatric Management Institute (PMI) put on another great practice management conference in Las Vegas last January.Screen Shot 2016-02-21 at 10.55.37 AM

The content was excellent, thanks to the fabulous faculty PMI brought in.

The topics varied from customer service principles to fundamental changes happening in the health insurance industry and how those changes are – or soon will be – affecting doctors’ financial bottom line.

Below are a few highlights and notable points that resonated with me.

ANCILLARY SERVICES | INCOME DIVERSIFICATION

Dr. Jeanne Marconi presented an account of how her practice diversifies income streams by incorporating ancillary services into her practice.

Admittedly Dr. Marconi’s comprehensive – almost overwhelming – plethora of services (they even offer in-house exercise training programs for children with high BMI) is probably too much for the standard practice to implement.

But for me, her talk wasn’t an invitation to follow her footsteps, but instead, provide insight into what is possible, what can be done and what is available to practices.

Dr. Marconi dished out several challenges to the physicians in the crowd. But the one that resonated with me the most was her call for pediatric practices to challenge the status quo, expand their minds, think creatively (or to use a cliche, think outside the box) and begin to think about ways to diversify practice’s revenue streams.

HOW HEALTH INSURANCE COMPANIES ARE PAYING DOCTORS

Susanne Madden arrived in Vegas with her extensive knowledge and expertise of the health insurance industry.

Screen Shot 2016-02-21 at 11.10.10 AM
Dr. Jeanne Marconi and Susanne Madden

She presented attendees the sobering reality of how health insurance companies are adjusting, changing – even experimenting in some cases – with their models to continue delivering value to “their” shareholders. And by value, she means lower cost and higher profits.

Susanne underscored the importance of implementing quality measures such as P4P, HEIDIS, PCMH into our medical practices. But not for the reasons you might think.

While many of these health insurance programs are currently in place as rewards (e.g., enhanced or incentive payments) for medical practices that achieve quality measures thresholds in patient care, Susanne highlighted that these programs will soon become a requirement for practices.

What does this mean exactly? Insurance companies will soon stop offering enhanced payments programs to practices for achieving PCMH level III certification (or other types of incentives). Instead, they will reduce payments to doctors don’t meet PCMH certification.

As if that wasn’t bad enough, she added that many payers are evaluating providers based on how much the provider costs the company in benefits payouts.

How is that different than what they do now?

The difference is that they are not looking at the practice as a whole, but rather evaluating each provider individually.

The implications are that if you have physicians in your practice that don’t adhere to designated quality standards, payors can potentially pay each doctor in the practice different amounts.

HOW MUCH CAN WE AFFORD TO PAY AN EMPLOYED PROVIDER?

PMI’s very own Paul Vanchiere gave two of his hallmark presentations. The first one focused on customer service using the acronym KIDS (Kindness, Integrity, Dignity & Service).

His second talk was my favorite. Why? Because Paul took a complicated, MBA, executive consulting level exercise (determining how much can your practice afford to pay an employed provider) and distilled it into an easy to follow, step-by-step, process, which only requires one to understand a few financial concepts and enter value sets into a spreadsheet.

BROADEN YOUR CODE REPERTUAR

Dr. Rich Lander went over the fundamentals of proper coding. In addition to reviewing the differences between coding Level 2, 3, 4 & 5 for a sick visit, Dr. Lander stressed the importance of documenting “time” correctly in a patient’s chart.

Screen Shot 2016-02-21 at 10.56.21 AM
Joanne Blanchard and Dr. Richard Lander

Dr. Lander shared multiple clinical scenarios that we often encounter with patients. But some of the codes he suggested I wasn’t all too familiar with. I couldn’t recall if we used them.

So I wrote down a reminder to myself to check how well (or not) providers at Salud Pediatrics were using the full scope of codes available.

NO PRESENCE, NO INFLUENCE

Dr. John Moore – a new PMI faculty member – brought us up to speed with some of the new social media trends (Are you familiar with SnapChat and how kids are using it?)

Screen Shot 2016-02-21 at 11.10.19 AM
Dr. John Moore and Paul Vanchiere

One of the points that Dr. Moore articulated that I appreciated the most was the importance for pediatricians to embrace social media.

He said something that I’ve been saying for a long time; which is, had pediatricians adopted social media at a faster clip, the pro-vaccine vs. anti-vaccine arguments would have been balanced. Moreover, there was the potential to stifle the anti-vax movement.

CHANGE IS THE NEW STATUS QUO

You can always count on Chip Hart to deliver great wisdom and insight. Chip also gave two talks.Screen Shot 2016-02-21 at 10.56.11 AM

I’ve heard Chip speak many times, but this time, I felt his talks were different. Chip’s talks had a subtle, tough-love tone to them.

While addressing the challenges practices are facing today, he stressed that pediatricians have faced similar challenges before. He mentioned that during all previous tectonic shifts (aka industry changes) naysayers shouted out the demise of private practices. Much like many are shouting today.

Chip eloquently argued that not only are the doomsayers wrong, but that pediatricians are actually in a better situation than most think.

Chip wasn’t disregarding the challenges or downplaying the potential threats. We are indeed going through tough times. But these tough times were an opportunity to transform and reinvent our practices, he argued.

My takeaway was: If the plan is to defend the status quo and hedge the long-term success of your business on account that you have the initials MD after your name, thus somehow inoculated from change, the end is certainly near for you.

MEETING, CONNECTING, NETWORKING, SOCIAL LEARNING

Attending a seminar like this to learn from the speakers is certainly worth the price and the time. But more often than not, the icing on the cake, at least for me, is the immeasurable, intangible value I glean from networking.

The people who attend these events are the smartest and brightest in my opinion (and I’m not talking about the faculty, although they are good too).

Whether attendees are veterans in managing practices or opened their first private practices last week and believe they have no clue what they are doing, the truth is, there is opportunity to learn from everybody.

The faculty makes the trip worthwhile. But I would say the attendees make the event special.

Next year I hope to see you there. Especially if you didn’t get a chance to attend this year.

Place: New Orleans
Dates: Jan 27-28th 2017

 

Increase Your Medical Practice’s Bottom Line In One Easy Step

A few months before we opened the practice, we picked up a flyer inviting doctors, billing and coding staffers to attend a coding seminar in town.  It looked like something we ought to go considering we were about to open our very own private practice and had zero billing and coding knowledge.

Screen Shot 2014-11-26 at 2.57.08 PM

About one minute into the lecture, I was lost. I had no idea what they were talking about. I was merely a marketing guy and had no idea about managing a practice, let alone billing and coding.

But I didn’t worry. My wife was a few years out of residency at the time, so this logical questions ran through my mind: surely this coding thing was still fresh in her mind?

As the trainer continued talking in a foreign language (I later found out was divided into two dialects, CPT and ICD9) I assured myself …doctors are taught this peculiar character/numerical dialect during medical school and then get the change to master it during residency. It would be as foolish as having a sail boat with no sails to not teach doctors how to bill and code. Besides, how do you pass the boards without knowing billing and coding? 

I had nothing to worry about.

What? You’re as clueless as I am? Didn’t you pass the boards? You mean to tell me that in those 3-years they didn’t even give you a lunch seminar on how to get paid for your work?

My next thought was, Oh boy! We are a deep, deep, sh… I mean 787.91.

Here is the thing, as ridiculous as not teaching residents at least the basics of billing and coding may sound, what’s more ridiculous, is that many doctors don’t do anything about it. Few docs – knowing very well that billing is coding determines their pay – learn how to document and code properly. Many don’t even go to coding seminars regularly.

Instead, may docs (not the ones that read this blog, of course) blame health insurance companies or blame their EMRs for getting payed less while to do more. All of which is likely true.

But here is a hard truth. If you’re a health provider and you do not take the time to learn and stay current with with coding and billing guidelines, then you need to get the list of all the things you blame for declining pay and write your name at the top of that list.

Why? Because the loss of revenue is happens in your examining room as a result of poor documentation and poor coding. 

Fundamentally, most pediatricians are doing the work. But because they lack knowledge and awareness on how to document and bill as a result of not keeping up to date they are leaving countless dollars – dollars they’ve worked for – on the table.

It also is worth mentioning that relying on your billing and coding team is not an excuse to not to keep up to date on coding and billing guidelines. To put it in perspective, putting all the responsibility on your billing and coding department is like asking your nurse or MA to take full responsibility for your patients.

And I’m not diminishing the role of clinical support staff or the coding and billing department. My point is that RNs and MAs, as well as billing and coding personnel, are there to assist.

If want to improve your medical practice’s bottom line in one easy step, all you need to do – for starters – is:

Attend a coding seminar,  pronto!

I’ll guarantee you’ll increase your bottom line.

You’re welcome!

5 Deceptively Easy Ways to Become an Internet – Savvy, 21st Century Pediatrician

If you are going to be at this year’s AAP National & Exhibition conference in San Diego, come check out a talk I’m giving with Dr. Natasha Burgert. The title of the talk is: 5 Deceptively Easy Ways to Become an Internet – Savvy, 21st century Pediatrician.

We’ve packed the presentation with a lot of information, personal experiences and practical examples that we think are going to be valuable for pediatricians that are looking to remain relevant trusted sources of information in this new, fast-paced, technology driven, mobile phone obsessed culture.

Want a little more? Sure! Here is a glimpse of how we plan to kick off the talk.

Being an internet savvy pediatrician is not just about how to set up a Facebook page or understanding Twitter hashtags. These real-time media channels are certainly important and we will be talking extensively about their utility as a tool, but we will not be telling you the ins and out of how to technically create pages or followings.

Internet savvy pediatricians are intentional in using the web to solve problems, create solutions and improve child health.

This presentation will be about how to leverage the internet and the tools it provides – not only to remain relevant as trusted sources of information – but change pediatrics as we know it today.

Dr. Burgert and I have been working diligently putting together the presentation and we’d be delighted if you stopped by. Oh, and if you are a reader of PediatricInc, come up an introduce yourself. I’d love to meet you.

Session #: S1056
5 Deceptively Easy Ways to Become an Internet – Savvy, 21st Century Pediatrician.

Day: Saturday
Date: 10/11/2014
Time: 8:30 am – 10:00 am