EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Is ‘Safe Harbor’ Needed After ICD-10 Implementation Deadline?

Is ‘Safe Harbor’ Needed After ICD-10 Implementation Deadline? | EHR and Health IT Consulting |

As the ICD-10 implementation deadline drew closer, more lawmakers began attempting to develop a different type of transition period in which healthcare providers would not be penalized for reporting inaccurate ICD-10 codes. For example, HR 2247, the ICD-TEN Act, would create a “safe harbor” for providers in which they wouldn’t be denied reimbursement “due solely to the use of an unspecified or inaccurate sub-code.” 

The Coalition for ICD-10 states that the Centers for Medicare & Medicaid Services (CMS) has often accepted less specific codes under ICD-9 and, when the ICD-10 implementation deadline hits, the new reporting requirements will have no difference in level of specificity.

“CMS has reiterated numerous times that their acceptance of unspecified codes will not change as a result of the ICD-10 transition,” the Coalition for ICD-10 explains. “Furthermore, it would be inappropriate and a violation of coding rules to require a level of specificity that is not documented in the medical record. Indeed, CMS has made it abundantly clear that it would be inappropriate to select a specific code that is not supported by the medical record documentation or to conduct medically unnecessary diagnostic testing in order to determine a more specific code.”

Essentially, the ICD-TEN Act was proposed due to physician fears that there may be a significant increase in the number of claim denials once the ICD-10 implementation deadline takes effect.

However, the latest CMS end-to-end testing results show that there is only a 2 percent denial rate of claims due to ICD-10 errors. This shows that the physician fears may be unfounded.

According to the Coalition for ICD-10, a “safe harbor” transition period is not necessary and the current status of the ICD-10 implementation deadline should take effect on October 1 as is.

Additionally, CMS released its acknowledgement testing results taking place between June 1 and June 5. CMS accepted a total of 90 percent of claims submitted across the nation during this time period.

While a 10 percent denial rate is significant, CMS holds that the majority of claim rejections were due to submission errors within the testing environment that won’t affect the processing of claims when real claims are submitted after the ICD-10 implementation deadline.

It is time for providers to be ready for the ICD-10 implementation deadline or else risk having their claims rejected once October 1 hits. Any provider who submits ICD-9 codes after the deadline risks having the claims returned to their facility, returned as unprocessable, or rejected, according to apamphlet from CMS.

“As we look ahead to the implementation date of ICD-10 on October 1, 2015, we will continue our close communication with the Centers for Medicare and Medicaid Services to ensure that the deadline can successfully be met by stakeholders,” House Energy and Commerce Committee Chairman Fred Upton (R-MI) and House Rules Committee Chairman Pete Sessions (R-TX) stated at the end of 2014. ““This is an important milestone in the future of health care technologies, and it is essential that we understand the state of preparedness at CMS.”

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Factors that Make a Patient Portal Successful

Factors that Make a Patient Portal Successful | EHR and Health IT Consulting |

Medical practices across the country are searching for that special ingredient that will get patients to sign up for — and keep coming back to — their portal. Unfortunately, it's proven to be very hard to find.

Still, some healthcare systems are finding it much easier to secure patient engagement than others.

Take Kaiser Permanente, for example. Currently 4.5 million of its members are using its portal, more than 90 percent are satisfied or very satisfied with the portal, and 98 percent would come back to the portal.

That's according to Judy Derman, director of member engagement in the digital services group at Kaiser Permanente, who presented at the Healthcare Information and Management Systems Society (HIMSS) conference in Chicago.

During her session entitled "Provider Perspectives on Patient Adoption of Portals, Secure Messaging," which she copresented with Susan Hull, CEO of Wellspring Consulting, and family physician David Willis, CMIO of CommunityHealth IT and medical director for the Heart of Florida FQHC, Derman shared some of the strategies Kaiser uses that may help your practice get patients engaged.

Marketing the portal
Kaiser's marketing strategy included promoting the portal through a variety of methods at a variety of touch points, said Derman. Just as everyone learns through different methods, there's no one-size-fits-all approach that works when marketing to a wide variety of people, she said.

"I think the key ... is the integration into every single contact, every newsletter, every article, every time you turn around," she said. "You just need to use every avenue."

Getting patients engaged
While great marketing might get patients to sign up for the portal initially, the tricky part for practices often arises when attempting to get patients to continue using it.

One way to get patients coming back is to offer the features that they respond to most favorably, such as online bill pay and secure messaging.

You also might want to consider providing patients with online access to test results as often as possible. In fact, this is one of Kaiser's most popular portal features, said Derman. While there are, of course, situations in which tests can't be released online, most can be and should be, she said.

Another popular portal feature among Kaiser's patients is the ability to share digital images via the portal, said Derman. While many physicians initially feared that patients might use the feature inappropriately, they were pleasantly surprised, she said. "Every single time ... they do use it appropriately."

Making it personal
If you feel like you've exhausted all your options in attempting to get patients to use your portal, you might want to try to shift your perspective.

During the presentation, Hull, who is also a nurse and co-leader of the ANI Consumer eHealth efforts and serves on the ONC's Content Standards Workgroup, stressed that while patients are slow to engage with the portal, providers and other clinicians' may also be slow to engage with the portal when they are healthcare consumers. In fact, only about 30 percent to 40 percent of nurses are actually using their own patient portals and personal health records, said Hull. 

To truly see the benefits, limitations, and barriers to portal adoption, providers may need to begin engaging with portals more when they, and their families, are patients, she said.

"I think patient adoption of portals and provider adoption of portals and our collective experience will drive one another ...," said Hull.

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Five Mobile Health Tools for Practices to Consider

Five Mobile Health Tools for Practices to Consider | EHR and Health IT Consulting |

As technology evolves and medical practices attempt to get more patients actively involved and engaged in their healthcare, many practices are exploring how mobile devices might help them along that journey.

But with so many mobile device options available and with so little long-term evidence to show which tools are most effective and in what circumstances, it can be difficult to determine what mobile health solution is right for your practice.

Chanin Wendling, the director of the division of applied research and clinical Informatics at Geisinger Health System, is involved in determining what mobile and portal technologies drive digital patient engagement and facilitate the provider's ability to deliver quality patient care.

During her presentation, "Active Patient Engagement: mHealth as a Tool for Interaction," at the Healthcare Information and Management Systems Society (HIMSS) conference in Chicago, Wendling discussed some of the most notable mobile health options available to practices today. She also shared some of her feedback regarding which of these tools practices might want to consider and why.

1. Patient portals (that can be accessed via a mobile app or on a mobile device). Patient portals are a fundamental platform in helping patients become more informed about their healthcare, said Wendling. They also may be a great tool to help patient visits go more smoothly.

Wendling noted that Geisinger recently introduced a new pre-visit center patient portal feature to see if it helps streamline patient visits and help patients come to appointments more informed. Two weeks prior to appointments, patients receive a message that they should log on to the portal to fill out go pre-visit paperwork, review notes from previous visits, and so on.

2. Mobile apps. While mobile apps are generating a lot of buzz, practices may want to proceed cautiously before rushing to implement them. Wendling said that since there are so many options, and since many of them are "young," it can difficult to determine which are going to be valuable to your patients and healthcare system.

So what's a good place to start with mobile apps? If your healthcare system is using desktop-based applications and your vendor offers a fairly inexpensive mobile app, it's probably worthwhile to deploy that, said Wendling.

3. Text messages. Text messages have been an "underrated" mHealth tool, said Wendling. Since patients are already interested in and familiar with text messages, a text message program is cheap to deploy, and such a program can be implemented quickly, it's a great mHealth option for many health systems, said Wendling.

Examples of how Geisinger is using text messages include text message appointment reminders and text messages sent to diabetic patients hoping to lose weight that include motivational language and tips.

4. Activity trackers. Wendling was bit more cautious about mobile devices that track activity and health information that can then be shared with providers. "... I think the big issue there is, do you want the data?" she said, noting that it may add to physicians' workload.

While this type of mHealth has promise, carefully consider whether the approach you are considering is necessary and of clinical value to your patients. 

5. A multi-faceted tablet approach. Another mHealth tool that Wendling touched on is a variety of ways tablets might be used in patient care.

Geisinger, for instance, is embarking on a pilot program to test whether tablets distributed to in-house patients can entertain and serve as a positive distraction for pediatric patients, connect patients to medical information, enable patients to provide feedback to providers (such as their pain level), and so on.

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EHR Systems Lack Adequate Lab Data Graphing Functions

EHR Systems Lack Adequate Lab Data Graphing Functions | EHR and Health IT Consulting |

Current electronic health record systems lack adequate laboratory data graphing capabilities, according to a study published in the Journal of the American Medical Informatics Association, Modern Healthcare reports.

Study Details

For the study -- which sought to determine the abilities of various EHR systems to display test results -- researchers analyzed eight EHR systems based on 11 criteria.

Of the eight EHR systems included in the study, six had been certified by the Office of the National Coordinator for Health IT, including those from:

  • Allscripts;
  • Cerner;
  • eClinicalWorks;
  • Epic;
  • Meditech; and
  • Partners Longitudinal Medical Record.

The other systems were the Department of Veterans Affairs' Computerized Patient Record System and Glassomics, an EHR prototype designed to work with Google Glass.

The study did not rate the EHR systems by name.


Overall, the researchers found none of the systems met all 11 criteria.

According to the study, the highest-rated system achieved 10 of 11 criteria, while the lowest-rated system achieved five.

The most common problem among EHR systems was the failure to label the vertical, or Y-axis.

Other flaws included:

  • An EHR system that labeled data in reverse order with the most recent data on left instead of the right;
  • An EHR system that did not equally space out data points on graphs, which could result in an erroneous slope when measuring rates; and
  • Three systems that did not include patient identification directly on the graphs.

According to EHR Intelligence, the results showed a lack of standardized workflows among EHR systems, which could lead to an increase in medical errors and a decline in patient safety.

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Do EHR Systems Improve Doctor-Patient Relationship?

Do EHR Systems Improve Doctor-Patient Relationship? | EHR and Health IT Consulting |

Health IT adoption has revolutionized patient care across the healthcare spectrum, from the exam room and diagnostics to the surgery departments, laboratories, and billing. EHR systems surpass the use of paper charts, but one team of researchers wondered how EHRs facilitate communication skills of resident physicians.

In a study published by the Journal of the American Medical Informatics Association (JAMIA), the researchers looked at how physician-patient communication was fostered by EHR use versus paper charts. The residents participating in the study came from the University of Utah, School of Medicine and were followed for three months in 2012.

Resident physicians examined patients and treated them using either paper charts or EHR systems and video was taken of the interaction. Three trained observers used the Four Habits scale to determine the communication skills of the doctors based on both video and audio recordings.

Some of the habits of physicians were subpar, such as failing to communicate what they were carrying out when typing or writing. Other items were accomplished effectively such as developing a plan for follow up and framing the dialogue toward the patient’s perspective.

The results show that, when physicians used EHR systems, they score statistically better in six out of 23 skilled areas as compared to the paper chart. Most other communication factors are very similar between use of paper-based records or EHR technology. The researchers conclude that using electronic records via a laptop computer instead of paper charts seems to enhance the communication skills of first-year residents when meeting with patients.

Recently, a follow-up by Drs. David Hanauer and Kai Zheng published in JAMIA mentions that there may be other factors influencing physicians in the study to show better communication when utilizing laptop computers to record patient data.

First it is important to establish that EHRs vary drastically from paper records. Health IT systems include e-prescribing and drug alerts, coding for billing requirements, and reminders for immunizations and age-based preventive measures. In EHRs, there are a variety of dropdown menus, text entries, checkboxes, and other documentation functionalities.

The additional data entry tasks of EHR systems as well as a multitude of allergy and drug alerts do pose other challenges for physicians, according to Hanauer and Zheng. Time constraints may actually bring doctors to fill out much of the additional information while a patient is in the exam room, which may limit patient-doctor dialogue in the healthcare setting.

The authors wonder whether the outcomes of the study would be the same if the observers rating the interaction were not given video access. They postulate the observers were affected by the benefits of electronic records and knowledge about the study’s purpose.

Only future research will tell exactly how EHR systems are fostering the patient-doctor relationship and whether patient engagement is achieved through Stage 2 Meaningful Use regulations.

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New Grant Program Advances Health Information Exchange

New Grant Program Advances Health Information Exchange | EHR and Health IT Consulting |

The development of health information exchange institutions is aimed at advancing coordinated care, delivering superior quality of medical services, and improving public health outcomes. Certified EHR technology and health IT systems can enhance the communication channels and connections between different coordinated care settings, which is why EHR interoperability and health information exchange is so important.

In Massachusetts, the Massachusetts eHealth Institute at MassTech (MEHI) announced that a new grant program is available to strengthen technologies and communication channels among various medical facilities in varying regions across the state, according to the public entity’s press release.

The grant program called Connected Communities Implementation Grant Program is currently accepting proposals from groups that are working together to develop effective health information exchange and utilize health IT systems in an effort to advance coordinated care. The grant is meant for improving workflows and giving providers an opportunity to solve the many challenges of coordinated care and transitions of care within their communities.

The hopes behind these type of grant programs and healthcare reforms is that it will achieve better patient outcomes, quality of care, and lower healthcare costs through efficient health information exchange.

“The Connected Communities Grant Program provides us with an opportunity to support impactful health IT programs driven by the priorities in individual communities,” Laurance Stuntz, Director of MeHI, stated in the press release. “Through this approach, our hope is to receive proposals that identify region-specific roadblocks to sharing information, engage a broad cross-section of healthcare stakeholders, and address the unique needs of patients in that community through the use of technology.”

The cooperation and coordination among multiple medical facilities remains a key focus of the healthcare industry especially in terms of long-term and acute care as well as behavioral health services. This particular grant program asks for one or more specialty providers in these areas to send a proposal in order to help further strengthen important partnerships.

Those who receive the grant will initially obtain up to $25,000 from MeHI. The grantees will need to develop a strong action plan, detail health information exchange pathways in a diagram, outline a ‘use case,’ and provide a budget for the anticipated costs.

“Finding ways to improve information sharing and real-time data capabilities, while enhancing providers’ ability to treat patients at the community level, will go a long way toward helping the Commonwealth meet its healthcare cost reduction goals,” David Seltz, Executive Director of the Health Policy Commission, said in a public statement. “We look forward to continuing our work with MeHI and other stakeholders to build a stronger healthcare system.”

The grant program is looking to push forward provider access to clinically important data including laboratory results and discharge plans, better healthcare outcomes, and reduced hospital readmissions along with duplicative tests. Massachusetts medical providers and groups who are interested in expanding their health information exchange capabilities would be wise to send a proposal to MeHI in order to advance the quality of their patient care services.

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Five Considerations in Starting an mHealth Program

Five Considerations in Starting an mHealth Program | EHR and Health IT Consulting |

Engaging patients in their care through the use of mobile devices, also known as mHealth, is one of the biggest healthcare technology trends of 2015. But what exactly should your medical practice be doing to get involved?

That's a question that Chanin Wendling, director of the division of applied research and clinical Informatics at Geisinger Health System, explored during her presentation, "Active Patient Engagement: mHealth as a Tool for Interaction," at the Healthcare Information and Management Systems Society (HIMSS) conference in Chicago.

Wendling said health systems that want to get more involved with mHealth must adopt the right perspective first.

Don't get lured in by a mobile tool just because it is exciting and cutting edge, she said. Instead, consider whether the tool will provide value to your patients and providers.

"You need to look at this technology in that same context of hiring another physician or buying another medical device — what is this going to accomplish for you?" she said.

For Geisinger, Wendling said the value of mHealth is improved patient engagement that leads to better outcomes and lower costs. That's "a very strong business rationale," she said.

Here are five of Wendling's other suggestions for practices hoping to form a successful mHealth program:

1. Define the objectives. If you don't have an end goal, it's difficult to determine how to get started. Wendling said that before embarking on an mHealth project, you should first define your objectives. At Geisinger, those mHealth objectives include helping patients understand their health, helping them be better prepared for patient visits, and helping them control their health conditions.

 2. Determine how fast you want to move. Just because the health system down the street is using a particular mobile tool, that doesn't mean it's the right tool for your practice. Similarly, just because that health system is rushing to adopt mobile tools, that doesn't mean your practice needs to do so.

"You can be a follower" and let others figure it out first, said Wendling. "The key is to think about where you want to be, what's important for your specific organization, what [you] value, what kind of patients do you have, and what kind of business measurements you have..."

3. Assign project management responsibilities. Before embarking on an mHealth project, make sure you have identified the appropriate staff to lead it. Also, make sure you provide them with adequate time and resources to be successful, said Wendling. "I believe that if something is important you dedicate resources to it."

4. Determine what projects to pursue and what tools to use. When determining what type of mHealth project to pursue, consider your desired outcomes and what tool might increase the likelihood that you will achieve those outcomes. Possible mHealth Tools include patient portals that can be accessed via a mobile device or app, mobile apps, text messaging, and so on.

5. Consider the patient perspective. Regardless of what tools you decide to use and what project you embark on, keep the patient's perspective at the forefront of your decision-making, said Wendling.

Think about what a patient would prefer in relation to the tool. For instance, it might be helpful to offer a medication reminder through both a mobile push from an app and from a text message so the patient can choose what will work best for him. Also, consider whether the mHealth solution best suits patients' needs. For instance, it might be helpful to enable patients to choose what time of day they receive medication reminders, rather than having all the patients receive the reminders at the same time.

Some methods Wendling recommended to get patient feedback regarding mobile device design and deployment include:
• Ask clinicians to share feedback they receive from patients. 
• Conduct a survey on your patient portal and offer an incentive to those who complete it, such as a gift card. 
• Discuss mobile devices with patients when they come in for visits.
• Ask your patient advisory council for input (if you have one).

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How EHRs and Telehealth Technology Affect Healthcare

How EHRs and Telehealth Technology Affect Healthcare | EHR and Health IT Consulting |

Health IT along with EHRs and telehealth technology is impacting the medical sector and patient care in a variety of ways. Other healthcare reforms like the development of accountable care organizations (ACOs) require the implementation of key technologies and the efficient sharing of medical data.

At the World Health Care Congress + Exhibition, CareFirst BlueCross BlueShield President and CEO Chet Burrell spoke about how technology is revolutionizing the healthcare industry.

Burrell explained that the majority of his company’s claims processes are cloud-based, which allows for easy communication between billers and physicians. Whether discussing care plans and the ongoing progress of patients with chronic diseases or the sharing of vital medical data, cloud-based health IT systems provide an efficient means of communication.

“If you take the example of a primary care physician, no matter how automated they are, they explain only a small portion of the medical dollar – usually six percent – so much of what happens is outside of the [patient’s] view,” Burrell said. “With the kind of systems we provide – [the patient] would see the underlying information like lab results, what services were provided, which physician provided the services, and what drugs [the patient] is on.”

The latest encryptions and cybersecurity techniques within cloud-based systems also reduce the privacy and security risks associated with electronic storage of patient data. Along with cloud-based EHR systems, telehealth technology has also impacted the healthcare industry and patient care especially in rural areas.

Remote teleconferencing allows for patients who would otherwise be unable to visit a physician practice or hospital to speak directly with their doctor. The American Hospital Association (AHA) released a reportThe Promise of Telehealth For Hospitals, Health Systems and Their Communities – on the expansion of telehealth technology within the hospital setting.

In 2013, as many as 52 percent of hospitals implemented and used telehealth technology while another 10 percent had begun the process of integrating telemedicine. Recent research also shows that 74 percent of consumers would be interested in using telehealth services while 70 percent are content to use text, video, or email to communicate with their physicians.

Both telemedicine and advanced EHR technology play a significant role in healthcare initiatives like accountable care organizations, which require both data sharing and communication tools among a variety of healthcare professionals in order to improve the quality of care.

The Department of Health and Human Services (HHS) recently announced that the Centers for Medicare & Medicaid Services (CMS) will be implementing a new project aimed at developing the next generation of ACOs. This will alter both the payment standards and care delivery within the ACO model.

“This ACO model responds to stakeholder requests for the next stage of the ACO model that enables greater engagement of beneficiaries, a more predictable, prospective financial model, and the flexibility to utilize additional tools to coordinate care for beneficiaries,” Patrick Conway, deputy administrator for Innovation and Quality and chief medical officer for CMS, said in a public statement.

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A Physician's 3 Tips for EHR Success

A Physician's 3 Tips for EHR Success | EHR and Health IT Consulting |

Internal medicine physician Troy Tyner's Dayton, Ohio-based multi-specialty group implemented its EHR in 2012. Though the group has not been able to see the same volume of patients since implementation, Tyner says it is in great shape financially. The reason? Physician documentation has improved dramatically due to the EHR, which has led to higher reimbursement.

"Because you are documenting all the care that you really were doing before, that you couldn't document in the paper world, you are now getting paid properly for the hard work you are already doing," says Tyner, whose practice has successfully attested to both Stage 1 and Stage 2 of the EHR incentive program.

Here are three of Tyner's suggestions for practices attempting to master their EHRs:

1. Adapt to physician needs.

Post implementation, a few of Tyner's physicians voiced concerns about the tablets they were using to access the EHR. Rather than forcing the issue, Tyner allowed them to test out and purchase new devices (after confirming that they were EHR compatible). "We did not want to be penny-wise, pound foolish," says Tyner. "Give [the doctor] what the doctor wants."

2. Upgrade your connection.

If your Internet connectivity is slow, get it to the fastest speed possible, says Tyner. "We have fiber optic. It may cost a little bit more but you’re not waiting. Each click [you're making in the system] costs money. My general calculation is if you're a family doc each click costs you 5 cents. Get rid of clicks."

3. Recruit physician champions.

Make sure physicians take an active role in the EHR planning and implementation process. "My whole push as a physician leader in our group and whoever I talk to is: doctors take charge," says Tyner. "There are lots of people that will take things away from you, but if you are out there and you want to take charge and take care of your destiny, you have that opportunity. Get your training, understand it, and you can thrive. We're in private practice; we're not employed; we have to make it work."

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Selecting Staff Benefits for Your Medical Practice Team

Selecting Staff Benefits for Your Medical Practice Team | EHR and Health IT Consulting |

Studies show that losing an employee and subsequently conducting a search and rehiring for that position can cost an organization one-fifth of that person's annual salary, according to The Center for American Progress. You owe it to your practice to invest just as much work and care in retaining quality staff members, as you do hiring new ones. One way to do that is to offer a competitive benefits package. Many practices can't offer significant raises or bonuses. And most can't compete with the local hospital system. But what you can do is find out what is meaningful to your staff members and then make it happen.

Maybe that will be a dedicated parking spot for those cold, wintry days in Northern Wisconsin. Maybe a flex schedule for new moms? It's up to you to find out. We talked to a number of staffing and practice management experts to identify that magic mix of benefits that will warm your staff members' hearts. Here's what they recommended.


In Physicians Practice's 2014 Staff Salary Survey, 87 percent of respondents said they offered their staff paid vacation and sick leave, nearly three-quarters said they offered health insurance, and half offered a retirement plan with an employer match. Dental insurance and short-term disability insurance rounded out the top five benefits that practices said they offer their staff. If the other practices in your community are offering a close facsimile of this type of benefit package and yours doesn't, it will put your hiring manager at a distinct disadvantage.

Joe Capko, a principle with Capko & Morgan, a San Francisco-based consulting firm, says that benefits should be viewed as a significant part of the practice's culture. "We like to think of the benefit package that is offered to employees as one of the components to building, really, a culture of appreciation among the management and the staff," he says.

Here are some other reasons to offer a high-quality benefits package:

• Staff loyalty and retention. Apart from salary and robust benefits, practices can engender staff loyalty by offering small, extra perks that may not cost a lot of money. Even a heartfelt thank you can go a long way to creating happy, loyal staff members. Happy people like to stay where they are, and they also work hard for a practice that appreciates them. If your staff takes ownership of their roles and their commitment to patients, then everyone benefits.

• Strong competitor. Like many other professions, regional healthcare can be a small, intimate community. Everyone pretty much knows everyone else. Sometimes the grass can look greener in the next pasture, especially if your employee is feeling overworked and underappreciated. Offering great benefits, or individually tailored ones, can make your practice a competitive employer that attracts the best employees.

Carol Stryker, principal at Symbiotic Solutions, a Houston-based consulting firm, says it's the "absence" of benefits that will take your practice out of the running for a top-notch employee. "I'm never sure that benefits, with the exception of health benefits, ever attract an employee. … The lack of them can eliminate your practice for consideration," she says.

• Well-qualified staff. The best staff members have their choice of employers, and they will look first at salary and benefits as major determinants in selecting one practice over another. A good compensation package will also help keep the best employees in your camp. Capko says that smaller practices have an advantage over larger ones because, "It's easier for the management to know all of the employees, allowing management to tailor a benefit package that offers the biggest staff benefit per dollar."


Just as highly productive, well-oiled practices tend to staff at higher ratios, those that are willing to spend a bit more on their staff benefits tend to retain top employees. Yes, that means greater expense, but there are ways to find economies of scale. Sometimes you may even be able to join up with a professional association to get more bang for your buck.  

Capko says his firm advises administrators to network with other practice administrators, "So, for example, you can very easily find yourself reinventing the wheel. Someone may have already found out, 'Hey, this is great coverage through this professional association,'" he notes.

Stryker says, "Continuing education benefits are huge for people," but she cautions talking to staff first. She adds there's nothing wrong with being transparent and telling your staff that you only have a certain amount of money to spend. Ask them what they want. Spending money on a benefit that's not wanted is a waste, and won't endear you to staff either.


What are some of the perks that great practices offer? And what are the perks that you should slip off your radar? It depends: on your community, your staff, your schedule; even your specialty.

Daniel Bernick, a principal at The Health Care Group, a practice-management consulting firm based in Plymouth Meeting, Pa., says, "The most popular benefits are vacation, sick days, personal days, paid days off — PTO [paid time off] in one form or another is very popular and expected by staff."

Bernick notes that benefits are an important part of any compensation plan, because of the value they bring. "It is a tax-advantaged way of compensating employees," he says.

Aside from paid days off, health benefits are an essential component in most benefit packages. While Capko notes that many practices are spending less on the type of health insurance plan they offer to employees because of financial pressures (like choosing a plan with a greater deductible, or more cost sharing), there are other ways to make it up to employees — for example, offering flex schedules to young parents.

If a practice wants to offer full-time employees a basic benefits package, Bernick says it should include paid vacation time, sick days, personal days, a 401K plan, and health insurance with a cost share. However, he notes that a practice can use discretion in determining how much of a benefit they wish to offer.

"You could offer a larger amount or a smaller amount. Simply because you are offering vacation doesn't mean that you offer six weeks of vacation. You don't necessarily offer a lot of benefits, but at least you provide something in these categories. It is meaningful and people really appreciate it," Bernick says.

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