Ellen Hight, M.D., a family medicine physician in East Greenwich, Rhode Island, says the electronic health record (EHR) completely changed her practice, and not necessarily in a good way. “When our practice started using an EHR, I began to feel a distance between myself and my patients because I was constantly staring at the computer,” she says. Her work-life balance also took a hit as she began to spend Saturday mornings finishing her notes from the previous week.

When the Rhode Island Primary Care Physicians Corporation (RIPCPC), an independent practice association to which her practice belongs, approached her about piloting a virtual scribe program — and said it would pay for the first two months of participation — she jumped at the opportunity. “When I heard about virtual scribes, I thought, ‘Well that’s a good idea,’ ” she recalls.

Scribes are someone who works offsite or in a different area of the practice (i.e., not in the exam room) to document important aspects of the encounter so the physician or other provider can focus on providing patient care and working more efficiently.

RIPCPC partnered with an outsourced virtual scribe vendor to launch the two-month pilot program that included Hight, one other physician, and one nurse practitioner. Hight says the pilot was a huge success, prompting her to continue working with the scribe, a dentist in India. “My hands are not on the keyboard and I’m looking directly at the patient,” says Hight. “It’s more personal. I just feel so much more relaxed.”

Greater efficiencies enable Hight to see six or seven additional patients a day without putting in extra hours. She also usually does not take work home at night or on weekends.

The other physician who participated in the pilot continues to use a virtual scribe. Hight’s still assessing whether it makes financial sense for the nurse practitioner (who bills under her own national provider identifier rather than incident-to a physician) to continue.

Jonathan Weiss, MD, internist in Monticello, New York, has used a domestic virtual scribe for the last four years and says his scribe does just about everything except take vital signs, draw blood, perform electrocardiograms and administer vaccines. For example, in addition to completing all relevant documentation, the scribe listens to the doctor’s verbal instructions and then orders tests, initiates referrals, messages relevant office staff to obtain prior authorizations and checks off boxes in the EHR for quality measures. She even navigates to different parts of the record to retrieve information for Weiss upon request.

“To me, virtual scribing is one of the holy grails of making medicine tolerable again,” says Weiss. “During a 15-minute established patient visit, I can produce an incredibly well-documented note, get all the tests ordered and stay on schedule. In the majority of cases, I can legitimately obtain a higher E/M (evaluation and management) level because my notes are so robust. Ten minutes after my last patient, I’m in the car and headed home.”

Weiss is also able to see an additional three or four patients per day without extending his hours. Previously, he would have stayed until 8 p.m. and paid his staff overtime. In addition, his medical assistant is not tied to the computer and can engage patients more directly.

“Working with a remote scribe has been the single most work-changing thing I’ve done in 15 years,” he says. “If it was taken away from me, I would quit my job. I could not go back to the way I was doing things before.”

At UW Health, an integrated health system of the University of Wisconsin-Madison serving more than 700,000 patients each year in the Upper Midwest, working with virtual scribes was part of a deliberate effort to reduce physician burnout, says Christine Williams, director of health information management.

“Providers didn’t go to school to document. They went to school to practice medicine and make a difference,” says Williams. “With virtual scribes, physicians can stay connected to the patient. This is true whether it’s a small practice or a large academic medical center.”

Physicians at UW Health have the option of working with a virtual scribe. If they opt in, they are required to see one additional patient per session (i.e., every four hours). This additional revenue covers most of the cost of the scribe, says Williams.

UW Health began its scribe offering with a pilot program in 2019 that subsequently converted into a permanent program focused on ambulatory providers. Williams says she eventually wants to include emergency department physicians and hospitalists. Approximately 150 ambulatory providers currently use virtual scribes with an additional 10 providers joining each month.

Why offer a virtual scribe program? Preventing burnout ultimately reduces costly physician turnover, says Williams. “Physician resignation and needing to fill vacancies is a very large cost, especially for small practices,” she adds.

Matthew Malek, M.D., M.P.H., family medicine physician and medical director of provider experience at Thundermist Health Center, a federally qualified health center in Rhode Island, agrees. “If you can prevent one physician from leaving, this is an incredible savings on the order of $300,000 to $500,000,” he says.

Why are the costs so high? First, it takes time to find and hire a new provider. “When you consider the lack of billing during this time, that’s a big chunk of change,” says Malek.

It also takes time for physicians to build a patient panel and maximize efficiency. “At our organization, it takes about a year for a new physician to get to their eventual baseline productivity,” he adds.

Using virtual scribes at Thundermist Health Center was a data-driven decision, says Malek, who was instrumental in launching the program. The health center partnered with the American Medical Association to assess physician well-being using the Mini Z 2.0 burnout survey. It also used a set of validated questions about efficiency of practice and teamwork as well as community self-reported data. Finally, the health center tracked an EHR-based metric called the WOW8 to objectively measure work outside of office hours. This metric is defined by time on the EHR outside of scheduled patient hours per eight hours of patient scheduled time.

“We realized that our clinicians were spending a lot of time outside of the clinical work doing clinical documentation,” he says. “We had the data to bring to leadership to justify the virtual scribes.”

The pandemic was the perfect backdrop for a virtual program. “We also use remote scribes in our COVID(-19) evaluation and treatment clinics,” he says. “It’s nearly impossible to fit three people in an exam room and maintain appropriate distance.”

Now that the program is up and running, physicians choose whether to participate. If they do, they also decide how many hours they would like to work with the scribe. However, the vendor requires a minimum of four continuous hours and 50 total hours per month. Thundermist requires physicians using scribes to add roughly two visits per day to cover the cost, says Malek.

“The maturation of the scribe market makes it a much more understandable value proposition,” he adds. “I think remote scribing is a very scalable intervention to improve physician well-being.”

Think a virtual scribe may be what you’re looking for? Industry experts provide six tips to help you succeed.

 Are you exploring a virtual scribe program to address burnout concerns and prevent attrition? See additional patients and generate more revenue? See the same number of patients in the same or fewer hours? Improve patient satisfaction?

Knowing the why helps physicians gauge impact and return on investment, says Sean M. Weiss, chief compliance officer at DoctorsManagement, LLC, adding that some physicians work with virtual scribes simply to ensure timely, accurate documentation that establishes medical necessity for services rendered. Your why will determine the key performance indicators necessary to measure the success of the program. Examples might include physician and staff turnover rates, physician self-reported data related to well-being, or patients seen per hour.

Experts recommend asking these questions:

What type of training or credentials do the virtual scribes have? For example, are they an RN, LPN, or have some other medical training?

What type of ongoing education for medical specialties, terminology, anatomy, physiology and pharmacology do they receive?

What is their knowledge of medical coding and clinical documentation requirements (including CPT modifiers and quality measures)?

What is the vendor’s plan if a virtual scribe is suddenly unavailable (e.g., due to sickness, vacation or turnover)? Can it provide immediate backup coverage?

 “There’s a significant risk of using remote scribes and really any third-party vendor, and it’s not getting the attention it should,” says Sean Weiss. “That risk is the risk of cyberattack.” He says most breaches occur through third-party vendors such as outsourced billing/coding companies, outsourced release of information vendors, virtual scribes and others.

Sean Weiss points to a recent case in Florida in which a hacker fraudulently billed $10 million to Medicare by gaining access to patients’ protected financial information, demographics, diagnostic information and the provider’s UPIN (unique physician identification number). “The group practice actually had a strong cybersecurity protocol, but this individual was able to hack into the system through the third-party vendor,” he says.

Experts agree that practices intending to work with a virtual scribe should ask these questions of the vendor employing the scribe:

What is the risk management plan in place to test the system, and how often do these tests occur?

What were the results of the most recent risk assessment?

What corrective action plan, if any, was implemented?

Has the vendor ever experienced a cyberattack?

What is the vendor’s plan for business continuity during downtime due to a cyberattack?

What is the risk management strategy going forward? For example, does each virtual scribe have their own login information? Do they receive ongoing HIPAA (Health Insurance Portability and Accountability Act of 1996) training?

 “A scribe can be trained by someone else on how to navigate the EMR (electronic medical record), but the provider really needs to train the scribe on their specific dictation style and workflow,” says Williams. This process could take a few weeks and physicians need to be on board with the upfront work that’s required, she adds.

 “This ensures it fits within the autonomy of that practice specifically,” says Williams. “It ensures you’re not interrupting five or 10 clinicians at a time. You have one or two who are really committed to working out some of the kinks. It’s not just plug and play.” For example, practices will need to ensure processes for patient notification and reviewing documentation for billing and compliance purposes.

 “If physicians are only asking for documentation, they’re missing half the boat,” says Jonathan Weiss. “They should be pushing scribes to be a virtual medical assistant. You get much more value for your dollar.”

Articles

How ‘virtual’ scribes can reduce EHR headaches

Cryptocurrencies can be complicated. As a busy medical professional, you likely do not have time to research tokens or the nuances of this specific asset class. As you invest, how will you know whether you are doing the right thing? As prices zoom up and down, it feels like you should do something in response to market movements, but what exactly?

At Makara, the first automated cryptocurrency investment adviser registered with the Securities and Exchange Commission, we believe investing should be smart, inexpensive and simple. We have distilled our philosophy down to five key rules.

These markets are very volatile and will go up and down frequently. You cannot control that but you can dictate when and how much you invest. Be consistent and focus on what you can control. Investors who chase good performance or run away from poor performance are less likely to be successful.

It is difficult to know where cryptocurrency prices will move in the short term. The trick is to not worry about the short-term market. Focus on the long term and invest your money when you can. Do not waste time guessing where prices will go next; instead, focus on longer-term investments.

Diversification can reduce risk without hurting returns. We have long known about this in the traditional investing world, but it has been slow to arrive in cryptocurrency. Some assets go up in price, others go down. A balanced approach can be beneficial.

Invest in yourself while you invest in the market

Learn about what you are investing in along the way. The technology behind cryptocurrency is fascinating, and learning about it can be done in small steps. Developing an appreciation for cryptocurrency’s innovations will give you the conviction to stick with the asset during volatile times.

If you believe that cryptocurrency will be valuable over the long term, you benefit by getting started sooner rather than later. The best way to take advantage of the next wave of excitement is to invest today.

If you are already investing or considering investing, the five tenets above serve as a foundation to incorporate cryptocurrency into your larger investment strategy.

Jesse Proudman is the co-founder and CEO of Makara as well as the co-founder of Strix Leviathan, a cryptocurrency hedge fund. Prior to Makara and Strix Leviathan, he served as an IBM distinguished engineer focused on blockchain and cryptocurrency. To learn more about cryptocurrency investing, visit makara.com.

 is an investment adviser registered with the Securities and Exchange Commission. Registration as an investment adviser does not imply a particular level of skill or training. Makara exclusively provides investment advisory services related to investing in cryptocurrencies and other digital assets. Makara is not a broker-dealer, exchange, custodian or wallet provider, and is not intended for frequent trading activity. Investing in digital assets is highly speculative and volatile and Makara is only suitable for investors who are willing to bear the risk of loss and experience sharp drawdowns.

5 cryptocurrency investing rules for busy doctors

Most physicians spend their sleepless nights worrying about malpractice lawsuits but not medical board complaints. However, a complaint to a medical board is a considerable challenge posing as much risk to a physician’s career as a malpractice case.

Such a complaint often can be very trying and potentially damaging to one’s reputation. Some of the reasons behind medical board complaints involve a doctor’s code of ethics. Medical malpractice, misdiagnosis, failure to treat a patient and mismanaging a patient are common allegations in such complaints.

Alex Keoskey, a partner at Mandelbaum Salsburg P.C., a law firm based in Roseland, New Jersey, notes it is essential that legal counsel be retained whenever there is a threat of an adverse action against a physician from any source. “Physicians should take medical board complaints far more seriously than a medical malpractice complaint,” he says. “Physicians need to be aware of the reporting requirements enshrined in state and federal law relating to adverse actions by medical boards.”

Kevin O’Mahony, an attorney at KOMahony Law in Johns Creek, Georgia, notes disciplinary action resulting from a medical board complaint can include a reprimand, restrictions on a physician’s practice, continuing medical education or monitoring requirements, probation and license suspension or revocation. “The adverse consequences of a medical board complaint do not end there,” he says. “Physicians generally are required by contract to report disciplinary actions to their professional liability carriers, managed care plans and patients’ health insurance plans.”

Federal law also requires that discipline be reported to the National Practitioner Data Bank, which hospitals must check before granting or renewing medical staff privileges. “In most states, all public disciplinary actions taken by the medical board are required to be entered on the physician’s profile on the board’s website,” O’Mahony says. “The public board order itself can be viewed online by anyone who wishes.”

Public disciplinary actions are also reported to the Federation of State Medical Boards (FSMB), a national clearinghouse whose membership comprises all state medical boards across the country. The FSMB issues periodic reports to all state medical boards informing them of any public actions taken against a physician by another state’s board.

If a physician licensed in Georgia, Florida and North Carolina is the subject of a disciplinary action by the Georgia Composite Medical Board, the action will be reported to the FSMB. The FSMB will then report that action to the Florida and North Carolina medical boards, which may initiate their own investigations leading to disciplinary actions in those states as well.

Additional collateral effects of a medical board action may include loss of hospital privileges, loss of participation in preferred provider organizations, loss of enrollment with third-party payers, loss of board certifications, loss of Drug Enforcement Administration registration, and exclusion from participation in Medicare, Medicaid and other government programs.

Attorney Keith Roberts, co-chair of litigation at the Brach Eichler firm in Roseland, New Jersey, has been representing physicians with medical board complaints for almost two decades. One of the biggest reasons for complaints lately, he shares, involves physicians overprescribing opioids. Others involve crossing patient boundaries and not communicating effectively.

“Physicians need to maintain a high level of ethics and professionalism,” he says. “They need to adhere to the standard of care. Don’t assume you are up to date. Seek it out. Stay on top of respected journals and attend regional and national conferences — because things evolve.”

Medical board complaints can be avoided by following protocol and understanding the patient’s expectations. When expectations are not met, empathy and professionalism should be applied.

There are myriad things physicians can do to avoid medical complaints, O’Mahony says, starting with properly training, supervising and utilizing support staff and allied professionals. Other musts include taking time to learn about patients’ individual characteristics; identifying their unique needs and accommodating them where possible; being courteous and respectful; being receptive and responsive to questions and complaints; minimizing delays and communicating about anticipated time frame issues as soon as possible; and ensuring proper and thorough medical recordkeeping and billing documentation.

“It’s also recommended to avoid inappropriate language in medical record and billing documentation, recognizing that any medical record or bill could later be used as evidence in a medical board or legal proceeding,” O’Mahony says.

Additionally, physicians should properly and thoroughly document informed consent, properly refer patients to other qualified health care professionals when appropriate, have a formal policy in place for identifying and resolving complaints, and apologize — without admitting liability or fault — when appropriate.

“Although a physician can take steps to identify and prevent the most common types of complaint, he or she may not be able to avoid a complaint ever being filed,” O’Mahony says. “Despite a physician’s best efforts, he or she may not be able to please all patients or all parties who could be sources of medical board complaints all the time. Even the finest physician may be the subject of a medical board complaint at some point in his or her career.”

Liana Casusi, M.D., a general physician and consultant, notes that medical board complaints and medical malpractice lawsuits stem from almost the same cause — failure to perform primary physician duties within the expected competencies. “Before practicing your medical profession, plan the dynamics thoroughly,” she says. “How do you receive a patient? How do you create and keep medical records? How do you issue prescriptions? How do you advise follow-up? And these are just a few considerations. Prepare all your record form templates and have your counsel check them for any missing information.”

Her biggest tip for avoiding complaints is to review the rules of one’s medical board and let them guide their lifestyle. “On the actual practice aspect, be thorough before arriving at a diagnosis — and, of equal importance, record everything in the chart,” Casusi says. “Check and double-check prescriptions before issuing them, to eliminate any errors. Always keep private all information about the patient unless you are legally obliged to share it.”

Some practical advice from Roberts involves becoming engaged in billing practices. “Having to ask the billing department is not an advisable position,” he says. “Physicians should know what they’re billing (and) why they’re billing it, and they should be regularly auditing medical charts on a quarterly basis to make sure they are properly documenting codes.”

Whenever a medical board complaint is filed, a physician should consult with qualified legal counsel as soon as possible. “Most physicians are not equipped to represent and defend themselves in a medical board proceeding without the assistance of qualified legal counsel,” O’Mahony says. “The damage that can be done to a physician’s reputation and livelihood by a professional complaint far outweighs any legitimate concerns he or she may have about retaining the services of an attorney experienced in this area of the law.”

Elizabeth Greene, a partner in Mirick O’Connell’s litigation and health law groups, Westborough, Massachusetts, notes physicians should check their malpractice insurance to see whether they have coverage for legal counsel for licensing board complaints. Even if they do not have coverage, it is prudent to engage experienced board counsel.

“With the assistance of counsel, physicians are better equipped to protect their license and avoid responding emotionally or inappropriately to a complaint or investigation,” she says. “Physicians should never alter or destroy records, including when they are faced with a board complaint or investigation, and they must remember the EMR (electronic medical record) leaves a footprint of all actions—the metadata.”

If a physician receives a letter or phone call from a medical board investigator, it is crucial that they not procrastinate or ignore the notice. It is almost never advisable for a physician to meet with or be questioned by a medical board investigator without legal counsel present or on the phone. Once a lawyer has been retained, it is critical that they be promptly provided with all pertinent documents and information, as well asany known grounds for defending the allegations.

“It is important that the physician provide the attorney with all information relating to the complaint, including the good, the bad and any ‘ugly’ facts which may be relevant,” O’Mahony says. “A physician does not want his or her lawyer to be unpleasantly surprised by damaging evidence when it is too late for the attorney to consider how best to minimize or deal with its impact.”

If the medical board conducts a thorough investigation, all relevant information will almost certainly come to light. Withholding important or potentially damaging evidence from their lawyer because the physician hopes it will not come out will impair the attorney’s ability to prepare — or assist the physician in preparing — an appropriate response or defense. Therefore, physicians can best handle medical board complaints by having an experienced lawyer, upholding the code of ethics and behaving professionally.

Casusi recommends keeping all information about the complaint private. “It is actually unnecessary and dangerous for us to share information — especially through letters, SMS or online platforms — because these may be easily leaked and made into evidence in favor of the complainant,” she says. “Another tip, trivial as it seems, is to remain calm. Yes, it is human nature to react with anger, and that is valid. However, avoid impulsive acts of rage that may aggravate the condition.” Examples are badmouthing the complainant or blaming others.

Every case is different, and each case must be examined and evaluated based upon its own facts and circumstances. But a key to resolving medical board complaints successfully — or on terms as favorable as possible — starts with taking the complaint seriously from the get-go.

Roberts notes a physician should never try to take matters into their own hands and contact the complaining party to try to talk them out of it. This will almost always lead to failure and further problems down the line.

If disciplinary action is unavoidable, O’Mahony notes negotiating the most favorable or least damaging resolution possible. Fully complying with all agreed-upon or ordered terms must be accomplished.

A complaint to a medical board is a considerable challenge posing as much risk to a physician’s career as a malpractice case.

Dealing with medical board complaints

ichael J. Hennessy Sr., the beloved chairman and founder of MJH Life Sciences™, the parent company of 

®, passed away in November after a lifetime spent turning his passion for building businesses and creating jobs into a run of successful ventures and brands. He was 61.

Following his graduation from Rider College (now Rider University) in Lawrence, New Jersey, in 1982, he started his career in medical publishing as a sales trainee, eventually advancing to the position of chief operating officer. In 1986, Hennessy became chief operating officer of Medical World Business Press, which was part of the launch of medical newspapers and other media products. The company prospered and was eventually sold to a Boston-based venture capital firm.

Hennessy launched Multimedia Healthcare, LLC, in 1993 and built a portfolio of award-winning clinical journals. In 2001, Freedom Communications, Inc., acquired Multimedia Healthcare, about the time that Hennessy was pioneering a new approach to print and digital publishing with Intellisphere®, LLC (now part of MJH Life Sciences™). Guided by the principles of innovation and entrepreneurial spirit and reflecting its founder’s dedication to improving quality of life through health care research and education, Intellisphere® publishes a variety of integrated print and digital products focusing on a range of topics in research and clinical medicine.

To build a comprehensive multimedia and education platform, Hennessy added companies and capabilities to the MJH Life Sciences™ portfolio. In 2004, he acquired HRA® (Healthcare Research Analytics), which has been the leader in health care market research for over 30 years. In 2005, Hennessy acquired ArcMesa Educators, LLC, leaders in online certification for physicians, pharmacists, nurses and other health care professionals.

In February 2008, Hennessy acquired the rights to the journals 

®, both recognized in their respective markets as authoritative, trusted media platforms that provide essential information to a large audience of health care professionals.

In April 2011, MJH Life Sciences™ acquired Physicians’ Education Resource®, LLC (PER®), an accredited continuing medical education company that is an industry leader in producing high-quality, first-rate oncology and hematology meetings and conferences. The PER® acquisition included a variety of multichannel enduring educational activities, as well as the rights to legacy medical meetings, such as the annual Miami Breast Cancer Conference®.

Hennessy’s commitment to improving the lives of patients with cancer is deeply rooted within the halls of MJH Life Sciences™. As a complement to the industry-leading OncLive® platform, he developed the Giants of Cancer Care® awards to recognize the leaders and pioneers who often go unrecognized for their contributions to advancing oncology care.

He further strengthened his commitment to education by acquiring CURE Media Group in 2014, followed by the purchase of the Chemotherapy Foundation Symposium, in his quest to provide oncology professionals with focused education on innovative cancer therapy.

In 2019, MJH Life Sciences™ made its largest acquisition to date when it acquired the Healthcare and Industry Sciences divisions of UBM Medica, nearly doubling the size of the organization and adding legacy titles such as 

® to an already impressive portfolio. This acquisition made the organization the largest independently owned medical communications company in North America.

Later in 2019, Hennessy elevated his own role to chairman while naming his son, Mike Hennessy Jr., to assume the leadership role of the organization and carry on the family legacy. Under Mike Jr.’s leadership, the company enhanced its global potential by entering a long-term partnership with BDT Capital Partners, LLC, in November 2021.

Hennessy’s true passion was his relationship with his wife, Patrice “Patti” Hennessy. After they met in college, Hennessy devoted his life to Patti and his family, raising four wonderful children, Shannon, Ashley, Mike Jr., and Chris. Hennessy was Patti’s rock as she bravely battled cancer for almost 10 years until her death in January 2020.

Hennessy recently honored Patti by making a donation to Rider University to expand the Science and Technology Center at their alma mater. The Mike & Patti Hennessy Science and Technology Center is set to be completed in 2022.

Hennessy’s legacy and “family first” mantra will live on through his children; their spouses, Matt, Phil, Rachel and Jordan; and his 10 grandchildren. He will be greatly missed by his family, friends and MJH Life Sciences™ family.

Remembering  Michael J. Hennessy Sr.

Top challenges facing physicians in 2022

2021 was one of the most challenging on record for U.S. physicians. After the lockdowns and telehealth surge of 2020, the year 2021 has been strange. Although things went back to “normal” in that most practices resumed seeing patients in person, the COVID-19 pandemic and its challenges remain. As we do each year, 

® surveyed our audience to find out what the big challenges were. By far, the top answer was “administrative burdens” including staffing, prior authorizations and electronic health records (EHRs). 

Our editors decided to take a closer look at what these burdens entail, to help physicians get ready for whatever challenges 2022 will bring.

Slideshows

Medical Economics asked our audience what they considered the major challenges facing physicians and practices in 2022.

Editor's Note: The past year has been one of the most challenging on record for U.S. physicians. After the lockdowns and telehealth surge of 2020, the year 2021 has been strange. Although things went back to “normal” in that most practices resumed seeing patients in person, the COVID-19 pandemic and its challenges remain. As we do each year, Medical Economics® surveyed our audience to find out what the big challenges were. By far, the top answer was “administrative burdens” including staffing, prior authorizations and electronic health records (EHRs). We decided to take a closer look at what these burdens entail, to help physicians get ready for whatever challenges 2022 will bring. Here's number one.

A medical practice relies on more than the physicians who see patients, with nonclinical administrative staff being vital to overall success. Between those at the front desk, medical records staff, human resources, billing and other back-of-house employees, it takes a village to run smoothly.

Hiring and retaining staff can often be difficult. The recent fears of COVID-19 caused many to stay far away from the health care field, although even before the pandemic the industry was experiencing a shortage of qualified applicants. Issues such as no room for advancement, generational differences, greater salaries in other industries and interest in working virtually have all contributed to employees not being interested in the field. Plus, the “Great Resignation” of 2021 — the trend of people quitting their jobs — has hit most industries as many reexamine their work/life balance.

“This is a big problem for everyone,” says Halee Fischer-Wright, M.D., M.M.M., FAAP, FACMPE, president and CEO of Medical Group Management Association (MGMA), a medical practice advocacy organization. “Health care is as much impacted as every industry is across the globe at this time.”

A drop in patient volume at the onset of the pandemic led to some medical practice staff being furloughed, and many decided not to come back when things picked up. “One of the more interesting statistics is that one-third of nonclinical staff not coming back are not vaccinated,” Fischer-Wright says. “The MGMA has heard that 88% of medical practices (have) had difficulties recruiting front-of-office staff.”

The most obvious way to entice people to take jobs is by offering higher salaries and better benefits, but a practice can utilize extras that can raise interest in working there. Examples include allowing flexible hours, treating employees to lunch twice a week or paying for transportation costs. These perks could make the practice appealing to someone looking for work.

“We recommend being aggressive in recruiting strategies and not waiting until you need staff, so you can start to develop the relationships that help to bring new people in that can contribute immediately when needed,” Fischer-Wright says. “Practices also need to optimize their practice to make employees happy.”

When it comes to retaining staff, Fischer-Wright believes the key is to alleviate boredom, which often comes down to repetitive tasking. “We recommend that physicians take a look at practice operations and weed out what is necessary versus what is habit,” she says.

A good solution is cross-training staff, so different people can take turns doing tasks with less chance of burnout. It is also a good idea to increase communication among the staff, so you can learn of concerns early.

“What we see in workers today is that they want this delightful combination that’s almost impossible to achieve — both flexibility and certainty,” Fischer-Wright says. “What we find in medical practices is often they work by need-to-know, so we’re encouraging a much more holistic communication strategy even within the smaller practices so people understand what’s going on.”

Although in September a record number of people resigned from positions in the United States, many experts are optimistic that 2022 will be different. Here are some tips on hiring new staff.

1. Increase compensation and incentives: 

Money talks, but so do benefits and perks. Offer sweeteners that workers will not find anywhere else.

The days of the 8 a.m. to 6 p.m. workplace are quickly fading. Although it is unreasonable for a practice to allow employees to work whenever they want, be open to having them work at different times on certain days so they can attend to family and other life issues.

When looking for new employees, utilize job sites like Monster.com on both a local and regional level. Use your internal social media channels for networking and finding worker talent.

For current staff, ask employees what they want and what issues they are having. Solve problems before they get too big and fix concerns that are reasonable. Employees will appreciate that you listened.

Practices often prefer those with experience in health care, but many qualified people have never worked in a practice. Be open to bringing in bright people from outside the health care arena. 

Top challenges of 2022, No. 1: Hiring and retaining staff

Editor's Note: The past year has been one of the most challenging on record for U.S. physicians. After the lockdowns and telehealth surge of 2020, the year 2021 has been strange. Although things went back to “normal” in that most practices resumed seeing patients in person, the COVID-19 pandemic and its challenges remain. As we do each year, Medical Economics® surveyed our audience to find out what the big challenges were. By far, the top answer was “administrative burdens” including staffing, prior authorizations and electronic health records (EHRs). We decided to take a closer look at what these burdens entail, to help physicians get ready for whatever challenges 2022 will bring. Here's number two.

Since their introduction, EHRs have been a perennial issue for physicians across all specialties. From user experience to interoperability, nearly every facet of the computer-based systems has drawn the ire of those using them.

A recent study found that the amount of time spent in the physician’s inbox and total time using EHRs were associated with higher physician turnover. However, it was found that less time spent on EHR-based tasks was correlated with a higher rate of physician turnover.

Despite this finding, physician burnout tied to EHR use is greater than initially anticipated. The American Medical Association found that EHRs contribute to between 11% and 60% of the burnout physicians experienced in 2021. With the implementation of new information-blocking rules — aimed to prevent EHR vendors from interfering with record access or exchange — from the Office of the National Coordinator for Health Information Technology on the horizon, 2022 has the potential to be another year of EHR frustration.

David Lareau, CEO of Medicomp Systems, says medical practices can combat the burnout associated with EHR use by focusing on these four core areas for improving their systems.

 Incorporate technological tools that work behind the scenes to capture and interpret billing and coding detail. Streamlining work flow in this area can help physicians quickly find medical information they need to achieve better health outcomes for patients.


Work flows supporting the automatic identification and interpretation of medical information from previous sessions, inpatient records, laboratory reports and other sources allow physicians to focus on the patient instead of their computers. EHRs should not disrupt the way physicians think and work.


 Rather than using inefficient, error-prone manual methods, practices should incorporate technologies that prompt the physician at the point of care when patients have potential hierarchical condition category conditions, allowing the doctor to immediately address treatment, documentation or coding gaps while the patient is in the room rather than during a follow-up appointment.


EHR systems can reduce operational expenses by enhancing clinician productivity and streamlining documentation, coding and billing processes. Documentation tools that support quick, efficient capture of visit information at the point of care can reduce or eliminate the need for transcription services.

The new frontier of EHRs is the ever-growing number of apps available to be integrated into the systems. There was a 20% increase in the number of EHR-integrated apps available across app galleries operated by Allscripts, athenahealth, Cerner Corporation and Epic Systems Corporation in 2020, according to the Office of the National Coordinator for Health IT.

Of the available apps on these platforms, 42% handle scheduling, check-in and billing, 38% of available apps handle clinical functions, 31% handle care management and 20% deal with patient engagement.

Micky Tripathi, national coordinator for health information technology at the U.S. Department of Health and Human Services, says these apps are the key to unlocking more functionality from EHR systems and directly addressing physician frustration. “What (the introduction of these apps says is) that your EHR should be more of a platform than it is a closed software system,” he said. “I see my EHR as a conduit to more…apps that make life better for me, and that also allows individual providers to tailor their experience a little bit.”

Top challenges of 2022, No. 2: Electronic Health Records

Editor's Note: The past year has been one of the most challenging on record for U.S. physicians. After the lockdowns and telehealth surge of 2020, the year 2021 has been strange. Although things went back to “normal” in that most practices resumed seeing patients in person, the COVID-19 pandemic and its challenges remain. As we do each year, Medical Economics® surveyed our audience to find out what the big challenges were. By far, the top answer was “administrative burdens” including staffing, prior authorizations and electronic health records (EHRs). We decided to take a closer look at what these burdens entail, to help physicians get ready for whatever challenges 2022 will bring. Here's number three.

Doctors want to treat patients using the care they were trained to give but often find themselves arguing with someone from an insurance company about what the best course of treatment is. This is the main reason physicians consistently rank third-party interference as one of their biggest challenges.

“The problem with a lot of insurance companies is they change what’s on their formularies, and one day the insulin NovoLog is covered and then next day it changes to Humalog, and now the patient has to switch and it’s very confusing. And if you want to keep them on the same one, you have to put in the prior authorization, and the insurance company wants them to try the other one first,” says Richard Bryce, D.O., a family medicine physician and chief medical officer for the Community Health and Social Services Center in Detroit.

This back-and-forth costs the practice time and money and puts the patient’s health at risk.

“Now you’ve wasted a week or two figuring this process out when a patient needed the medication to take care of their ailment,” Bryce says. “The process should be easier.”

Although prior authorizations aren’t going away, there are some strategies practices can use to streamline the process.

Assign a staff member to each payer. This person can become an expert on the payers for which they are responsible, learning their specific expectations and what to avoid. They can also build relationships with their counterparts at the payer, which may help expedite claims and appeals. This person should also create a basic guidebook for each payer that others can follow if needed.

Maximize the use of technology. Most payers offer online forms for the prior authorization process and some EHRs integrate directly with payer formularies. The more a practice can use these online forms, the more quickly an authorization can be obtained. In many cases, any missing information will be flagged before submission.

Document all treatment decisions and back them up with evidence-based practices. Payer justification for prior authorizations is that physicians are not always following the latest evidence-based practices, so ensure all treatment decisions are based on the latest guidelines. If a prescription is not following the formulary, make sure all information as to why it is not is included in the prior authorization form.

Prepopulate forms for each payer. In some cases, you may be able to create a prepopulated form that has common information from the practice already filled in. This just leaves the specific patient information to be added. Although the time savings may be small for each form, it can add up when multiplied over the course of a year.

Create a spreadsheet outlining what treatments and medications for frequent diagnoses require a prior authorization by payer and what the permitted alternatives are. This quick-reference guide can save physicians time by directing them toward treatments the insurance company will accept.

Inquire about gold card programs. Some payers offer physicians with a good track record of following clinical best practices a gold card that allows them to skip the prior authorization process for some treatments. Find out whether you are eligible and what it takes to earn eligibility.

Fight to get rid of the prior authorization burden. Most professional medical societies have come out against prior authorizations and are pushing for legislation to limit their use. Check with your organization to find out how you can help. Write to your state and federal representatives and explain how the process harms patient care and raises health care costs.

Top challenges of 2022, No. 3: Prior authorizations

Editor's Note: The past year has been one of the most challenging on record for U.S. physicians. After the lockdowns and telehealth surge of 2020, the year 2021 has been strange. Although things went back to “normal” in that most practices resumed seeing patients in person, the COVID-19 pandemic and its challenges remain. As we do each year, Medical Economics® surveyed our audience to find out what the big challenges were. By far, the top answer was “administrative burdens” including staffing, prior authorizations and electronic health records (EHRs). We decided to take a closer look at what these burdens entail, to help physicians get ready for whatever challenges 2022 will bring. Here's number four.

Physicians are not the only option when it comes to primary care services. As venture capital firms, giant tech corporations and pharmacy chains jump into the retail, urgent and primary care space, it is becoming more challenging for traditional practices to stand out.

The competitive landscape is changing quickly. In October, for example, Walgreens announced it was investing $5.2 billion in VillageMD to open primary care clinics in its retail pharmacies. It does not stop there. CVS has MinuteClinic and HealthHUB primary care services in thousands of locations in the United States. Amazon and Walmart have been exploring the landscape as well.

This trend has been exacerbated by the COVID-19 pandemic and patients’ increased comfortability with telehealth services. Although the use of telehealth has fallen in 2021 compared to its 2020 highs, patients know what to expect from these services. Physicians will likely have to deal with growing competition from telehealth-only providers. For example, UnitedHealthcare announced earlier this year it is launching a “virtual first” health plan in which a patient is encouraged to choose an online doctor who acts as a first point of contact for most primary care and referral services.

It leaves primary care physicians in a bind. Not only do retail and other alternative care settings steal patients away, but they take mostly the lower-complexity cases, depriving practices of easier revenue and leaving physicians to deal with more complex, difficult cases.

“The expectations on primary care are so overwhelming,” says David Boles, D.O., a family physician in Clarksville, Tennessee. “Then you throw on top of that a walk-in clinic right down the street that doesn’t deal with any of those things and sees this person for a minor problem and gets paid similar to what we do for an office visit. They get the icing, and the real meat of the issue is left to us.”

How can physicians in traditional practices compete? Here are some strategies.

Patients want convenient services. Telehealth is one way to meet patients when, how and where they want to see their physician. It is something most physicians have had lots of practice with since the pandemic began. If your virtual care program has gone dormant as your practice opened to in-person appointments, dust off the cobwebs and get going again.

Patients do not get sick only during business hours; offering a few Saturday appointments no longer caters to their busy lifestyles. With urgent care centers and retail clinics offering extended hours daily, if a practice does not adapt its schedule to its patients, they will seek care from a place that does.

Make it easy — and do not make them wait

Patients do not want to spend 15 minutes on hold with your front desk to make an appointment. Practices need to offer online scheduling to make it easier for patients to book an appointment.

When they arrive, patients expect the doctor to see them within about 15 minutes of their appointment time. Consider implementing a system that texts updates on wait times to patients, allowing them to adjust their arrival to reflect the doctor’s current schedule.


The more forms that can be filled out electronically and in advance, the better. No one wants to sit in a waiting room filling out forms on a clipboard that could easily have been done the night before. Checkout should be just as easy, with little or no time spent standing in line.

Patients expect a response to questions posed via email or an EHR portal in 24 hours or less. This timeframe is basic business protocol established by the retail and service industry. Medical practices must embrace it as well.

Top challenges of 2022, No. 4: Increased competition

 The past year has been one of the most challenging on record for U.S. physicians. After the lockdowns and telehealth surge of 2020, the year 2021 has been strange. Although things went back to “normal” in that most practices resumed seeing patients in person, the COVID-19 pandemic and its challenges remain. As we do each year, Medical Economics® surveyed our audience to find out what the big challenges were. By far, the top answer was “administrative burdens” including staffing, prior authorizations and electronic health records (EHRs). We decided to take a closer look at what these burdens entail, to help physicians get ready for whatever challenges 2022 will bring. Here's number five.

Doctors often complain that, like the late comedian Rodney Dangerfield, they “don’t get no respect.” But when it comes to respect and trust, medicine and its practitioners fare better than many other aspects of American society.

In a 2019 Pew Research Center survey, 74% of respondents said they had a “mostly positive” view of medical doctors. By contrast, only 35% said they had a “great deal” or “fair amount” of confidence that elected officials will act in the public’s best interest, and 46% said the same of business leaders.

Still, trust in physicians has been declining. In a 2017 Sermo survey, 87% of doctors said patients trust them less than they did a decade earlier.

The trend is especially pronounced among younger Americans. A November 2021 Morning Consult survey found that 74% of baby boomers trust the health care system “some” or “a lot,” but that number drops to 44% among members of Generation Z — those born between the late 1990s and early 2010s.

What has caused this erosion of trust in doctors, and medicine generally? In part, experts say, it reflects Americans’ ongoing loss of faith in all institutions that began with the Vietnam War and Watergate. But there are also reasons specific to medicine. Probably the biggest of these is the limited time primary care doctors working for large hospital systems — now the majority — can spend with patients.

® in 2018 that many hospital systems, where the majority of primary care physicians now practice, require doctors to see an average of eight patients in 30 minutes. “Given that pace, it’s extremely difficult to build trust and create meaningful relationships,” Post said. Compounding the problem, patients often do not stay with the same doctor long enough to establish trust; doctors leave (or are dropped from) insurance networks, or employers change insurance carriers in search of lower costs.

Another contributor to eroding trust is the ready availability of medical and wellness information, as well as information and ratings for health care providers, on the internet and via social media. A 2015 

® article noted that about 5% of all Google searches were health-related and the percentage has almost certainly grown since then. “We’ve seen an explosion in the kind of information that ordinary people can access about their own health and from sources like medical journals and the results of clinical trials,” author and patient engagement consultant Jan Oldenburg told 

Oldenburg and other experts say that although this “patient empowerment” lets patients become more actively involved in their health and wellness, it also means they are less likely to unquestioningly trust a physician’s diagnosis or follow a treatment plan than were patients in the era before the internet.

Patients’ confidence in their care providers is further weakened by skyrocketing care costs. Although doctors are not primarily responsible for the problem, they often bear the brunt of patient anger. Eighty-seven percent of physician respondents to a 2016 

® survey said their practices were encountering more angry patients than a year or two earlier, and 56% said financial issues were the main cause of patient anger. Among some patients, that anger takes the form of believing their doctor is recommending unnecessary tests or procedures to earn more money.

Of course, for large groups within American society — especially people of color — mistrust of doctors and the health care system is longstanding and frequently justified. A 2003 Institute of Medicine report on racial and ethnic disparities in health care found evidence that “stereotyping, biases and uncertainty on the part of health care providers can all contribute to unequal treatment.” Moreover, the report said, White clinicians who do not believe they are prejudiced “typically demonstrate unconscious implicit negative racial attitudes and stereotypes.” Many public health experts believe this distrust among members of the Black and Hispanic communities contributed to their initial reluctance to get COVID-19 vaccines as compared with White people (although the gap has since narrowed). 

Establishing — or rebuilding — trust with patients is not easy, especially given the time and financial constraints most doctors face. Nevertheless, it is possible. The process starts with maximizing the time available to spend with patients by, for example, delegating to staff members tasks that reduce time for doctor-patient interactions. Then use the time to listen. “Let patients talk about the personal aspects of their illness, then add an affirming comment like ‘That must be very difficult,’” Post advises.

Dhruv Khullar, M.D., M.P.P., a New York City internist and author of a 

 article about trust, reminds doctors that they can no longer expect trust automatically, but “if we work hard to demonstrate that we’re trustworthy, patients will come to trust us over time.”

Top challenges of 2022, No. 5: Loss of trust in physicians

Many physicians on the cusp of retirement are concerned about whether their portfolios will generate enough income now that inflation has hit a 30-year high.

As many physicians are self-employed, they lack corporate pensions pegged to inflation. Instead, they rely largely on their accumulated wealth to fund retirement, so having portfolios structured to generate enough income is critical. 

The classic low-risk solution has traditionally been bonds. This may have worked fine for your father’s retirement portfolio, which probably used the classic, 

now-obsolete 60/40 allocation of bonds to stocks

But this allocation—or any allocation to bonds—hasn’t made sense for years because of withering bond interest rates. And now, with current inflation, bond investors are losing several percentage points annually instead of gaining several.

Now that bonds are a portfolio albatross, the challenge for the retired and nearly retired is: How to assure decent portfolio income during retirement with reasonable risk? What bond alternatives can deliver enough income to stay ahead of inflation?

Some answers involve investment solutions that you may never have heard of, though they’re not really all that esoteric. After all, they’re traded in on public markets and plainly visible to inquiring investors who bother to look.

However, one solution is quite familiar—and ironic: stocks themselves. Stocks in general are widely dismissed as being risky in inflationary times, but 

 can provide an effective hedge against inflation. And within this index, dividend-paying stocks can be particularly advantageous as a hedge against inflation over the long term

Sure, all stocks are subject to the ups and downs of the equity market, but reliable dividend payers known as dividend aristocrats—those with 25-plus years of dividend increases--tend to have 

s of performance and stability. They pay reliable dividends because they tend to be large, mature companies. Unlike young companies, they don’t need to invest a lot in research and development to achieve profitability; most of them have been profitable for decades.

There are several dozen such companies, many with familiar names, including: McDonald’s, Colgate-Palmolive, Target, Walmart, Procter & Gamble, PepsiCo, Clorox, PPG Industries, Johnson & Johnson and 3M. Many are currently categorized as 

value stocks, which may be mustering for a performance upswing

, according to some indicators. Many of these aristocrats can be found in the holdings of exchange-traded funds (ETFs) like Proshares S&P 500 Dividend Aristocrats (NOBL).

Medical Economics January 2022