Being a physician is challenging. Being a woman and a physician might be even harder.

Tammie Chang, M.D., a physician and author, details the unique challenges facing female physicians and what women in medicine can do about them in her new book, “Boundaries for Women Physicians: Love Your Life and Career in Medicine.” Chang sat down with Medical World News® to discuss these topics. The following transcript was edited for length and clarity.

Medical World News® (MWN): What are some challenges female physicians face?

 There are lots of challenges. I think one of the biggest ones is just the lack of support for women. For female physicians, there are very few accommodations. Typically, when women physicians are just coming out of training, they’re coming out during the peak childbearing years, when they’re trying to start a family. They’re trying to juggle a lot of things: the home, the families, the workplace. The jobs themselves have very demanding work schedules and call schedules, and there just really isn’t a supportive culture. There are also few women making it to leadership. The leadership funnel narrows very early in the career. Only about 50% of leaders within health care are women even though women actually make up more than 80% of health care workforce when you look at all different fields, not just women physicians. So they’re not becoming decision makers, they’re not getting a seat at that table to really make change that’s conducive and supportive of women in the workforce. I think there’s still a lot of gender bias that women struggle with. It’s becoming more and more open and talked about now, thankfully, in health care and in this industry, but it impacts the daily lives of women physicians, because they are viewed as leaders, even though they don’t realize that they are. There is a double standard when it comes to how women are viewed in the workforce compared to their male physician colleagues. There’s a much tougher standard.

MWN: What are some of the challenges you were facing when you decided to write your book?

 I was severely burned out. I had taken on all the responsibility because that’s all I knew how to do. I was suicidal and had to take a leave of absence and almost quit practicing medicine. More than 70% of physicians are now experiencing moderate to severe levels of burnout at this stage in the pandemic. That rate is even higher in women physicians. But we don’t talk about it much, so that’s why I’ve written this book. I’ve essentially written everything that I wish someone had told me.

MWN: Do you have any favorite moments
or conversations you’ve had with fellow
female physicians?

 I’m running a five-day mini book club right now. We were talking about how hard it is to set some basic boundaries and we watch our male colleagues at work, and they don’t seem to struggle at all. It doesn’t seem to faze them. And so then it brought up questions about why. Is it biology? Is it how we’ve been raised or nurtured or socialized? Is it how we were raised with kids? Or another way to think about it is maybe it is actually bothering them, but they’re not showing it. We don’t really know what they’re experiencing on the inside, and so maybe not just assume that it’s easy for them, maybe it’s hard, too.

MWN: Why is it so important that we support women physicians?

 We’re finally at a place where 51% of med school students are women. However, 40% of women physicians are either quitting or going part time within six years of finishing training. That’s a problem. We’re not keeping them in the workforce. There is also data showing better patient outcomes (with women physicians) that include higher patient satisfaction scores anddecreased morbidity and mortality. It’s so important for us to continue to push forward and make things more equitable because we want to make things better for the next generation.

MWN: One of the biggest issues today is the conversation surrounding the pay gap between male and female physicians. What do you think society can do to bridge that gap?

 I think it’s huge that it’s hit big headlines recently. There are still a lot of people, even in medicine, who don’t believe it. I think awareness is the first piece, and then also getting people to recognize that it’s actually happening in their own system. There’s a 

 article that I shared and I got so much negative feedback from it. I had a few health care CEOs reach out to me say, “Oh, we don’t have that in our system.” And I’m like, “Yeah, I bet you do —you just haven’t looked.” It’s about being honest and having the humility to go, “Oh, maybe this is happening within my organization that I’m in charge of and who is responsible for these things?” Maybe it’s not happening, and that would be amazing, right? Then share that data widely. Make it one of your metrics that you’re trying to follow each year. It shouldn’t matter what the role is; it should be the same, regardless of gender. Doing that on a local level at home, in our own organizations and institutions — that’s huge.

MWN: What are some ways female physicians can support each other?

 There’s an unspoken understanding and bond when we’re a group that’s struggled together. It’s finding each other wherever we’re working. I call it a “raft of otters.”Female otters band together in stormy seas and create a raft with their paws. That’s what I strive to do in my daily work as the medical director of provider wellness for my health care system to which is trying to create little pockets of rafts for every single person working for our system. I tell people to reach out and connect with just one person, because the reality is that the other person probably needs a friend, too.

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Making medicine better for women

Remote patient monitoring (RPM) harnesses technology to create better outcomes for patients. As RPM expands, there are more studies that show its effectiveness. For a weight-loss program, patients using RPM lost 86.3% more weight compared with those without RPM. And patients are not the only ones who benefit; practices using RPM see better revenue to boost their bottom line — in some cases doubling their revenue per patient. Instead of focusing on bringing in new patients to increase revenue, practices can boost how much they are making from each patient all while boosting health outcomes. Payers are also recognizing the effectiveness of RPM and offering full reimbursement rates for many services as they transition to more value-based care. In addition, offering RPM services does not require additional staff members to implement, only a few hours of training time. Practices looking to boost their revenue and patient outcomes should consider remote patient monitoring.

Understand the benefits of RPM, how it works and which patients benefit.

Develop talking points for persuading patients to use RPM services.

Understand how to create an RPM, including revenue forecasts and patient outcome benchmarks.

emote patient monitoring is starting to take off as technology allows physicians not only to boost patient health outcomes, but also to increase their practice revenue.

In a study of 1,000 patients who received a diagnosis of obesity from across multiple practices, patients using RPM lost 86% more weight than patients who were not, and the RPM patients stayed on their weight-loss program 30.2% longer than non-RPM patients. The best news may be that getting these results doesn’t require an investment in additional personnel.

“None of these clients had to add staff to deliver these improved outcomes and engagement results,” says Wes Haydon, president and co-founder, CoachCare.

Now is a great time to start with RPM, says Haydon. CMS and commercial payers continue to expand their support for RPM services as they transition to more value-based care. Because physicians can now utilize auxiliary staffers and get reimbursed for additional diagnoses than previously, RPM is more cost effective than in prior years.

Haydon says RPM is for any physician looking to add revenue to their practice while building a best-in-class patient care program. “If you feel like you and your team are working hard every day, your staff is starting to get burned out and you just can’t seem to help patients enough, then RPM is for you.” He says physicians who don’t accept insurance or are not comfortable with new technology should probably not look into an RPM program.

One of the advantages of remote patient monitoring is that practices are boosting revenue on the patients they already have rather than trying to market the practice to potential new patients.

“Adding patients is expensive and you are going to have to pay for marketing, and ultimately, it puts pressure on already overwhelmed staff,” says Haydon. “And so that ultimately makes it not scalable, because the maximum number of patients you can see is limited by the number of hours you work in a day. You also have to add a lot of new patients in order to have any meaningful impact in revenue.”

Instead of focusing on marketing to new patients, practices can prescribe reimbursable remote patient monitoring to existing chronic, at-risk and even post-acute patients. “You avoid all that wasted marketing spend and at the same time are also able to drastically improve the efficacy of the treatments,” says Haydon. “Your staff is able to focus on these value-added activities, and their morale is reinvigorated because they’re doing good for patients while also doing well for the practice financially.”

Another added benefit is that when staff have downtime, such as when there is a canceled appointment or between appointments, that’s normally not billable time. But with remote patient monitoring, it can be.

With the right system in place, a practice can generate double the revenue with half the patients, and the work isn’t really any different from what most practices are already doing. “If you’re doing any type of monitoring of patients, checking up on them or calling them in between visits, you’re probably not getting paid for that,” says Haydon. “That is remote monitoring.”

Without it, patients might be in a slow decline that might not be detected until their next visit, which might not be for a month or more. Remote monitoring offers the possibility of seeing the patient’s vitals, which are transmitted from home in real time, and getting reimbursed for having junior staff periodically review the data. If it falls outside predetermined ranges, then the physician is notified and can take appropriate action versus finding out when they come back to the office in a month.

Earn more revenue for your practice with no extra staff.

Take advantage of payers’ expanding reimbursement for RPM.

Attract and retain patients with high-tech health solutions.

Remote patient monitoring (RPM) harnesses technology to create better outcomes for patients. As RPM expands, there are more studies that show its effectiveness. 

Bootcamp 2022: Remote patient monitoring boosts patient outcomes and practice revenue

Health care consumers’ attitudes and expectations around primary care are rapidly evolving. In fact, 50% of patients have higher expectations of their doctors since before the COVID-19 pandemic, and nearly one in five patients considered changing physicians based on how they handled the pandemic. High-deductible plans and higher co-pays mean patients are paying more attention to how their health care dollars are spent and are looking for ways to get more for their money. Today’s health care consumers have many choices of where to go for care, and they are desiring better relationships with their doctors and requiring retail-like customer service. If they don’t get what they want, patients will simply switch providers. These shifting consumer attitudes can have negative implications for medical offices, but a membership model can help physicians deliver an enhanced service experience that yields an overall healthier practice.

Understand how the COVID-19 pandemic influenced patient trends in primary care and how membership-based models can address these evolving needs.

Learn how membership-based models can increase physician and patient satisfaction while generating predictable revenue for the practice.

Hear from physicians who transitioned to membership models how it positively impacted their patients and their careers.


,Family Medicine
MDVIP-Affiliated Physician

, Internal Medicine
MDVIP-Affiliated Physician

oday’s health care consumers want more from their physicians than ever before. This trend has accelerated during the COVID-19 pandemic, and now patients desire the same level of service they receive from the nation’s top retail and hospitality companies.

Another reason patients expect more value from their primary care physicians is that more of the financial burden is falling on consumers’ shoulders. High co-pays and high-deductible health plans are more common and, as a result, patients are much more engaged in their care and what they are getting for every dollar. They want a closer relationship with their doctor that’s a two-way partnership for good health utilizing technology and data.

During the pandemic, many physicians struggled to meet these expectations. Almost a quarter of patients say their opinion of their doctor has changed since the COVID-19 pandemic began, and almost 20% of all patients are considering changing their doctor because of how they handled communication and medical needs throughout the health care crisis.

Patients now want more individualized care and are willing to share more information about themselves to get it. “This means patients will gravitate toward practice models that are delivering the personalized experiences they want and that can provide convenient digital tools for tracking and communication,” explains Chris Lillich, chief marketing officer, MDVIP.

Practices must also have a strong web presence. Consumers are increasingly relying on digital avenues to get a sense of a physician without ever visiting the office. Even those patients who get a referral from a friend or family member will use the internet to do their own research. “One of the first things a consumer sees when Googling a physician or practice is their ratings and reviews, and a positive online reputation is the No. 1 deciding factor in a patient choosing one physician over another,” says Lillich.

For independent physicians to succeed in our consumer-centric health care landscape, they need a solution to volume-based medicine, a model that’s not dependent on seeing more patients. The ideal model allows for unrushed visits with time to build more meaningful doctor-patient relationships, a focus on prevention, and the ability to research and follow up on cases,while having a predictable income and a better work-life balance.

Physicians who converted to a membership medicine model noticed a huge difference in the experience and care they can offer in a smaller practice. “Before, you couldn’t keep up with phone calls, you couldn’t answer patient questions, you couldn’t get people in to see you,” says Michael Stevens, M.D., an MDVIP-affiliated internist. “The pandemic brought on a tsunami of patients wanting information and wanting your time, and there was no way to keep up with it. After the transition to MDVIP, I was able to send out emails to all my patients every week on the latest information that was coming out of the CDC, and I was doing phone calls in real time with same-day callbacks to patients.”

Lara Hitchcock, M.D., FAAFP, a family medicine physician affiliated with MDVIP, believes the tools MDVIP provides to both the doctor and patients make it possible to really personalize the experience. There’s not only a portal with an associated app, but also exercises and nutrition resources she ties into the annual exam and wellness plan. “We do a body composition analysis as part of the program, and if patients lost any muscle from the year before, I’m able to compare one year to the next where they lost it and tell them what to focus on,” explains Hitchcock. “Right at the point of care, I’m able to look up exercises to give them.”

MDVIP gives doctors and patients the time they both want and need. While membership medicine may not be right for every practice, those who moved away from traditional primary care can encourage other physicians to ask themselves if they can keep practicing the way they do now for another 5 to 10 years. If the answer is no, now might be the right time to look at a new practice model.

Be aware of ongoing changes in health care that are driving patient expectations and choice.

Increase patient and physician satisfaction with a more personalized experience.

Spend more time with patients and less time on paperwork.

Focus on prevention and wellness, not just sick care.

Improve physicians’ work-life balance and financial stability.

Shifting consumer attitudes can have negative implications for medical offices, but a membership model can help physicians deliver an enhanced service experience that yields an overall healthier practice.

Bootcamp 2022: Address Patient Needs in 2022 With a Membership-Based Model

To see the entire video presentation, go 

For primary care practices, earning enough revenue to meet overhead expenses and provide quality care has always been a challenge. But practices often make the challenge even greater through sloppy coding and billing, leading to delayed or incorrect reimbursements from payers. The Centers for Medicare & Medicaid Services estimates that in fiscal year 2021, Medicare made $6.25 billion in fee-for-service payments that were improper under its coverage, coding and billing rules.

Fortunately, there are steps doctors and practice administrators can take to ensure they receive all they are owed in a timely fashion. But it requires forethought, training, and commitment from everyone in the practice.

Identify the most common reasons for denials and how to handle them differently to improve practice revenue.

Audit your practice’s coding program and identify areas for improvement.

Learn coding best practices and what changes may be in store.


Independent Consultant
MGMA Health Care Consulting Group

didn’t go to medical school to become a medical coder or biller” is a common refrain among doctors unhappy with the time and resources those tasks require. Nevertheless, coding and billing are inescapable parts of practicing medicine, and doing them poorly can have severe financial consequences, either from frequent claims denials or overbillings that the practice must then repay.

Longtime coding consultant Nancy Enos, FACMPE, CPC, CPMA, says claims denials often are the result of errors in billing. Consequently, reducing denials requires identifying the source of the mistakes and providing feedback to staff on how to avoid them. “Without that feedback loop there’s no education and no stemming the tide,” she says.

Enos advises practices to focus on three areas for reducing billing errors and claims denials: front office, clinical staff and back office. Common front office-related reasons for denials include the following:

Lack of coordination of patient benefits.

Expenses not covered by a patient’s insurance.

Expenses incurred prior to the patient’s coverage date.

Lack of required precertification/authorization for an expense.

“The front office is where the revenue cycle begins,” Enos says. That means staff members need to verify eligibility up front so patients know their financial responsibilities and agree to meet them.

Clinicians can minimize claims denials by making sure their notes are concise, detailed and specific, Enos says. “’Diagnosis lacking specificity is one of the biggest reasons for denials. Putting in the clinical details such as the problem’s severity and whether it’s chronic or acute will get you to the most specific diagnosis code and get your claim paid faster,” she explains.

Other problems she frequently sees in clinical notes include:

The date of service doesn’t meet frequency limits.

Time spent with the patient for time-based services is not documented.

The billing provider’s and service provider’s names don’t match.

The note doesn’t support the CPT codes reported for it.

In some ways, back office staff face the biggest challenges in the effort to reduce claims denials because many of the issues they deal with are ambiguous, Enos says. She cites the example of erroneous unbundling. “It’s difficult to completely prevent it because you don’t always know which payers will pay for lesser procedures at the same time as more comprehensive ones,” she says.

Other issues back offices frequently deal with include the following:

CPT codes are inconsistent with the place of service.

The patient has reached the benefit maximum for the time period.

Procedure/modification combinations are incompatible.

When such mistakes occur, “it’s the back office’s responsibility to rectify them as quickly as possible, then share the feedback with the source of the errors,” Enos says.

The possibility of having to repay thousands of dollars following a payer audit is another reason for closely monitoring billing and coding procedures, Enos notes.

“Plan to be audited at some point, and don’t assume everything’s OK as long as you’re getting paid,” she advises. The best way for practices to prepare, especially individual and small group ones, is to follow the compliance program developed by the U.S. Department of Health and Human Service’s Office of Inspector General. Its recommendations include the following:

Conduct internal monitoring and periodic audits.

Implement compliance and practice standards by developing written standards and procedures.

Designate a compliance officer or contact(s) to monitor compliance efforts and enforce practice standards.

Conduct training and education on the standards and procedures.

Investigate violations or allegations of violations and disclose any incidents to the appropriate government entity.

Develop open lines of communication such as staff meetings on how to avoid erroneous or fraudulent conduct.

Enos recommends doing “benchmark” audits of five to 10 records per provider, followed by a minimum sample of 10 to 20 of the provider’s claims submissions, either retrospective or prospective. Departments or individuals of particular concern should undergo focused audits using at least 50 charts.

“Don’t look at auditing and monitoring as a form of punitive obligation, but as a way to ensure that you’re billing and coding properly,” Enos says. She says internal monitoring has the additional benefit of identifying and correcting undercoding, a problem common to most of the practices she works with.

After completing an audit, it’s critical to share the results throughout the practice. “It makes sense for a patient to see their doctor after getting an MRI, so why wouldn’t you want to provide feedback after an audit?” she says. Then she urges using the results to develop further training and education.

“Use that audit feedback to learn, to protect your practice and make sure that you’re optimizing your reimbursement and reducing your risk,” Enos says.

Front office staff can help minimize claims denials by verifying patient insurance coverage and eligibility before the appointment.

Clinician notes should be as detailed and specific as possible in order to obtain the correct billing code(s).

Billing and coding errors should be corrected immediately and feedback provided to the source of the error.

Practices should conduct periodic internal audits of their billing and coding and share the results with clinicians and staff members.

Don’t treat internal audits as an onerous task but rather as a method of self-protection and a tool to prevent undercoding.

For primary care practices, earning enough revenue to meet overhead expenses and provide quality care has always been a challenge. But practices often make the challenge even greater through sloppy coding and billing, leading to delayed or incorrect reimbursements from payers. 

Bootcamp 2022: Preventing coding and billing errors can reduce claims denials

Doctors and consumers generally know it’s best to start saving for retirement as much as possible, as early as possible. A 2021 survey by the American College of Physicians member insurance program found about half of early-career physicians, those in their 30s and 40s, were behind where they would like their savings portfolio to be.

In 2021, inflation forced Americans to reconsider the value of a dollar, now and in the future. In the 12 months from January 2021 to January 2022, the Consumer Price Index for All Urban Consumers rose 7.5%, according to the federal Bureau of Labor Statistics. Doctors were left wondering how to put more money in their pockets to cover rising costs in the future.

Remarking on the ratification of the U.S. Constitution, Founding Father Benjamin Franklin noted that “in this world, nothing is certain except death and taxes.” Physicians spend their careers helping patients fight against the former. For their own financial health, they should consider ways to fend off the latter.

Discover actionable tips to grow your retirement nest egg.

Identify tax minimization strategies well suited for you and how to use them.

Understand the benefits and steps required to personalize your financial planning.

Alexis E. Gallati, EA, MBA, M.S. Tax, CTP

, founder and lead tax strategist at Cerebral Tax Advisors of Knoxville, Tennessee. Gallati is the author of the book “Advanced Tax Planning for Medical Professionals” and has written for 

Taxes are one of the biggest expenses physicians will have throughout their careers.

Failing to plan for them is one of the biggest mistakes they can make, says Alexis Gallati, EA, MBA, M.S. Tax, CTP, the founder and lead tax strategist at Cerebral Tax Advisors of Knoxville, Tennessee.

To start, there are two ways to save money.

Defense is cutting expenses and spending less. That is helpful but goes only so far, Gallati says.

Going on offense means creating a plan that reduces tax burdens to put more money in physicians’ pockets to make more money.

Gallati referred to the golf maxim: Drive for show, putt for dough. “Tax planning is definitely putting for dough,” she says.

Physicians should have a healthy respect for the Internal Revenue Service (IRS). Unwarranted fear and “audit paranoia” can be a huge mistake, Gallati says.

Audit rates are at historic lows. In 2019 the overall rate was half of 1% and the IRS tends to target small proprietorships in cash-heavy industries, Gallati says.

“The truth is, most experts say it pays to be aggressive and that’s because overall audit odds are so low that most legitimate deductions aren’t likely to wave red flags,” she says.

Physicians can consider forming their own small business entities. Most start as a sole proprietor and then grow, Gallati said.

The IRS recognizes partnerships, S corporations and C corporations. Each has its own regulations but doctors should approach them with the same goal of minimizing taxes paid. An S corporation can minimize self-employment tax and is a well-established, mainstream planning strategy for tax purposes. S corporations also have a low risk of being audited: Just 2/10 of 1% of S corporations and partnerships were audited in 2019.

Managing money through retirement is a cycle with three phases: the seed, the growth, and the harvest.

The seed is the initial investment in an asset or an account. Growth happens over time.

The harvest is money used to live on during retirement.

“You can pay or avoid taxes at each of these points depending on the nature of the assets you buy or the account you invest in,” Gallati said. “Which place is the best? Well, it depends on a lot of factors, most importantly including where your personal tax rates are at any particular point in your cycle.”

Younger physicians may have situations different from those at retirement age or beyond it.

Different investments – taxable stocks, traditional or Roth IRAs, nonqualified annuities, cash value life insurance, health savings accounts – have different tax advantages at each stage.

For example, with a traditional IRA, the seed and growth are tax free. But withdrawals — the harvest — are taxable.

Gallati says health savings accounts are a personal favorite because the seed, growth and harvest all are tax free for paying for qualified medical expenses.

Each investment needs research, but tax breaks may be available on the seed, growth or harvest. Take the break when it’s the best, Gallati says.

“You basically have to figure out where you’re at in your finances and you have to play a little bit of mind reader and have your crystal ball to know what tax rates are going to be like,” Gallati says. “Different people have different philosophies when it comes to what would end up being best.”

A home office — with family as staff — can be part of a physician’s retirement savings plan.

Hiring children is a favorite strategy, Gallati says, because it allows doctors to put away money for retirement for themselves and for their children.

The employees, 7 years and older, must earn reasonable wages and have their own job descriptions, time sheets and bank accounts. With the right amount of savings, time and investment growth, children may be millionaires themselves when they retire, Gallati says.

Home offices, along with mileage and meals, can serve as tax deductions for physicians.

Building a retirement nest egg consists of defense – cutting expenses – and offense – saving money to make money.

Physicians should respect the IRS but shouldn’t be afraid of creating a legal tax plan that minimizes taxes to maximize retirement savings.

Sole proprietorships, partnerships and corporations are small businesses that can help physicians reduce their income tax burdens.

Different investments offer tax breaks at different times – some when they start as seeds at the time of investment, some when they are ready for harvest, or withdrawal.

Consider hiring children to maximize retirement savings for yourself and for them.

Bootcamp 2022: The foundations of a great tax plan

As health care leaders navigate our transition from life in a pandemic to a world where COVID-19 is an endemic disease, interoperability will likely be top of mind. As we enter the pandemic’s third year, we can expect four new drivers to propel interoperability:

Interoperability and the recent surge in support from health care leaders for Fast Healthcare Interoperability Resources (FHIR), spurred by federal mandates, have unlocked previously siloed data stored behind propitiatory internal enterprise systems. By mandating that patient data be made accessible via Application Programming Interfaces (APIs) and standardized formats, health care is effectively liberating data resources, allowing parties beyond payers and providers to create value on behalf of patients.

Now data have the potential to flow freely between stakeholders in health care, but questions remain: Is the information verifiable and can we trust it? Trust is a foundational element across the health care ecosystem, impacting quality of life and cost of care for millions of patients.

For governments, health plans and providers to use the data now accessible, the pipelines providing the infrastructure for transport and aggregation of the data must be verified and certified. The expectation is for a push to develop and implement a nationwide fabric of policies, technologies and governance mechanisms to guarantee trust in quality of information, as well as the dependability of its delivery to and from digital end points. This would require the fully articulated consent of patients. The industry will be able to deliver on the vision of value-based care like never before, because ability to accurately report on quality of care and the impact of decisions on payments and premiums is now reality.

Consumer apps that verify negative COVID-19 test results and vaccination status are quietly gaining significant support across political lines for many reasons. Already these apps have proven useful for international travel, cruises and increasingly for access to public event venues, conferences and even weddings and other private affairs. Domestically, and to some extent internationally, most of these apps are adopting the HL7 FHIR standards promoted by the VCI Initiative and using the SMART Health Card framework.

Adoption of these digital tools by consumers and vendors will inevitably accelerate interoperability and the use of FHIR. Payers, providers and other stakeholders will continue to expand the use of SMART Health Cards to enable patients to become true agents of interoperability, carrying their information to every encounter where it might be required.

Generation Z’s demand for a more personalized experience

Generation Z is the first to know only a world with the internet, smart devices and apps. As a result, its members have radically different views about privacy and trust in the digital world, as well as an understanding that convenience is often based in transparency. Having grown up with Google, Facebook, Amazon, Instagram and Yelp, Gen Z has become accustomed to the instant availability of information about anything while seemingly having little hesitation about sharing.

With these patients, there is an emerging quid pro quo relationship between sharing information and receiving better access to great care. Add big data, machine learning, artificial intelligence, ubiquitous cloud access and REST (representational state transfer) APIs, and the expectations bar for Gen Z will be much higher than anything we have seen. Gen Z is pushing the industry to mirror the same consumer-centric experience as e-commerce at large. Interoperability will be key in reaching that level of personalization.

The dangling carrots for interoperability have increasingly been the real dollars associated with reduced burden, reduced cost and fully engaged patients — all within the context of increased quality of and better access to care.

Meanwhile, legislation such as the No Surprises Act and the 21st Century Cures Act that broadly cover payers, providers, and technology vendors act as sticks banging on the industry with which to further enhance interoperability.

More than ever, payers, providers and now patients are realizing the value in interoperable data exchange. In 2022, we can expect interoperability discussions to transition from how we share data to how we trust data.

John Kelly provides strategic consulting to Edifecs customers, specializing in information exchange and applying principles of supply chain integration to the health care delivery lifecycle. Previously he was CIO of health care network provider NaviNet, director of eBusiness Architecture at Harvard Pilgrim Health Care, and managing director of his own health IT consulting firm.

As health care leaders navigate our transition from life in a pandemic to a world where COVID-19 is an endemic disease, interoperability will likely be top of mind. 

The next chapter for interoperability is upon us   

If the last year and a half has taught us anything, it’s that the future is rather unpredictable. That being said, it pays to take a cleareyed look at the powerful potential that existing and emerging digital technologies offer for improving the quality

Here are five ways that digital health is reshaping the health care environment:

 Proactive, predictive, personalized digital health management enhances care

When patients think about digital health, they typically envision the opportunity to have a telehealth/virtual visit with a caregiver because they don’t feel well or are experiencing symptoms that concern them. However, it’s time to start thinking about digital health in a much broader perspective: the capability to anticipate and address issues before serious or life-threatening health concerns arise.

Specifically, remote patient monitoring (RPM) — a key component of virtual care — will increasingly help clinicians proactively manage post-acute and chronic care using a highly personalized, data-informed approach. Step 1 is to establish a personalized profile for each at-risk patient using artificial intelligence (AI)-based analytics applied to continuous real-world patient data captured by wearable sensors. Step 2 is to identify and alert clinicians about anomalies specific to that individual patient that can signal potential health problems.

For example, rather than comparing a patient with heart failure to millions of others living with the same condition, this technology can determine the baseline at which an individual patient has been functioning and safely living. By tracking changes in sleep, exercise, vital signs or other physiological measures, clinicians can intervene proactively to prevent or mitigate issues in a more personalized approach.

The result is a win-win-win: Clinicians may improve quality of care, hospitals may reduce unnecessary and costly readmissions and patients may remain in their own homes longer, more comfortably and more confidently.

 Hospital-at-home options enable providers to maximize resources

The pandemic vividly underscores the challenges health systems face when seriously ill patients outnumber available hospital beds and exacerbate clinician shortages. Deploying digital health platforms that continuously monitor patients and use AI to extract clinical insights can significantly help stretch these limited resources.

In some cases, patients who were believed to require hospital admission can be “admitted” to their home while clinicians remotely manage their care, freeing up hospital beds for the sickest individuals in need of such care. Providers then deliver commensurate quality of care in a lower-cost environment and patients recover or manage their condition in the comfort of a familiar environment. In other words, the hospital comes to the patient.

Enhancing hospital-at-home options enables health systems to deliver the right care from the right clinician to the right patient at the right time. The expanded and innovative virtual care payment models CMS implemented so hospitals can count on receiving reimbursement for this approach further support its viability.

 Continuous RPM and AI analytics help prevent avoidable, costly readmissions

Unnecessary and avoidable readmissions continue to be a costly challenge for hospitals. For example, readmission rates are often as high as 25% for patients living with heart failure and chronic obstructive pulmonary disease. The ability to prevent just a handful of those readmissions provides significant savings.

Continuous RPM combined with AI to extract insights and provide context around the physiological data captured delivers a more complete picture of the patient. This, in turn, supports clinicians’ ability to intervene in a timely manner to prevent readmissions. To cite just one example, a clinician may need to understand whether a patient’s heart rate spiked because she just ran up the stairs or because her condition is deteriorating. On-demand access to near real-time data can guide decision-making and appropriate treatment.

 Disease- and device-agnostic RPM plus AI analytics provide valuable health insights

Wearable sensors are becoming increasingly commonplace, with the global wearable medical devices market poised to expand at a compound annual growth rate of 26.8% from 2021 to 2028, according to Grand View Research. As consumers grow more comfortable wearing nonintrusive devices as part of their daily routine, it has become easier to monitor a broad range of vital signs and physiological activity important to understanding wellness and illness.

But data alone are often insufficient for health management; the “magic” comes from applying AI-based analytics. Disease- and device-agnostic machine learning-based platforms can extract personalized clinical insights from volumes of data and trending, zeroing in on the specific health needs of each individual. Armed with this information, clinicians can partner with patients to create, implement and monitor health management plans tailored to patients’ unique requirements and goals.

 Digital health technology supports better medication dosing and adherence

Poor medication adherence costs our health system billions of dollars each year. Digital health platforms using AI may improve medication adherence through increasing the touch points with patients to help them more easily stay on track with their medication regimen.

But even more exciting is the opportunity for life sciences companies and clinicians to collaborate with technology companies to help provide the information needed for clinicians to titrate medications according to specific patient needs. For many medications, adjusting the drug to the optimal dose requires multiple patient visits. This is burdensome for both patient and clinician and delays optimal treatment. Remote monitoring of the patient’s physiological response to the current dose allows the clinician to track key vital signs that may make it safe and effective to adjust medication doses while the patient stays home. This home-based approach to medication management reduces the hurdles to optimal dosing for myriad diseases.

Digital technologies are increasingly redefining health care in multiple ways. They help patients take the right medications in the right dosages at the right time and enable clinicians to identify signs of decompensation and other clinical risk factors so they can proactively intervene to improve outcomes. They also support providers seeking cost-efficient ways to optimize finite health care resources. All of this bodes well for exciting opportunities for everyone to live their healthiest lives possible.

Gary Manning is senior vice president and general manager, healthcare, physIQ.

How digital health is reshaping patient care in 2022

Trusts can be effective and important legal tools, but they are not all the same and they are not universally interchangeable. We examine some of the trust law basics and terms every successful physician should know when evaluating their own legal planning needs.

For the purposes of our discussion, a trust is a formal, binding, legal document that allows an individual to create and transfer title to property or value of any kind to the control of another for the benefit of a third party.

The entity that creates and funds a trust is known as a “grantor” or “settlor.” If there is more than one, they are known as “co-grantors”; e.g., husband and wife as co-grantors.

The trust is under the control of a “trustee.” If more than one trustee is serving at the same time, they are known as “co-trustees”

The trustee manages the trust in accordance with the terms it provides, most commonly for the benefit of a third party, known as the “beneficiary.”

There may be one or more beneficiaries and some trusts name “primary” and “contingent” beneficiaries; e.g., a wife leaves her estate to her husband as primary and to her three children as contingent beneficiaries if he predeceases her.

There are also cases where one may create and fund a trust for their own benefit, during their own lives, as opposed to those created solely for the benefit of third parties. These “self-settled trusts” are commonly seen in various forms of asset protection trusts, including those used by successful, high-risk professionals like doctors and those for Medicaid asset protection planning.

The term “situs” refers to the jurisdiction and choice of law selected for the trust. Trusts may be established under the law of your state, another U.S. state, or the laws of a foreign nation or “offshore.” Different jurisdictions may have significantly different laws, taxation, and compliance requirements, including which asset protection benefits they provide.

Some special purpose asset protection trusts don’t rely on specific creditor protection laws, but rather on other well-established legal principles, including arm’s length sales transactions (e.g., you sell an asset to a trust for fair market value) and gifts to trusts that are considered “completed gifts” by the IRS for tax purposes and of which you relinquish title and control.

Any asset protection plan or planner that uses the term “secret” should be a red flag and most likely avoided. There is no such thing as secrecy in the law (as opposed to privacy, which does exist and can be a trust benefit) and any plan that relies on assets being held in a trust, limited liability company, etc., that you hope isn’t found will also require your willingness to actively lie to conceal it. Why? Because an experienced litigator will simply ask you, under oath in discovery, in a deposition, in a debtor’s exam, etc. to disclose “any trust, partnership, corporation, foundation or similar device that you are a grantor, trustee, beneficiary, officer, member or director of.” You’ll either answer honestly or you’ll be committing perjury.

Two key trust terms: ‘revocable’ and ‘irrevocable’

These are key terms in any trust. Understanding them is especially important to those who are using a trust as part of an asset protection plan. A revocable trust can be revoked at any time up until your last breath, allowing you to change the trust details, including the trust’s assets and beneficiaries. As such, a revocable trust is defective against your creditors and liabilities, during your lifetime. An irrevocable trust, on the other hand, makes a permanent transfer of assets away from yourself to the trust so that the assets are trust property and not available for your personal or professional liability. With these basics in mind, we will look at specific types of trusts in greater detail.

Ike Devji, J.D., has practiced law exclusively in the areas of asset protection, risk management and wealth preservation for 16 years. Send your legal questions to Medec@mjhlifesciences.com.

Trusts can be effective and important legal tools, but they are not all the same and they are not universally interchangeable.

Trusts 101 for physicians

Before her practice joined an accountable care organization (ACO), payer contract negotiations seemed impossible, according to Karen Smith, M.D. Her family medicine practice in Raeford, North Carolina, couldn’t compete with large multispecialty clinics and hospital corporations.

“We accepted what we were given,” Smith says. “Contract negotiations were definitely one-sided.”

Since her practice joined the ACO, however, payment rates have gone up. There’s also the potential for shared savings — additional money that ACO members receive for providing cost-effective, high-quality care.

“Now we get paid in a manner that supports our practice, including our overhead,” she says. “That makes life a little easier and it allows me to invest back into my practice.”

Medical Economics May 2022 edition

Making medicine better for women

Bootcamp 2022: Remote patient monitoring boosts patient outcomes and practice revenue

Bootcamp 2022: Address Patient Needs in 2022 With a Membership-Based Model

Bootcamp 2022: Preventing coding and billing errors can reduce claims denials

Bootcamp 2022: The foundations of a great tax plan

The next chapter for interoperability is upon us

How digital health is reshaping patient care in 2022

Trusts 101 for physicians

10 tips for successfully negotiating payer contracts

Understanding cost segregation as a tax strategy

Five benefits you can receive from donor-advised funds

Hiring staff during the great resignation

High Stock Volatility Signals Investor Opportunity