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Business Consultants/Guide to Starting Your Own Medical Practice

8 Myths About Being a Self-Employed Physiatrist

Do you dream of being a self-employed physiatrist but feel like you don’t have the money, knowledge, or skills to get a practice going? Your concerns might be unfounded and grounded in some of the common myths about self-employment. Imagine being able to increase your income and have a more flexible schedule. These benefits are a real possibility when you are your own boss. So, let’s start exposing the eight myths for what they really are.

1. Self-employed means working long hours. Many people who work for themselves do work long hours, but this is frequently a choice. They simply love what they do. Many people can start practices that generate income even while they aren’t working. If you choose a practice that includes passive recurring income, you won’t necessarily have to spend a lot of time working once you get going.

2. Being an employee is less risky. This is one of the biggest myths. Employees get laid off all the time. And what if you need to raise some extra cash quickly? That’s tough to do when you’re working for someone else, and your income is fixed. Being self-employed gives you more control over your income and the assets of the practice. Control helps reduce risk.

3. Self-employment means putting all your eggs in one basket. If you’re an employee, how many patients do you have to lose in the practice in order to lose your paycheck? This can be as little as one patient. But if you have a number of patients, they all have to fire you for you to lose all of your income.

4. Self-employment equals stress. When you work for yourself, you can create whatever work environment you choose. You can have greater stability over the long term, and you have more control over your hours. You can also choose a practice that isn’t inherently stressful. Generally, you can make it whatever you want it to be, which will make your stress level only as high as you find acceptable.

5. Being self-employed is lonely. Working for yourself can be a much more pleasant lifestyle if you choose. With more flexibility, you can often rearrange your schedule to suit your social life. When you work for someone else, your coworkers tend to be your social life. Over time, that can get old.

6. Self-employment means doing everything yourself. While you’re the one that has to ensure that everything gets done, that doesn’t mean you have to do everything yourself. Hire people to do the work for you. Your time should be spent growing and expanding the practice, not doing the grunt work.

7. Running your own practice is complicated. Yes, there is quite a bit to know, but none of it is difficult. There are books and experts available to help you along the way. Nothing is overly complex about insurance, payroll taxes, and bookkeeping. It’s just new to you. Plus, you only have to learn information once. Then you can start as many practices as you like.

8. You can’t start a practice without a lot of money. That largely depends on the practice. A website and accompanying social media platforms can cost less than $100 a year. Your home phone or cell phone is already paid for as part of your monthly expenses. A tank of gas isn’t that expensive, relatively speaking, nowadays, plus they have electric vehicles. And ads are inexpensive also. There are a lot of inexpensive ways to start and market a practice. You could market directly to other doctors and/or set up free educational webinars that describe your services.

Where there’s a will, there is a way. Don’t let a bunch of myths stop you from taking the plunge into self-employment. You can even start a practice on the side and continue working your regular job until your new practice brings in enough income to replace it. Now that we’ve separated myths from facts, what are you going to do? Put on your thinking cap and figure out a way to make your dream a reality. There’s no time like the present to take control of your life.

This article was contributed by Hassan Akinbiyi, M.D., https://drhassanrehab.com/about-dr-hassan/

ProMedica Partners has released a new step-by-step guide about starting your own medical practice.  They gathered the best quality resources, references, tools, & information you need to open your own practice, all in one place.  One of the items in this blog on their website provides information about the possible need to hire a practice startup consultant.   “Though consultants can be expensive, their fees can be well worth it, if you utilize their services effectively. Start with a professional association such as the NSCHBC, and also ask colleagues for reference, especially others in your specialty.”  To find out more of their comprehensive information on this subject, Check out part 2 of the new guide here

This information is courtesy of ProMedica Partners, https://promedicapartners.com/

Physiatry Practice Opportunities

The number of physiatry practice opportunities is less this year because of COVID.  There are sports medicine fellows who are open to general rehab positions and residents who want to do inpatient who are open to outpatient work.  This applies to the urban areas and less so for more suburban or rural areas.

There are more and more subacute and skilled nursing facility physiatry practice opportunities. Some of them are with private practices and some are with large national or regional companies.  These companies often have an income guarantee and then take approximately 30% of the billings.

Part-time physiatry practice opportunities are not unusual in large metropolitan areas like New York City.  Physiatrists there may not be able to find a full-time position.  Sometimes it’s wise to have two part-time physiatry practice opportunities so that if one physiatry practice opportunity folds then the physiatrist has the security of the other job.

Licensure is an aspect of the practice search that is often overlooked.  Most physiatrists prefer to hold off on licensure because of its cost.  However, licensure puts you at an advantage over a physiatrist who is not licensed in that state.  Therefore, it’s worthwhile to pursue a license particularly in states that are in high demand such as NY, FL, and CA.  It’s also important to pursue a license early on if you’re interested in a state which licensure process is lengthy such as TX, CA and NJ.  Sometimes, practices/hospitals will pay for a license if you take their practice opportunity.  Without a license, you put yourself in possible financial disadvantage because credentialling with insurers can’t be started until you have a license number.

When considering physiatry practice opportunities, be wary of practices/hospitals with a revolving door of doctors.  You may hear about this situation at a hospital/practice from doctors in the area or through research.  It happens more often in metropolitan locations where there is a high demand for physiatry practice opportunities.  In these locations, a hospital/practice can easily replace one doctor for another doctor.

When considering physiatry practice opportunities, you may want to consider the cost of living of various areas across the country.  For example, a practice in Las Vegas with a physiatry practice opportunity makes a point that for what you’re saving by not living in Los Angeles, CA, you could buy a new car very year!  If you make $212,000 in Los Angeles, it’s equivalent to making $300,000 in Las Vegas.

Another consideration when thinking about is state income tax.  I know one NYC physiatrist whose main consideration with physiatry practice opportunities was states with no state income tax.  States without a state income tax are AK, FL, NV, NH SD, TN, TX, WA and WY.  As one physiatrist in NV told me who is hiring a physiatrist, a doctor moving here from a state with income tax would be able to buy a new car each year.  For example, for every $100,000 you earn, you would save $10,000 by not having to pay state income tax.  Hence, the savings amounts to a new car each year!

Interviewing is a major component of the practice search process when considering physiatry practice opportunities.  Be prepared to answer the standard questions such as “What do you have to bring to the table?”  “What are your practice interests?” and “Tell me about yourself.”  You can find countless tips online describing how to respond to the typical interview questions and to show that you’re an excellent candidate for the job to include on our website.

Another type of interview question are personality/psychological questions.  Examples of these type of questions are “Describe your approach to patients.”  “Tell me about a patient who came to you unhappy with the care they received elsewhere, and how you handles it.” “What makes you uncomfortable?”  “When are you the happiest?”  Tell me about one of your professional relationships.” “Tell me about your best supervisor.”

These questions are to see how you work under pressure.  They want to know how you react to surprises, and if you can handle unusual situations quickly, creatively and effectively.  The interviewer will likely ask questions about you and your work style to determine how to handle stress and challenging situations.  There are no right or wrong answers to these questions, but you’ll still want to prepare as much as possible.  You’ll want to answer honestly while at the same time trying to match your replies to the practice’s needs.

You can still practice how to handle these questions.  First, you can practice answering strange questions with a friend or family member.  This will help you practice staying calm and confident, even when you feel stumped.  Show empathy and compassion in your responses.  Try to demonstrate your listening skills, interest in patient education and ability to engage patients in their healthcare.  If you are stumped by a question and need a little more time to respond, ask the employer to ask the question again and/or repeat the question that’s been asked.

Also, be prepared to ask questions during an interview. It shows that you have an interest in the physiatry practice opportunity.  Asking good questions won’t guarantee you the job but they will certainly help make a good impression.  Sample questions to ask include “How much time is allotted for appointments with new and follow-up patients?”, “How much time is allotted for appointments with new and follow-up patients?”, “How many patients a day will I be expected to see?”, “What constitutes a full-load in your practice?” and “Is this a new or replacement position?”

Having said all of these objective items to do during your physiatry practice search, it remains to be said that using your intuition/gut to decide if it’s a good physiatry practice opportunity is very worthwhile.  All the questions and answers during an interview still aren’t enough to decide on a physiatry practice opportunity.  Beyond what objective information you can secure, use subjective information to decide on a job.  Read between the lines of what was said and not said by the employer.

In regards to compensation, according to MedScape’s 2019 physiatry survey from data collected between October, 2018 and February, 2019, the average compensation for a physiatrist is $306,000.  This is up from $269,000 in 2018.

Compensation varies by area.  For example, Atlanta on average pays 29% more than the national average, Miami 5% more, Tampa 1% more, Cleveland 3% less, NYC 5% less, Chicago 8% less and Philadelphia 23% less.  This is information according to payscale.com.

Also, according to payscale.com, the average physiatrist salary is $208,543 with an average bonus of $72,000, and an average profit-sharing percentage of 10%.  The low compensation for a physiatrist is $147,000, $290,000 as a median and $286,000 as the 90th percentile.

When considering physiatry practice opportunities, there are 3 basic compensation models:  straight salary with incentive, equal shares and production-based.  A straight salary is most often seen in HMO’s  and academic settings.  Obviously, a straight salary is the easiest to determine its value.  They are guaranteed regardless of your productivity.  On the other hand, if you are a hard worker and productive, then a straight salary is not your best friend.  They also don’t offer an ownership track.

Regarding an incentive, you need to find out how it is derived and if it’s achievable.  According to a physiatrist, it’s much more important to know an incentive’s derivation than simply that one exists.  She was offered an incentive to earn an additional $50,000 a year provided her billings exceeded a certain amount.    The problem was that the higher earnings were unrealistic.  Looking back, she realized that she should have asked for the performance financials for other physiatrists in the practice, the payor mix, the productivity of the other physiatrists, etc.  Find out how the incentive works in practice, not just in theory.

The incentive may be modest the first and second years of practice as it takes that long for the practice to break even with a new doctor.  If you’re in a private practice, the incentive formula will probably start at 25% the first year, 35% the second year and 50% the third year.  It’s usually by the third year that you become a partner.

Even though you probably won’t be able to negotiate the compensation model, it’s important to understand it to realize what annual income you might anticipate.  Determine how the compensation model works initially and at different points in time.  For example, if the first one or two yea’s salaries are fixed and then compensation then moves to a productivity basis, ask for details on how the transition is handled and how other physicians have fared in year two and three.  As Merritt Hawkins Executive Vice President Mark Smith says, “if physician can’t determine how much they will earn while brushing their teeth, the plan is too complex.”

One type of incentive formula is based on getting a percentage after x times the salary or receipts.  For example, you might get 20% of collections after three times your salary.  For example, a salary of $180,000 with collections of $600,000 would result ($180,000 x 3 =$540,000, $600,000 – $540,000 x 20%) in a $12,000 incentive bonus.    This is an example of what I spoke to earlier that you should make sure the collection incentive is attainable.  Also, I was just talking with a physiatrist yesterday who told me there were different collection thresholds with different associated percentages.  The percentages should be the same.

Another type of incentive formula is a percentage of the difference between the net income and expenses.  For example, if your gross collections for a quarter are $150,000 and there are $60,000 in overhead expenses and $60,000 in physician expenses like malpractice, benefits, etc., the net is $30,000 and at a bonus of 20% you would receive $6,000 for the quarter.  Years ago, a physiatrist I recruited warned me of the physiatry owner who had a very large rental expense which a portion was to him and greatly reduced his income.  You may also receive a share of the ancillaries like PT and lab.

A third compensation formula is purely production-based.  There are a myriad of variations with these formulas just as is the case with the incentive formulas.  You might be paid a percentage of billings OR collections OR RVS units of service.  One physiatrist told me how his compensation formula was different than his older associates.  The overhead should be shared unless perhaps in situations of multispecialty groups.  The positive of a production-based compensation formula is that you are rewarded for the work you do.  A negative is that it might cause friction among the physicians as some physiatrists will be paid more than other physiatrists.

Other compensation considerations are to find out the percent of billings that the physician group/hospital typically collects and how quickly it collects it.  The time value of money comes into play.  It’s far better to step away from a practice opportunity before digging yourself in a hole.

Find out the patient mix.  Private pay pays the best but you have to be in a demographic that will support it.  The order of payment thereafter is commercial insurance, Medicare and Medicaid.  Personal injury payments usually are much longer to receive.  Also find out if you’ll be seeing the same share of these patients as the other doctors.

Don’t count on the incentive even if it looks likely.  This past year was a perfect example with the impact of Covid.  I talked with a doctor who told me she hasn’t earned the incentive in the 30 years with the hospital!

Partnership terms usually aren’t discussed upfront.  Until the doctor group works for you and feels comfortable with you, partnership won’t be discussed.  However, you could probably find out what the terms are for the existing physicians.  A five-year partnership track may be far less appealing than a two-year track and the longer route to partnership may mean less long-term earning potential.

Finally, the last aspect of considering a physiatry practice opportunity is the contract.  Large corporations and health systems have boilerplate contracts and won’t negotiate them so a legal review is not as valuable as it might be.  However, I recently had a group which told me to tell the physician to whom they offered a contract that it is a boilerplate that he couldn’t negotiate.  However, he did ask for a sign-on bonus and received a sizeable figure.

If you decide to work as an independent contractor and are responsible for your own billings, you might want to refer to my website to the Resources tab which includes for one, Physiatry Billing Specialists.  Other resources are included on this tab to include lawyers, billings, and practice management.

So here’s best wishes to you in your consideration of physiatry practice opportunities!

 

MIPS Reporting

FREE MEDICARE HELP WITH MIPS
 
CMS has launched a Small, Underserved, and Rural Support
initiative to provide free, customized Technical Assistance to
clinicians in small practices.
 

Technical assistance includes:
– Understanding general requirements of the MIPS program
– Advice on choosing measures
– Help in submitting data
 
Based on my experience, these companies are excellent!
 
Each state has a different company providing this technical assistance.
 

You can find who to contact by clicking on this link and entering
your state, or by calling the CMS MIPS Help Desk 1-866-288-8292
 
 https://qpp.cms.gov/resources/small-underserved-rural-practices

This article was contributed by Bruno Stillo, Physiatry Billing Specialists, 800-835-4482,www.physiatrymedicalbilling.com
[email protected]

AUTOMATIC MIPS Exception for Performance Year 2020

CMS issued a new directive on 2-25-21 – CMS will apply an AUTOMATIC extreme and uncontrollable circumstances exception (EUC) to the following clinicians for the MIPS 2020 performance year:

  1. Individual clinicians that haven’t submitted data. If you haven’t submitted data for 2020, then you don’t need to, if you want to avoid a penalty in 2022.
  2. Individual MIPS eligible clinicians that have submitted data for a single performance category (such as Medicare Part B Claims measures submitted throughout the 2020 performance period).

If you meet either of the above criteria, you will be automatically identified and will receive a neutral payment adjustment(i.e. – no penalty) for the 2022 MIPS payment year. You don’t need to take any additional action!

The automatic exception is welcome news for individual clinicians who are having trouble  meeting the requirements of the 2020 MIPS program.

Additional details may be found at https://qpp.cms.gov/resources/covid19 or by calling the QPP Help Desk at 866-288-8292.

This article was contributed by Bruno Stillo, Physiatry Billing Specialists, 800-835-4482,www.physiatrymedicalbilling.com
[email protected]

7 Types of Insurance to Protect Your Medical Practice

7 Types of Insurance to Protect Your Medical Practice

If you’re a family physician who manages your own private practice, then you are well aware of the challenges that come with being a business owner. You’re the judge, jury and executioner when it comes to laying the ground rules for how you want your practice to operate. But if you’ve recently acquired your own independent practice, there are a few things you need know – namely how you can protect your practice from various risks.

From day one of opening your practice, you expose yourself to certain liabilities, which is why it’s important to have the right types of insurance in place. One lawsuit or catastrophic event could be enough to wipe out a small business before it even has a chance to get off the ground. In this post, we’re reviewing the types of protection an independent family physician practice needs in order to protect everything you and your staff have worked so hard to achieve.

  1. Professional Liability Insurance

Professional liability insurance, or malpractice insurance, protects your practice in the unfortunate event that you are sued by a patient who claims negligence or that you failed to perform your job properly, resulting in harm.

While there is no one-size-fits-all policy, professional liability coverage helps cover the costs of legal defense and settlements, which can run into the hundreds of thousands of dollars. Since many small physician practices won’t have the resources to cover expensive claims, malpractice insurance is a must.

  1. Property Insurance

When you first opened your practice, you probably invested a lot of time and money in getting the right equipment, medical supplies, furniture and other necessary fixtures to make your business inviting to patients. However, if there was a natural disaster, how would you replace these items?

That’s where property insurance comes in. It protects the property you use in case it becomes lost or damaged due to common issues such as fire or theft. Property insurance covers both the physical building of your practice and personal property that is vital to the operation of your business (office furnishings, inventory, computers, etc.). Whether you own or lease your space, property insurance should not be neglected.

  1. Business Auto Insurance

Some physicians who are on their own have the flexibility to make house calls. This is especially common for concierge doctors who often drive to a patient’s home. If you use your own car for business purposes, you may want to consider business or commercial vehicle insurance. Most personal auto insurance policies won’t cover damages to cars involved in an accident used mainly for business purposes. A business auto policy covers cars owned by a business.

This insurance pays any costs resulting from bodily injury or property damage for which your business is legally liable. Depending on your coverage, your policy may pay for repairs or replace your vehicle due to damage from accidents, theft, and/or other events.

  1. Workers Compensation Insurance

As a business owner, you probably hired a few hard-working, dedicated employees. If any one of them were to become seriously injured, how would you be able to run your practice? In all states (with the exception of Texas) an employer must have workers compensation insurance, depending on the number of hired employees.

This insurance pays for medical care and replaces a portion of lost wages for an employee who is injured during the course of employment, regardless of who was at fault. Even if your employees perform low-risk or low-impact work, slip-and-falls or other medical conditions such as carpal tunnel syndrome could result in expensive claims.

If a worker dies as a result of their injuries, the insurance then compensates the employee’s family. This is definitely a type of insurance you don’t want to overlook, especially for the livelihood of your staff members.

  1. Business Interruption Insurance

Depending on where you practice, your business may be more prone to natural disasters such as earthquakes, hurricanes or tornadoes. If a disaster or catastrophic event occurs, it is likely that your business’s operations will be interrupted. To help your practice get back up and running, consider a business interruption insurance policy.

This coverage is different from property insurance in that it covers incomes lost due to a disaster-related closing of a business or due to the need for structural rebuilding of the practice. However, BII can also be combined with a property insurance policy – this package is known as a Business Owner’s Policy.

  1. Life Insurance

While it may not seem directly related to your practice, life insurance is another form of financial protection that is often left on the backburner. If you were to pass away, who would provide for your loved ones’ future? Who would treat your patients?

Life insurance offers a death benefit to your appointed beneficiaries in the event that you can no longer financially provide for them. This type of insurance is very important because it allows peace of mind for you, your family, and your business partners. Life insurance is a great way to unburden your loved ones due to the loss of your income. If you need assistance protecting your family’s financial future, the AAFP Insurance Program is here to help.

  1. Practice Overhead Insurance

If you were unable to practice medicine due to an injury or illness, you’d probably consider Individual Disability Insurance. While this is a form of protection you should certainly have in your back pocket, think about your practice. If you’re out of the office, who will see your patients?

Practice overhead insurance steps in if you are temporarily out of the office due to a disability. It helps cover certain expenses such as utility bills, rent, salaries, taxes and other office costs. Don’t risk losing your income or control of your practice due to an injury.

 

By having the right types of insurance in place, your medical practice can avoid a major financial loss due to lawsuits or catastrophic events.

Taken from the AAFP, 2015, https://www.aafpins.com/2015/12/7-types-of-insurance-to-protect-your-medical-practice/

PHYSIATRY JOBS

PHYSIATRY JOBS

There are many physiatry jobs available in many different physical medicine and rehabilitation subspecialties.  The demand for physical medicine and rehabilitation is greater than the supply.  Although Farr Healthcare only recruits for physiatry, my understanding is that it is a specialty that is more in demand than many other specialties and has exceptional job prospects.  Please visit www.farrhealthcare.com for a list of physical medicine and rehabilitation practice opportunities.

There is a need for inpatient, general outpatient and interventional physiatrists.  The need is greatest for inpatient physiatrists, followed by general outpatient physiatrists and then interventional physiatrists.  The need is greatest for inpatient rehab because many middle age and younger physiatrists have chosen to pursue outpatient work.

Farr Healthcare doesn’t usually have many general outpatient physical medicine practice opportunities.  This may be due to there being less a demand for them and that there is a fairly large pool of outpatient physiatrists available.  It is usually in more rural locations that Farr Healthcare is asked to recruit general outpatient physiatrists.

The general outpatient sector can be broken down from the standpoint that some physiatry practices treat mostly acute cases while other physiatry practices treat mostly chronic cases.  The latter physical medicine and rehabilitation practices have experienced censure from the federal government for the use of opiates and some physical medicine specialists have even lost their licenses as a result.  As a result, many physiatrists shy away from treating chronic pain patients.

Outpatient physiatry work can also involve to a greater or lesser extent the care of personal injury and worker’s compensation cases.  As in all of the various areas of care physical medicine and rehabilitation doctors can pursue, the choice of this type of work is one of personal preference with some attention to economics.

Interventional physiatry practice opportunities are greater from the standpoint that there are so many different specialties seeking out their services, e.g., physiatrists, neurosurgeons, orthopods, anesthesiologists.  The compensation and partnership opportunities can vary significantly among these specialties.  One shouldn’t presume that because it is a physical medicine group that the compensation and partnership opportunities are greater.  They are different and unique on a case-by-case basis, and not necessarily particular to the specialty.

A guesstimate is that two-thirds of graduating physiatry residents however go onto spine fellowships thereby reducing the number of physiatrists available for general work.  Some employers require an ACGME-accredited fellowship.

It may be advisable to pursue a spine fellowship to increase your skill set but it may box you in later when you want to pursue other physiatry work such as inpatient.  Inpatient employers want physical medicine and rehabilitation doctors who have done inpatient work within at least the past year.  This interest in due to the many and changing Medicare regulations that inpatient rehab physicians must know.

Another field is regenerative medicine which has a much smaller supply of physiatrists due to its relatively new beginnings and the small number of physical medicine doctors qualified to provide these services.  The opportunities to learn these services are fairly small.  The reimbursement for services by insurance providers may not be recognized and private pay patients may be less able to partake of these services in difficult economic times.

Some physiatrists go into traumatic brain injury, spinal cord injury and pediatric fellowships.  The number of physical medicine and rehabilitation residents going into these specialties seems to be rising in the last 5+ years but not to the extent that it was 20 years ago.  There is a huge demand for these subspecialties.  Starting compensation for these subspecialties is usually higher although not relatively significant.

Other subspecialties are rising such as neuromuscular, palliative, research, etc. but the number of physiatrists in these remain few in number.  It is probable that these fellowships will grow in the number and in the number of graduates.   Again, as in the case of these and other subspecialties, one of many determining factors will be the ability and level for reimbursement of these subspecialties.

Service settings which have grown in the number of physiatrists in the last 15 or so years and continue to grow are subacute, long term acute care and skilled nursing facilities.  There are many large national and regional companies that own these facilities.   There are also many national and regional companies that contract with the facilities and then in turn contract with physical medicine and rehabilitation doctors to provide these services.  Some companies compensate based on a set salary while others are on a pure production basis.

As a result of the demand for physiatry, the compensation is often open to much negotiation.  Most hiring entities set a salary base with an incentive component.  Negotiation would usually focus on the base salary.

The other day a physiatrist commented to us about the future of inpatient rehab.  In his area, he was one of the few doctors of physical medicine and rehabilitation doing inpatient work.  He felt that inpatient rehab jobs in general were diminishing.

The reality is that there are many inpatient physiatry practice opportunities and that companies continue to grow and build more inpatient programs and facilities.  The supply of inpatient rehab doctors is much less than the demand as many physical medicine and rehabilitation residents go onto interventional fellowships.

Occasionally, we’ll hear from an interventional physical medicine doctor who wants to return to an inpatient job which has less overhead, less competition and less decreased reimbursements.

Some physiatry residencies have affiliations with for-profit hospitals, subacute facilities, etc.  This is a great opportunity for the physical medicine and rehabilitation residents to experience life as it will be once they graduate and help direct them in their career choice.  Physiatry residents graduating from such programs are also more desirable to these settings as they have the experience working in such settings and therefore are more inclined to have a longer retention in their positions.

Future prospects for physiatry practice opportunities should continue due to the aging population, the ability of physical medicine and rehabilitation doctors to treat pain and the complications resulting from Covid. According to the 2020 Association of American Medical Colleges Physician Shortage Report “population growth and aging — continue to be the primary driver of increasing demand from 2018 to 2033. During this period, the U.S. population is projected to grow by 10.4% from about 327 million to 361 million. The U.S. population under age 18 is projected to grow by 3.9%, while the population aged 65 and over is projected to grow by 45.1% by 2033. Therefore, demand for physician specialties that predominantly care for older Americans will continue to increase.”

Addressing the demand in physiatry services is the increase in graduating residents.  There has been a twofold increase in physiatry resident graduates in the last ten years.  Although this might seem to address the demand, it seems physiatry continues to be one of the few specialties seeing a shortage of physicians.  According to an article titled Physiatry rising: on engaging the next generation of physiatrists by Charles Odonkor, MD in 2016 “For every 5 people in the US, 1 has a disability and in order to be able to serve and meet this population’s medical needs, more physiatrists are needed. With aging of the population, the rise in chronic disease, chronic pain, neuromuscular and musculoskeletal conditions, post-war traumatic and dysvascular populations, demand for physiatry will continue to increase. ” 

 

 

PHYSIATRY RECRUITMENT QUIZ

How much do you know about the various aspects of physiatry recruitment to include compensation, contracts, practice management?

Take this quiz and find out!

QUESTIONS

Question #1.   Should you hire someone with a personality like yours?

Question #2.   What are the two major reasons doctors leave their employer?

Question #3.   How long does the average practice search take?

Question #4.   Can a restrictive covenant apply to part-time work?

Question #5.   What was the average physiatry compensation in 2019?

Question #6.   When you leave a practice what items might you have to repay?

Question#7.   What are the 3 main factors in determining the value of the practice in a buy-in agreement?

Question #8.  What should you do to resolve insurance denials?

ANSWERS

Answer #1.  No.  Although it would seem that you should because you think you would get along better, studies show that this is not always the case.  And, hiring someone with a personality unlike your personality is good in that they will have a different perspective which will broaden your practice’s abilities.

Answer #2.  Contract loopholes and low compensation are the two major reasons doctors leave their employer.

Answer #3.  The average practice search takes 6 months.  This considers the time to find the physiatrist, interviewing, negotiation, licensing, etc.

Answer #4.  Yes.  Part-time jobs can also be considered for restrictive covenant clauses.

Answer #5.  The average physiatry compensation in 2019 was $306,000.

Answer #6.  Sign-on bonus, recruitment stipends, relocation, student assistance clauses often include requirements that you must repay them if you leave before a certain amount of time.

Answer #7.  The 3 main factors in determining the value of the practice in a buy-in agreement are tangible assets, accounts receivable and good will.

Answer #8.  Phone calling is often necessary to resolve insurance denials.  It can be stressful and time consuming but it often resolves insurance denials.

Promoting Interoperability Hardship Exception Deadline 12-31-2020

As part of MIPS reporting for Performance Year, Eligible Providers are required to report under the “Promoting Interoperability” category (formerly known as Advancing Care which was formerly known as EHR(Electronic Health Records). For most hospital-based rehab providers, whose practice is in a free-standing rehab facility (such as Encompass Health), there is probably no capability of using an EHR system which satisfies CMS’ physician requirements – Encompass Health’s system does not meet physician reporting requirements.

In order to avoid losing 25% of points in the MIPS Scoring system, these providers can submit  a very simple Hardship Exception indicating:

-“Lack of Control over the availability of CEHRT,” or

– “Eligible Clinician in a Small Practice”(under 15 clinicians).

If approved, the application will move the 25% scoring from “Promoting Interoperability” to “Quality,” thus avoiding a loss of 25% scoring in the MIPS program.

Additional information regarding this exception can be found at:

https://qpp.cms.gov/mips/exception-applications#promotingInteroperabilityHardshipException-2020

This article was contributed by Bruno Stillo, CPA, MBA, Physiatry Billing Specialists, 800-835-4482,www.physiatrymedicalbilling.com
[email protected]

Interviewing physiatrists – Ask unusual questions

When interviewing a physiatrist for a new job, it’s easy to ask questions off the cuff or that you’ve stored away over the years for interviews.  However, these questions are the kind that are always asked and that most interviewees have prepared answers to. That’s why you might end up with a physical medicine and rehabilitation doctor who was perfect during the interview but failed at their job.  By asking these unusual questions, not only will you get answers that more truly describe the person but you will also see how they work under pressure as they won’t have prepared answers.

Why this matters

Communication is critical to health care. Doctors must be able to gather and share information successfully to facilitate accurate diagnoses, give therapeutic instructions, and establish caring relationships with patients. This should include an understanding of when and how to break down complex medical terminology and concepts to ensure comprehension.

What to listen for

  • Discussion of regulating patients’ emotions, facilitating comprehension, and managing expectations.
  • Strong candidates will encourage patients to voice their concerns as well as requests for more information.
What steps do you take to prevent medical malpractice?
Why this matters

Malpractice risks surround physicians every day, from alleged diagnostic errors to inadequate follow-up. Without due care and attention, these risks can result in lawsuits and other unwanted consequences. By recognizing risk, physicians can create and implement formal policies and procedures to protect their practices and ensure the highest quality care for their patients.

What to listen for

  • Evidence the candidate takes steps to establish trusting and open relationships with patients.
  • Mentions of consulting with other physicians about treatment or referring to specialists when outside of scope.
Many patients have multiple illnesses that require treatment. How do you avoid prescribing potentially hazardous drug combinations?
Why this matters

Preventing serious drug-drug interactions or drug-disease contraindications is essential to ensuring patient safety. To treat conditions and symptoms in the safest and most effective way possible, doctors must possess a thorough understanding of the various types and doses of medications each patient takes, and how these medications interact with one another.

What to listen for

  • Knowledge of the potential for adverse drug reactions.
  • A clear process for ensuring balanced prescribing, including asking patients about any other medications (prescription or otherwise) that they may be taking.
Describe the last medical emergency you handled.
Why this matters

Doctors may encounter various medical emergencies in general practice. They’re rarely anticipated, and when every second counts, it can be difficult to know the right action to take. Your candidate’s answer will show their ability to quickly analyze patient information, evaluate potential results, and determine the best solution.

What to listen for

  • Candidates should demonstrate an understanding of when to handle emergencies themselves and when to refer patients to a hospital.
  • Strong candidates will speak to the importance of communication with the patient or family members to gain essential information fast.
What is the biggest mistake you’ve made over the course of your medical career? What did you learn from it?

Why this matters

Accountability is critical in healthcare, so it’s important to know that your candidate can own up to and learn from their mistakes. The best doctors are always working to enhance their skills and understanding to improve patient care, so they should recognize what they can do differently next time. But they should also take extreme care to avoid unnecessary mistakes whenever possible.

What to listen for

  • Look for signs that the candidate recognizes the potentially life-threatening consequences of medical mistakes and puts appropriate checks and balances in place to avoid them.
  • Particularly serious or careless errors, or vague answers, may be a red flag.
Why this matters

Doctors must remain current with the state of the healthcare industry to provide the best possible patient care. New developments in medicine are constantly being tested and rolled out, so what a doctor learned in medical school will only take them so far. As such, the desire to constantly deliver the most relevant care is one of the most important qualities to look for in a potential hire.

What to listen for

  • Examples of specific websites, journals, conferences, and professional bodies that the candidate follows.
  • A proven ability to adopt a new process or technology or adapt their approach in response to new findings is a plus.
What qualities do you look for in a physician? Can you provide an example of a physician who embodies any of these ideals?
Why this matters

Doctors should dispense the healthcare they would want to receive, so a candidate’s positive experiences with healthcare professionals will shed light on their deepest beliefs about patient care. It’s likely that the scenarios and physicians they describe will have shaped their own approach to medicine, whether it was a doctor who treated them personally or a mentor they particularly admire.

What to listen for

  • Signs that the candidate aligns with your organization’s mission, values, and approach to patient care.
  • An emphasis on trust, honesty, and listening to patients.
How do you practice empathy and compassion in the workplace?

Why this matters

Doctors have a high-pressure job, but it’s crucial that they approach even the toughest situations with empathy, understanding, and compassion. This allows them to keep patients calm, reassure worried family members, and build strong working relationships with the rest of their medical team. You want a doctor who has a demonstrated history of blending technical skill with an empathetic nature.

What to listen for

  • A clear understanding of the role empathy plays in healthcare environments.
  • It’s okay if they describe themselves as ethicists, meaning they believe it’s important to maintain a professional distance from patients, so long as this aligns with your organization’s culture.
The information above is courtesy of LinkedIn.
There are some unique questions which are being asked my CEO’s at major companies which offhand you wouldn’t think of as professional.  However, these are the questions that might better predict a physiatrist’s on-the-job performance.  Some sample unique questions are:

If you could be another person, who would you be?

Who is your hero?

What makes you uncomfortable?

When are you the happiest?

Tell me about one of your professional relationships.

Tell me about your best boss.

ANOTHER way to tell a person’s character is to ask your front desk person how the individual was.  Often the way a person interacts with your office staff is a good predictor of how they will act with patients.

AND FINALLY, although interviewers tend to look for people with similar personalities to their own remember that the new physiatrist will be interacting with many different personalities within your office and among your physical medicine and rehabilitation patients so being like you won’t necessarily be the best and only great candidate.   In fact, you most likely need someone different from you who can deal with people different than you. 

 

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3 Keys to Physiatry Contract Negotiation

One of the most damaging financial threats to your career as a physician is the possibility of inadequate compensation through complex payment formulas or a contract containing legal pitfalls that undermine future income. Low compensation and contract loopholes are two of the main reasons almost 50% of physicians leave their employers, according to the 2013 Physician Retention Survey by Cejka Search and AMGA.  From physicianthrive.com

I’ve written on this subject before and you can find these articles by using the search feature on my physiatry recruitment website. Here are some brief notes as a review of some key features of the PM&R contract process. First, as the term implies, negotiate! Nothing is written in stone. It doesn’t hurt to try to negotiate. You have everything to gain and nothing to lose.
Second, use a lawyer. The physical medicine and rehabilitation contract terms cover you as you work. But please remember, it also defines the process if and when you should leave. These terms have significant impact to your physiatry professional life and livelihood.
Third but by no means last, identify the responsibilities of the PM&R position. These should be spelled out in the contract. They help determine what you should ask in salary.
Best wishes for a successful negotiation that enables you to secure the best physiatry job on the best terms for you!