What is an ACO?

This video briefly explains an ACO (Accountable Care Organization) in simple terms.

I am old enough to remember what it was like in the good ‘ole days; you know when we could pick up the phone and consult another physician directly in an efficient and effective manner.  We weren’t required to leave a message with the MA (which is insulting, by the way) who may or may not relay the message to the MD.  Oh yeah, that’s right:  in the good ‘ole days, more doctors were in private practice. It was so much easier then…

I take offense at the remark in the video that claims doctors only pick up the phone to talk to other doctors when they get paid for it.  Ouch!

It seems to me that ACO  is a 21st century term for the type of care which primary care physicians are already trained to do.  We are the quarter backs that coordinate care.  We don’t need another level of bureaucracy to tell us how to do our job.  We just need to get back to good ‘ole fashioned values.

What do you think?


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The Healthcare Ruling and the Supreme Court

healthcare ruling and the supreme courtThe healthcare ruling by the Supreme Court is currently a hot debate. In a commentary to NewJerseynewsroom.com, Rohit Arora, co-founder and CEO of www.Biz2Credit.com,writes …”Clearly something has to be done to prevent physicians from going broke while enabling small business to drive. Entrepreneurship is indeed the way to grow the economy.”

Click here for the full article.

I couldn’t agree more! Physicians need to take back control of their professions. This can be accomplished by practicing the high-quality medical care we have been trained to do in private medical practice settings. However, to succeed in private medical practice you need to know how to successfully run your medical practice as a business. This is a skill that can be learned, practiced, and accomplished.

My husband and I have successfully run our medical practice for 20 years. I invite any questions or comments.

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The Foundation of Medical Practice Management: Financial Statements


Practice Management, Financial Statements

The financial health of a medical practice can easily be assessed by analyzing the financial statements.  They are the foundation of your business.  Reading financials is a skill that can be learned and practiced.

Let’s begin:  where do you find financial statements?  If you are using a software program such as QuickBooks, click on the “Reports” tab and then “Company & Financial” then “Profit and Loss”, “Balance Sheet” and “Statement of Cash Flows”.  I am assuming other bookkeeping software programs are similar.

I understand. I’m a science person as well. Memorizing a biochemical pathway is much easier than reading a financial statement.  We were recently reminded of the importance of analyzing these reports on a regular basis.

Our medical practice is a S corporation.

In tax terms, this means our taxes are due March 15.  It’s always interesting how preparing the tax info forces us to deal with the numbers, whether we want to or not.  I will admit, we are not good about keeping up on this as we should.  Let’s face it, it’s not exciting and we can be afraid of what the numbers show.  After all, they don’t lie.   Back to our story: our end of the year numbers did not look good at all.  This forced us to look at our reports, not only the financials but also the reports from our billing service.  We found that our charges were down not because we were seeing less patients but because we down charged our services.  In plain English, we were working harder for less money (again!).  This actually went on for many months.  It was a subtle change that we did not notice but at the end of the year, it adds up.  Ouch!

Learn from us:  successful practice management depends on the regular analysis of financial statements. Continue reading

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Medical Records Management Software – Part 4 of 4

Medical Records Management Software – Part 4 of 4

medical records management softwareHaving discussed when we converted to EHR and the pros and cons of medical records management software, I would like to discuss the “Meaningful Use” regulation for electronic health records.

To break through the barriers to successfully transition to EHR, Congress and the Obama administration authorized the Health Information Technology for Economic and Clinical Health Act (HITECH).  Through HITECH incentive payments totaling up to $27 billion over 10 years, or as much as $44,000 (through Medicare) and $63,750 (through Medicaid) per clinician would be provided to support not only the adoption but also the “meaningful use” of EHRs.  The list of criteria that need to be met in order to qualify for the incentive payments is demanding and inflexible.  We are concerned that despite our best efforts at successfully meeting all the requirements that this all-or-none approach is something that we would be able to achieve.  The amount of money that we would have to pay our staff to input all this data would far outweigh the promised incentive payments.  This program is well intentioned but it will not only cost us more money it will also, more importantly, take away from patient care.  The time we would be using to input the data is time away from patients. Continue reading

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Medical Records Management Software – Part 3 of 4

medical records management softwareHaving discussed the pros of medical records management software, the following is a list of cons of EHR.



  • It is not a matter of “if” the computers go down; it is a matter of “when”.    The computers will go down.  The solution is twofold:
  1. You need a great, dependable IT person.  He exists.  He may take a while to find but when you find him, keep him.  Tip:  you do not need to sign a contract with this person.  We did this initially with the first person we had and he was awful and very expensive.  The person we have now is on an as needed basis and he is awesome.  Another tip:  I do not want to be biased, but the younger people know their computers.
  2. Have a plan in place when the computers are down to be able to continue to see patients.  The staff knows what to do.  When the computers are up again, the data needs to be entered into the system. Continue reading
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Medical Records Management Software – Part 2 of 4

Medical Records Management Software – Part 2 of 4

This section will cover the pros of medical records management software.

medical records management softwareThere is no doubt that patient care is much better and faster.  For example, we had an elderly patient in the office the other day that needed to be evaluated in the ER.  Not only was she a poor historian but she was in no mood to give her history.  On her way to the ER, we faxed her entire medical history and the evaluation in the office with the push of a button.  The ER doc greatly appreciated the info and was able render appropriate care more quickly and easily.

In addition there are no more illegible prescriptions.  The pharmacies love us! The patients’ also love it that their rx is sent to the pharmacy before they even leave the exam room.

We just returned from 3 beautiful days in Carmel, California.  There’s always something special about the ocean and breathing that fresh sea air.  In years past before we had EHR, Continue reading

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Medical Records Management Software

Medical Records Management Software, Part 1 of 4

medical records management softwareWe have successfully converted to EHR but it was not easy and it was a lot of work, initially.  It definitely requires a change in mindset especially for us older physicians who are used to paper charts. We arrived at managing our medical records electronically as an afterthought.

It was 1999.  We were in Orlando at our annual AAFP scientific assembly.  In the exhibit hall, we were admiring the creative booths of the various vendors.  The” WWW “was something that we heard of but weren’t really interested in learning.  Patient care and the newest treatments for the multitude of diseases we treat were our main concern.  There was no time left to learn yet another new venture.  However, the number of booths dedicated to this computer stuff began to catch our attention.  Reluctantly, we added another class to our ever growing list of lectures we wanted to attend.  We adjusted our schedules and forced ourselves to learn this “WWW” thing.  Having realized that this was the future and Continue reading

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Effective Healthcare Reform

On June 16, 2011 Rush Limbaugh spoke about the following:  American Medical Association Reconsiders Obamacare Mandate

Click here to read the transcript.

Rush Limbaugh brings up a good point.  Physicians are leaving private practice by the droves because they hate the administrative aspect of medicine aka the business of medicine. We almost did ourselves on several occasions.  In fact in our own community there are only a handful of Family Physicians left in private practice.  No internal medicine and no pediatric physicians are left.  It is absolutely frightening.

We experienced a time in our practice where we considered leaving private practice also.  We  interviewed at one of the largest health care organizations in our area.  On the way home as we discussed our options and what life would be like, we realized that it felt like residency all over again.  We would be told how many patients to see in a day, when we would see them, how fast we need to see them.  We would be restricted to the formulary of the facility and not have the option of going outside of it.  We would be constricted by the system of the facility with regard to the timely ordering of labs, imaging studies, and referrals to specialists.  We would have to work with the staff that would be assigned to us. Essentially we would be giving up a lot of freedom.  Continue reading

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Practice Management Solutions: 5 Myths about Debt

practice management solutions

When considering practice management solutions, you need to examine your beliefs about debt not only in your medical practice but also in your personal finances.


Debt.  Not a nice word if it means bad debt.

What do I mean by bad debt?    An example is credit card debt.

The secret to keep yourself from living in an endless syndrome of debt is to increase your level of awareness about the behavior that got you there in the first place.

There 5 Myths about debt that you may be acting on.

Myth #1 – Higher income will get you out of debt.

Nothing could be further from the truth. In fact, statistics show that the more money you make, the higher the amount of your debt.  Think more income = bigger, more expensive “toys”.

Myth #2 – Small debt is no Big Deal.

People who think that small debts don’t make a difference usually have large debts. The secret to getting out of debt and staying out of debt is to stop incurring even small debts.

When looking for solutions to practice management, develop good money management habits beginning with small amounts of money. Continue reading

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True Wealth is Knowledge

In 2006 there was an interview Jim Cramer gave to TheStreet.com’s Aaron Task. The Huffington Post had this to say: “In it, the host of Mad Money says he regularly manipulated the market when he ran his hedge fund. He calls it “a fun game, and it’s a lucrative game.” He suggests all hedge fund managers do the same. “No one else in the world would ever admit that, but I could care. I am not going to say it on TV,” he quips in the video.

He also calls Wall Street Journal reporters “bozos” and says behaving illegally is okay because the SEC doesn’t understand it anyway.

Here are some gems:

-On manipulating the market: “A lot of times when I was short at my hedge fund, and I was positioned short, meaning I needed it down, I would create a level of activity before hand that could drive the futures,” Continue reading

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