Online Reputation Management for Doctors
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Online Reputation Management for Doctors
Curated and Written Articles to help Physicians and Other Healthcare Providers manage reputation online. Tips on Social media, SEO, Online Review Managements and Medical Websites
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Physician Online Reputation Management

Physician Online Reputation Management | Online Reputation Management for Doctors |

Physician review sites like Vitals, RateMd and Yelp have become increasingly important in the digital medicine revolution.  Patients are relying more and more on the input of other patients to help them make decisions on a medical specialist.  In most instances, prospective patients are finding a physicians website and then cross referencing their services with review sites to solidify whether or not they should make an appointment.  Ensuring your online reputation is managed properly has become a science in and of itself.

Sadly, review sites have become a Pandora’s Box for disgruntled consumers.  One study showed that dissatisfied consumers are 3 times more likely to leave a review than satisfied customers.  This is likely due to the cathartic feeling many consumers may feel after bashing a product or, in your case, a physician.  After that review has been posted many feel vindicated in knowing they may have permanently damaged your reputation by leaving an indelible smudge on your online reputation.

So, how do you avoid this seemingly inevitable pitfall?  First, let’s review what NEVER to do in regards to reviews.

Directly Responding To A Negative Review

For many physicians seeing a negative review immediately puts them on the defensive and they feel the need to publicly refute these claims.  This is one of the worst mistakes you can make.  Publicly addressing this gives other potential patients the idea that you are petty and self-righteous.  I know it may be hard to sit idly by while a patient misrepresents a series of events or experience with your practice.  However, going on the message board and defending yourself lets patients know you can more about your online reputation than you do your patients.

Inherently, we know your online reputation is important but the potential patient can never know that.  Your results and reviews have to seem organic and not micro managed or orchestrated.

Instead, try and do the research as to what patient left that review.  It may take some looking through your records, but with some digging you can usually narrow it down.  Once you have established who the patient is, reach out to them directly whether it be via phone or email.  Let them know that you saw their review and that you are aware of their disappointment and vigorously apologetic.  Offer to rectify the complaint with another consult at no cost or recommending another specialist for them.  Do not be afraid to be personal and say things like, “As a medical professional my primary concern is my patients.  Seeing reviews like this really makes me evaluate my bedside manner and helps me improve my demeanor for future patients.”

The most important thing to convey is that their grievance has been taken into consideration and will help you in the future.  Many times the patient will supplement their original review and note that you reached out to them personally.  Many others will remove the review altogether.

Patients Can Smell It From A Mile Away

Most physicians believe that a slew of gleaming 5 star reviews is the best way to capture new patients from a review site.  Wrong.  By nature, most people are inherently skeptical and pessimistic.  Many only visit review sites to validate their preconceived notions of a product or service.  Sadly, no one believes in perfection.  If patients see nothing but overwhelmingly positive reviews about you they are going to become suspicious.

This may seem counterintuitive as 5 stars is always better than 4 stars.  However, it is a matter of plausibility.  A 4 star review is often more plausible if the only complaint was something a patient would reasonably expect.

For instance, an effective 4 star review would be:

“Dr. Smith was great.  He explained why I was in so much pain and took the time to go over all of the things I could do at home to relieve my pain.  We also discussed surgery but he wanted to wait and make sure we had gone through all of the conservative treatments first.  My only complaint was that my appointment was at 5:30pm but I was not seen until 5:45pm.  Other than that Dr. Smith was great and I would definitely recommend him.”

You lost a star, but it is negligible because the review was so positive.  The only complaint was a longer wait time than expected.  However, this is nothing new to anyone who has ever been to a physician’s office.  The key here was plausibility.  As a potential patient, I believe this person is real and I believe their assessment of their interaction with you because of the slight imperfection.

Leaving Fake Reviews

Many practices have taken to leaving fabricated reviews that reflect positive reviews of patients that never existed.  Although this may seem like a good idea it is irresponsible in terms of ethics.  I know it seems like an easy way to bolster your reputation but I urge you not to engage in this shameful practice.

Also, many review sites have become savvy to this tactic and have begun tracking ISP’s to determine whether or not these reviews are valid.  If a review site sees an abundance of reviews being left from the same ISP and location it may flag your page.  If prospective patients find out you have been lying about your reviews they are also going to wonder what else you may be lying about.  Your credentials?  Your skills?  Your expertise?

Furthermore, there are legal ramifications for leaving fake reviews:

The FTC has the following guidelines for patient reviews:

  • All reviews must be truthful and not misleading in any way

  • Even paid endorsements are considered to be deceptive if they make false or misleading claims

If the FTC or BBB find that your practice has been posting fake or deceptive reviews online, or that they are being compensated for the activity, you could face a hefty fine.

This is also true for leaving negative reviews on competing physicians review sites.

Many review sites, such as Vitals, will allow you to hide or remove 1-2 reviews that you feel are invalid or fake.  Other sites allow you to contest a review if you can prove that it is not genuine.  It is always best to attempt to hide these reviews first as attempting to deal with the Customer Service teams on these sites is an exercise in futility.  Generally, their response is that they are not responsible for the reviews left on your page as long as the site has deemed them to be credible.  “Credibility” is usually based on a proprietary system that the site uses to crawl reviews.

Another thing to be aware of is that Yelp has a filtering system that posts some reviews and not others, according to a article.

“My wife, a Realtor, had a similar experience: ‘They seem be wary of first-time reviewers. If your first review is negative then they let you post other reviews, but if your first review is positive then they remove it. The same goes if all your reviews are positive.’

She went on: “I called Yelp after a business associate posted a positive review about me which was later removed. They hinted that if I advertised on Yelp this may not have occurred.”

A case can be made that this borders on extortion.

A Practical Solution

With many of my clients I have faced the daunting task of cleaning up their online reputations after years of mismanagement.  In response to this I created a simple process that has worked incredibly well.

I created a card that is slightly bigger than a business card that physicians give to a patient as they are leaving the office.  This card thanks them for coming in, includes the practices phone number and also encourages them to leave a review on one of the physician review sites and includes a short link to each site.

The most important thing about using this system is what I call “The Moment”.  This occurs when the patient is exiting the exam room and you know that they are ecstatic.  It is at this point where you need to break the confines of the doctor patient relationship, look them in the eye, shake their hand and genuinely thank them for coming in.  During this time is when you say to them, “I am truly thrilled that you are so happy.  Here is a card with my number on it.  If you need anything please do not hesitate to call.  Also, if you want to leave a review just take a look at the back of the card.”

The patient is so flattered by your handshake and sincerity that they are now exceedingly likely to leave a positive review  The key is to encourage the right patients to leave reviews.  These are the patients that you know are happy and are willing to go the extra mile for you.  The success rate of these cards is astounding but it is predicated on your ability to captivate them in “The Moment”.

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Are You Avoiding Social Media? Maybe You Shouldn't.

Are You Avoiding Social Media? Maybe You Shouldn't. | Online Reputation Management for Doctors |

I'm not a big social media user. I don't tweet or Instagram or Snapchat — I'm only on Facebook so I can see what my kids are posting. I figure my coworkers hear enough from me while we're inside the office that they don't need to know every single thing I'm doing outside of it.

I meet a lot of physicians who feel the same way, who do everything they can to keep their professional and personal lives separate. But I recently read a study that made me think a bit differently.

According to CareerBuilder, 35 percent of employers are less likely to interview candidates they can't find online. And that's not just IT folks or sales employers. Nearly 50 percent of healthcare employers look at social media to screen candidates.

So what does this mean to physicians who are considering a new job? It's time to get online.

Start by googling yourself

Unfortunately, no matter how hard you try to keep your life off the Internet, chances are good you're still there. Take a second and type your name into Google. You might see a link to your current employer, an old photo from an alumni publication, or the minutes associated with political causes you've donated to. And you will certainly see patient reviews — both good and bad — on websites like

Now put yourself in an employer's shoes. What do these Google results say about you? Do they paint a complete picture of you as a physician? Do they highlight your skills? Your professional accomplishments? Your rapport with patients?

If not, you've got some work to do.

Find the right type of social network

Not all social media networks are created equal. Facebook is great for sharing pictures and stories with those you're close with. Twitter is good if you want to interact with strangers or weigh in on issues in real time. But if you're looking to create a professional profile, I recommend you start with LinkedIn.

LinkedIn is a great place to tell your story. Not only can it house your resume, but it also allows you the freedom to bring your CV to life. You can highlight professional accomplishments, share why you're passionate about medicine, or promote your research. It also allows you to reconnect with former colleagues or friends from medical school who could help you get the inside track on a new position.

Once your profile is complete, potential employers can easily find you online and get a quick snapshot of both your professional experience and who you are as a person. And most importantly — as opposed to online review sites — you control the message.

LinkedIn is not the only option. ZocDoc and Vitals also allow physicians to create a custom profile with photos, credentials, and accomplishments. Because these sites are targeted at consumers, they also include patient ratings.

Be careful of what you share

If you're looking for a new job, or just want to have an impact on what people see when they Google your name, having a social media presence may be a good idea. But once you're online, make sure to think before you post. HIPAA regulations apply on social media, too, so never reveal names of patients you're treating or post photos of things that could identify them; e.g., charts, notes, or X-rays.

It's also smart to keep things positive. A lot of people use social media to vent about their job, boss, or coworkers. Even if these messages never get back to the involved parties, they can be a real turnoff to potential employers.

When in doubt, keep it simple. Maintaining a succinct professional profile on one or two social networks will allow employers to easily find you online and help you present your best self to your next boss.

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What Physicians Should Consider When Managing Their Online Reputation

What Physicians Should Consider When Managing Their Online Reputation | Online Reputation Management for Doctors |

Your online reputation as a physician is valuable; probably even more so than you may realize. But if you do not manage your reputation the right way, it could lead to huge difficulties. The Internet has opened up the door to allowing people to find your practice easily, but by the same token it has made it possible for there to be fraudulent information and negative reviews, all of which can do damage.

It Looks Real

There are several problems with online reviews that will be imperative to act upon for physicians. For starters, it is illegal for you to pay someone to write a favorable review for you. This is a process known as "astroturfing," and is a problem that has plagued the Internet for years. With astroturfing, people (or sometimes the physician themselves) will log on to review websites and will leave glowing reviews, simply because they have received something in exchange (e.g. cash and/or incentives) for those reviews other than good service.

The reviews give great feedback and are typically "over the top," in regard to the product or service. In contrast, there are some people who will get others to purposely write negative reviews of their competitors, when there is a chance they have never been a customer at all.

The Legalities

What many people fail to realize is that astroturfing, fake reviews or reviews done in exchange for something, is illegal. In most cases it may qualify as a violation of the Endorsement and Advertising Guidelines, which are standards set by the Federal Trade Commission. Fake reviews have lead to monetary sanctions being placed against those who have written them.

Physicians need to exercise caution when it comes to managing their online reputation. It is essential to balance review management while remaining legal. While you can suggest to your happy customers to leave a review for your practice, it is best to avoid offering them something, such as a discount, gift, or money, for doing so.

Managing Carefully

It is estimated that good reviews can boost a business’s sales anywhere from 32 percent to 52 percent, according to the Harvard Business Review. So it stands to reason that a business with poor reviews will in turn lose current customers, or prevent new ones. For example, one Washington, D.C., building contractor fought back when he received a negative online review that he believes lead to him losing $300,000 worth of business. The contractor, who sued the person who wrote the review, claimed that it contained information that was not factually correct and it cost him a lot of business.

It is imperative that physicians manage their online reputation. But navigating the waters to get it done successfully, as well as legally, may prove to be challenging for some. This is a reason some people turn to reputation management companies. They know how to manage the online reputation, keep it all legal, and help you gain business as a result.

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Online Patient Engagement Requires Practice Buy-In

Online Patient Engagement Requires Practice Buy-In | Online Reputation Management for Doctors |

Patients are taking a greater role in their healthcare than ever before, and a growing array of electronic tools are available to help physicians engage them, according to Shannon Vogel, director of health information technology at the Texas Medical Association during the Healthcare Information and Management Systems Society (HIMSS) 2015 annual conference.

Nearly 90 percent of U.S. adults use the Internet and nearly three-quarters of them have used the Internet to search for health information, according to 2012 data collected by Pew Research Center. Additionally, 58 percent of U.S. adults own a smartphone and more than half of smartphone owners have used their device to access health information. Vogel summarized the growing tool chest of electronic patient engagement options for practices, including patient portals, personal health records, Health Information Exchanges (HIEs), direct protocol e-mails, and health applications, and their respective advantages.

Vogel explained that the use of all health information technology in practice is still in its infancy, but patient demand and CMS meaningful use incentives are driving rapid growth in the use of these technologies. A survey by the Texas Medical Association found that between 2005 and 2014, the use of EHRs in Texas grew from 25 percent to 69 percent of practices.

Patients often want e-mail reminders, online scheduling, the ability to e-mail their physician, and online access to test results and their records. The most common way practices are working to meet these demands is by creating patient portals, Vogel said.

Patient portals are often part of the practice's electronic medical record, Vogel explained. All portals offer secure messaging between the practice and patient and a summary of the patient's clinical information. They may also include appointment scheduling, bill paying, or customized options.

Portals can help to reduce a practice's administrative costs and streamline workflows. They can also help practices meet meaningful use requirements, such as patient access to their medical records, patient reminders, and secure messaging, Vogel said.

"It's a great way to bring value back to the practice," said Vogel.Shannon VogelShannon Vogel

But one downside of portals is that patients with multiple physicians may wind up with multiple portals. One option that has emerged to help patients keep all their health information in one place is the patient health record (PHR). Patients can upload medical records from their physicians into their PHR and they can also enter information about supplements, data from health apps, and other information into the record. Patients can share access to this record with their physician. But Vogel said use of PHRs so far has been low. She explained that they may not help physicians meet meaningful use requirements, though CMS is looking into ways to help with this drawback.

Some practices are offering secure e-mail messaging only, Vogel said. And in some states, HIEs are beginning to offer some electronic engagement functionality. Additionally, practices may make use of the growing array of health apps that patients can use to track their health data. She noted that physicians might use these tools to ask patients to call or schedule an appointment if the patient's readings are outside of certain parameters.

No matter what electronic tools practices chose, Vogel emphasized that it is important for the physician and practice staff to become very familiar with the tool and familiarize themselves with the patient interface. She also noted that while some patients are eager to reach out online, others may not be comfortable with this or may lack access.

"Many patients are interested, but not all have the desire, time, and access to the tools," she said. "We need to meet them where they are."

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Strategies for Dealing with Value-Based Modifiers

Strategies for Dealing with Value-Based Modifiers | Online Reputation Management for Doctors |

As we know many payers are implementing various approaches to pay-for-performance reimbursement or value-based reimbursement programs. Medicare has announced significant goals in modifying payment models; rolling out value-based payment modifiers (VBPM) this year. Patient care activity in 2015 will impact every Medicare payment in 2017. Physician groups of 100 or more will have payments affected this year, groups of 10 or more in 2016, and all groups in 2017. Medicare will determine the amount of payment incentive or adjustment based on the information noted below. The range is from - 4 percent to + 4 percent of Medicare payments.

Below are some thoughts on how you can respond to VBPMs and optimize the care provided patients and maintain or gain financial viability.

1. Continue to participate in PQRS which is the basis for the Medicare Value-Based Payment Modifier program. Understand how your profile fits within the six domains (check meaningful use): clinical process/effectiveness; patient and family engagement; population/public health; patient safety; care coordination; and efficient use of healthcare resources.

2. Access your practice Quality and Resource Use Report, QRUR, by obtaining an IACS number from CMS. This report was published by CMS last fall and compares your practice to peers on both quality and cost measures. This can be downloaded in both PDF and excel formats. It's complex but worth spending time on to both understand and identify your practice profile.

3. Monitor your entire provider panel in key measures:


a. Preventable hospital admissions:

• Patients with acute episodes of dehydration, UTI, and bacterial pneumonia

• Chronic patients with heart failure, COPD, and diabetes

b. All cause hospital readmissions

Cost — your practice status:

a. All Part A and Part B payments (Part D excluded)

b. For disease categories: COPD, heart failure, coronary artery disease, and diabetes

c. Medicare Spend Per Beneficiary, MSPB, for three days prior to and 30 days post discharge

d. Total Medicare Allowable per applicable CPT code

4. Report monthly on what is occurring.

a. Your practice will not know the Medicare ranking until the end of period.

b. Rankings are determined by the eligible provider (EP) who has a "plurality" of primary-care codes assigned and the Medicare allowable charge amount assigned. Primary-care providers will be considered first, but any specialist may qualify.

c. A minimum of 20 episodes per measure (see quality above) hence the need to monitor your practice. If insufficient numbers are there, you may not see either the incentive or adjustment.

5. Regular review and reporting will help lead the practice toward a more "quality" impact and focus. When all staff, not just providers, work together, the cumbersome nature of reporting will become easier and part of everyday practice life — since in many cases the impact is not significant this year. It will however become more impactful in the years to come, as not only VBPM programs come into play, but overall payment model reforms are implemented. There will be an eventual culture change!

Long term outcomes for practices should be improved patient care, compliance with the new paradigm, and an improved financial picture. How you approach it now may determine the long-term success and viability of your practice in the future.

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Marketing Your Practice Online

Marketing Your Practice Online | Online Reputation Management for Doctors |

In previous years the conversation around marketing your medical practice centered on "Should I market my practice?" and "How much should I spend on marketing my practice?" Which then evolved into "Should I be online?" and "Is Facebook or social media really necessary to market my practice?"

Not anymore.

The conversation is now "How much time and money should I invest in online marketing?" It is now accepted that online marketing is not just an option for practices any longer; it is something they must do to attract new patients and stay competitive.

Determining cost

When determining a budget for your online marketing, it is best to start with the end in mind. Begin by looking at what your goals are for your online marketing program. I think it's best to frame them within short-term and long-term scenarios.

Here are some examples to get your creative wheels turning:

In 90 days, I would like to see an established and engaged audience of X number of people.

In 120 days, I would like to see my audience at X number, and receive X new patients per month from online efforts.

Once you have your goals set, you can determine the cost to achieve them. There are a number of factors to consider when determining the cost:

• Where does your ideal patient hang out?

Hint: Almost all practices should start with a website and Facebook.

• Who is managing the online effort — in-house vs. an outside firm?

There are many different levels of service available; from assistance with in-house efforts to complete outside management.

• What is the cost to reach your ideal patients?

Do you want to reach the 22-year-old diabetic patient in Boise, Idaho? You can, and often times for pennies. If you want to make your message more specific, it may cost a little more or less depending on the characteristics you seek.

• How will you stay in touch?

All of these variables, and many more, factor into what kind of investment you will need to make to reach the patients you want to see.

Compare these figures to what a single patient is worth to your practice to calculate how much time and money you should invest in online marketing efforts.

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Physician Beware: Ruling Expands Reach of Anti-Kickback

Physician Beware: Ruling Expands Reach of Anti-Kickback | Online Reputation Management for Doctors |

I lecture clients regularly on compliance with the Anti-Kickback Statute (AKS), a criminal federal statute that generally prohibits the giving or solicitation of “kickbacks” for referring federal patients to a particular healthcare provider. 

Unlike most statutes and their related case law, which typically allow healthcare attorneys to provide clients with fairly clear guidance, case development around the AKS has created much uncertainty, even for experienced counsel.

In yet another decision that adds complexity to advising clients on the AKS, a recent decision in the 7th Circuit (United States v Patel) has expanded the reach of the AKS even further.  In this case, the court examined the definition of a “referral” under the AKS and determined that an illegal referral can exist even where a physician plays no role in determining the healthcare provider from which a patient may obtain services.

In this case, a Chicago physician, Dr. Patel, routinely saw patients who required home healthcare services.  In order for a federal patient to receive home healthcare services, a physician must complete Form 485, which certifies not only that home care is medically necessary but it also outlines the diagnosis and treatment plan, among other details.  Although Dr. Patel’s patients apparently went to many different agencies, one agency (Grand) had an arrangement to pay Dr. Patel $400 for each signed Form 485 when the patient chose such agency, and an additional $300 if the patient was recertified for care beyond 60 days.

The interesting part of the Patel case is that although Dr. Patel decided when and if patients required home healthcare (and in fact nobody questioned that the patients were properly certified for such care), Dr. Patel played no role in steering  patients toward any particular home health agency.  In fact, patients were presented by a practice nurse with a wide variety of home health agency brochures from which to choose (and most chose an agency other than Grand). 

Still, the government found that the arrangement between Patel and Grand violated the AKS.

Most healthcare lawyers would likely not have approved the arrangement between Grand and Patel in the first instance.  After all, why was Grand paying Patel for a form he needed to complete for his patients?  Did it hope he would steer patients to Grand even if Patel apparently took no action to do so?  Did Patel not wonder why other agencies made no such payments? 

The AKS is an intent-based statute and case law in the area has always made it clear that if even one purpose of the remuneration is to induce the referral of a federal patient to obtain items or services from a particular provider, then the statute is implicated.  Under this scenario, I would have warned my clients that such payments were potential kickbacks.

In the Patel case, the court’s interpretation was different than expected.  Rejecting Dr. Patel’s argument that a “referral” cannot occur without a recommendation of a healthcare provider (and in this case, no “recommendation” was made), the court agreed with the government’s argument that a doctor’s authorization of care can be a “referral” within the meaning of the statute.

Accordingly, the court held that Patel determining that his patients could go to Grand put Dr. Patel in the role of “gatekeeper” to federally-reimbursed care.  Consequently, the court found that even if no specific recommendation was made, Dr. Patel did take some action to allow his patients to go to Grand, and was paid in return.

What does this decision mean for physicians and counsel setting up arrangements in the future? Payments from healthcare providers in any way, shape, or form must be considered suspect and fully examined. 

Although the same analysis and concerns regarding the AKS continue to apply, providers are advised to assume the broadest interpretation of the AKS that could apply to any arrangement, to closely review the direct and indirect flow of funds between all healthcare providers, and to keep an eye out for potential “gatekeeper” roles that a provider may play.

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Lawsuit Highlights Dangers of Physician Self-Referral

Lawsuit Highlights Dangers of Physician Self-Referral | Online Reputation Management for Doctors |

North Cypress Hospital (Houston, Texas) and its CEO Dr. Robert Behar are named in a lawsuit filed by Aetna. The allegations include fraudulent billing schemes, as well as violations of Texas Insurance Code and Racketeer Influenced and Corrupt Organizations Act (RICO). Fraudulent billings schemes often implicate both the Federal and Texas anti-kickback statutes, which may include criminal penalties.

In general, this case is about a 139-bed hospital located north of Houston's downtown, with reported annual gross revenues exceeding $1.5 billion per year. While some may say, "Wow, how can we achieve those earnings," others may ask, "Why are there revenues more than twice that of similarly situated hospitals that have more patients and a different case mix index?" The latter question is also the one Aetna's complaint alleges.

One area that should be of particular interest to physicians in this case is the fact that there are physician ownership interests in North Cypress Hospital. Moreover, Dr. Behar allegedly utilized a process to track both the volume and value of the referring physicians. While this practice may not be uncommon, what is uncommon is for ownership interests to increase or decrease based upon referrals. As set forth in the complaint, "Absent this, patients would not knowingly be treated at North Cypress and agree to pay much higher out-of-pocket amounts required under the terms of their plan, when they could get the same services at a fraction of the cost at hospitals in Aetna's network within close proximity of North Cypress."

North Cypress, in a press statement, indicated that "North Cypress has established that Aetna's upper management has engineered a scheme to sue out-of-network providers throughout the nation to coerce them into financially burdensome in-network contracts with Aetna, by filing suits alleging baseless violations of law which do not apply in commercial contexts, to release damaging press statements, and to 'bring down' any provider who dares oppose it."

For physicians, there are many takeaways:

• Do you know how you are ranked among your peers in terms of volume of procedures at any given place?

• Do you know how the hospital that you refer to and have privileges at ranks in terms of its PEPPER Report?

• Do you know if your ownership interest in any entity that you refer to meets the guidelines of the safe-harbors for the 40/60 Rule (referring physicians cannot comprise more than 40 percent of the ownership and cannot generate more than 40 percent of the total revenues)?

• Do you know if the state that you practice in has more stringent anti-kickback provisions than the Federal statute? For example, under Texas law, transactions that do not involve government dollars (i.e., Medicare or Medicaid) are covered under the State's statute.

• Do you have a compliance program in place and are you familiar with the 60-day Rule for self-reporting?

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Making Your Practice a 'Best' Place to Work

Making Your Practice a 'Best' Place to Work | Online Reputation Management for Doctors |

Every office has something the employees get excited about, whether it’s the summer picnic, bring-your-child-to-work day, or Taco Tuesday. At my office, we’ve never met a party that we didn’t like.

We celebrate birthdays and holidays and promotions and each of the goals we achieve. But no celebration is more meaningful than Fortune day.

Last week, our parent company CHG Healthcare Services was ranked 16 on Fortune magazine’s “100 Best Companies to Work For” list (and here’s how we celebrated).

One reason our company stands out as a great place to work is that fostering a healthy workplace culture is a top priority for us.

Here's why workplace "culture" is so important, and how you can cultivate a great workplace culture at your practice.

Culture Sets You Apart From Your Competition

After the dark days of the Great Recession, the economy has bounced back. In many industries, and especially in healthcare, people have gone from worrying about just hanging onto their job, to having the freedom to be picky about where they choose to work.

In a job seeker’s market, it’s important to ask yourself some tough questions. Why would a physician or staff member choose to work with your practice?  What makes you stand out from the competition? What are you doing to keep your current team engaged?

If you’re doing things right, the answer to each of these questions will be the same: We have, and cultivate, a strong company culture.

Cultivating a Great Culture

Making your practice a place where people want to work isn’t easy. It takes consistent and concerted efforts. Here are some of the things that can help.

1. Hire for cultural fit and train for skills. When it comes to hiring staff, strong skills and an impressive background are nice. But if you really want to hire the right candidate, focus on who they are as a person. Will they fit in with the team? Do they care about the mission of the practice? Will the job help them reach their long-term goals?

Remember, job candidates who are engaged not only make better employees, but they’re much more likely to stick around.

2. Give your team a voice. People want to work for someone they can trust. One of the keys to building trust is to ask for regular feedback from your team, whether it’s through formal channels like surveys or through more informal meetings.

But gathering feedback is just the first step. You also need to be willing to implement some of those ideas and be transparent about decisions affecting the practice.

3. Take care of each other. One of the best parts of working in healthcare is the opportunity to make a difference in the lives of those you serve. But that service doesn’t have to be constrained to the walls of the practice. Encourage your employees to give back to the greater community by offering them paid time off when they volunteer.

Creating a strong culture won’t happen overnight, but it will happen. As we’ve implemented these practices at our office, we’ve seen retention improve and engagement increase. Not surprisingly, our success in building culture has resulted in success in building our business.

And that’s something worth celebrating.

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How to Improve Patient Engagement in the Provider Community

How to Improve Patient Engagement in the Provider Community | Online Reputation Management for Doctors |

Patient engagement strategies have been heavily discussed in the media and among the vendor community, but digital participation on both the provider and patient side has been meek at best.

The latest report from Chilmark Research on the patient engagement market shows that the healthcare sector is still participating very minimally in digital communication with patients post-discharge or between visits.

In an interview with, report author Naveen Rao from Chilmark Research spoke about the potential of patient engagement for bringing broader models of care to the industry. More outreach is especially helpful for patients with chronic conditions or severe illnesses.

“We wanted to find out — what are people actually using today. Not what’s actually being sold but what’s being bought. We wanted to find out from the provider’s perspective, what are the limitations of the tools that are being purchased,” Rao revealed.

“Usually, there’s a feature or two that are dedicated to engagement,” he continued. “So we wanted to look at those features and see whether they are actually working. Are they cutting edge? Are they not?”

Specifically, Rao mentioned the benefits of mobile technology in the healthcare market. While some vendors have mobile-compatible apps, there is very limited device integration in healthcare. The provider side is not much better, as few physicians are utilizing mobile health technology to improve patient engagement. However, mobile health apps could improve administrative aspects of care such as faster scheduling as well as managing post-discharge care.

“If you look at the state of affairs when it comes to mobile tools for the patient in the year 2015, it’s pretty disappointing, particularly on the provider side,” Rao stated. “Providers don’t acknowledge that there’s this really great tool that every one of their patients is leaving the office with. They can and ought to be leveraging [it] a little bit more effectively.”

The most common tool in patient engagement is the patient portal. Some aspects that Rao encourages health IT vendors to include in the patient portal are mobile health tools and the longitudinal patient health record that is connected to their EHR. Additionally, health information exchange (HIE) capabilities that can pull in data from other hospitals across the country would benefit the patient portal greatly.

Patient-generated information and biometric data like blood pressure and diabetes management analytics could also be incorporated into patient portals and EHRs. However, vendors will need to move more quickly to incorporate some of these tools into the patient portal.

“We have the technology to send information and collect it from point A to point B,” Rao mentioned. “It’s not happening. There’s no way to put it [biometric data] into your record. Five or ten years from now, things are going to become more digital. The vendors out there aren’t really with the program.”

The Chilmark Research report focused on how the average providers are lacking effective patient engagement strategies. For providers who haven’t begun incorporating patient portals, Rao said the first step to take is to improve patient-doctor communication. Physicians should speak with their patients to find out their preferred method of contact.

After an appointment, doctors should follow-up with their patients via secure messaging/email, text, or phone call in order to enhance communication. After “mastering these basics,” providers should implement patient portals to improve patient satisfaction.

“There is a lot of capability possible through just a basic patient portal. That’s not exactly the most advanced tool that we have today, but it’s a great starting point,” Rao said. “Providers have the ability with their patient portals to send secure emails. But are they actually doing it?”

“Are you actually sending messages to patients between visits? If someone comes in with lower back pain, you send them home with a pill and you never follow up… when it comes to advanced models of care, we can use email to do a lot. If the doctor isn’t doing simple things like sending a follow-up, then what’s the point of having this technology in the first place?”

Providers will need to put greater emphasis on patient-doctor communication and follow-up contact in order to improve the quality of healthcare services. Naveen Rao also spoke about the type of health IT tools providers can utilize when gathering population health statistics. These include data management, data analytics, and stratification tools as well as information exchange and registry capabilities. Digital and mobile health applications can also play a lesser role in population health management.

Rao mentioned that telehealth and mobile technology will have a “big impact” on the healthcare industry in the coming years. He sees it become adopted more broadly in the next three to five years. The most important aspect, though, is to ensure multiple physicians can access the same patient records in real time. Telehealth services will have a strong, transformative influence on rural healthcare as well as patients with weather and geographic limitations.

As a greater shift toward population health management and patient engagement takes place, the healthcare industry will see providers rely more on multiple IT vendors. This is likely because a single vendor rarely is able to offer every single aspect of medical technology. This offers physician practices positive opportunities such as reducing the issues associated with limited EHR systems. However, with all benefits, come some disadvantages like more staff training, higher workload, the costs associated with new systems, and the overall responsibility of working with multiple vendors.

Physicians who are looking to increase patient engagement should consider the following strategic steps. First, find out a patient’s preferred method of contact. Next, partake in the patient activation measure, which essentially means work toward improving patient interest in their medical care and treatment protocols.

Doctors can also improve patient satisfaction by checking in and following up after an appointment. The last step to incorporate is patient-reported outcomes by recording data after receiving secure messages. Physicians looking to improve communication with their patients should consider implementing this patient engagement strategy.

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Why You Should Have a Dress-Code Policy in Your Medical Practice

Why You Should Have a Dress-Code Policy in Your Medical Practice | Online Reputation Management for Doctors |

During a meeting this week, I decided it was time to touch on the practice's dress-code policy. This policy should be reviewed about once a year. I had heard from some of the front-office staff members that patients were making potentially inappropriate comments about their clothing, such as, "That shirt looks really nice on you," and "You have great legs, you must work out."

Although these comments may seem harmless to some, they can be the cause for all sorts of disasters (for both staff members and the practice) — especially if management had been approached. It is your responsibility to protect your employees from patients who choose to verbalize thoughts that should be kept to themselves. Having a solid dress-code policy in place is your first line of defense.

If you are not sure where to start, or what to include in your dress-code policy, here are some ideas:

• Employees are expected to dress in an appropriate, professional manner that portrays an image of confidence and security for patients. Cleanliness and neatness are absolutely necessary at all times. Distracting themes in appearance or dress, low-cut clothing, exposed midriff, evening wear, or sheer clothing are unacceptable.

• Clinical staff will wear collared shirts or scrubs, non-denim slacks, and closed-toed, non-sneaker shoes. A nametag will be worn if the name is not embroidered on the company shirt/scrubs.

• Front-office staff should dress in "business casual." They are required to wear nametags or company shirts. As stated above, distracting items in appearance or dress, low-cut clothing, exposed midriff, evening wear, T-shirts, or sheer clothing are unacceptable. Business-like open-toed shoes may be worn, not to include flip-flops or beach sandals.

• (Your practice name) and its directors reserve the right to ask employees who are not dressed in what is deemed a clean and professional manner to change their attire. Failure to comply with the policy will result in being sent home without pay. Further infraction will result in written disciplinary action as decided by the directors.

• Appearance and perception play a key role in patient service. The goal is to be dressed professionally; any employee with body art must ensure that it is covered at all times.

There is a time and place to express staff members' personality, and the workplace should not be that location. If employees follow these types of guidelines and patients still make inappropriate comments, take the offending patient aside, privately, and share your concerns about inappropriate conversation.

It's also important to note that if nine out of 10 employees follow the dress-code policy, and you have one outlier, taking that employee aside and reviewing your policy in a private conversation is much more appropriate than including the entire staff.

The dress-code policy is in place not only to protect your staff, but also to protect your practice. Comments made by patients can be construed by staff as sexual harassment, and contribute to a "threatening work environment." It is up to you to make sure these types of scenarios never happen. In the event they do, have a solid dress-code policy to land back on.

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'Mix and Match' Documentation for Higher Reimbursement

'Mix and Match' Documentation for Higher Reimbursement | Online Reputation Management for Doctors |

Recent changes in how CMS permits you to select evaluation and management (E/M) service levels are a benefit to providers who manage patients with multiple chronic conditions.

E/M services may be provided at various levels of intensity, with more intensive services garnering higher reimbursement. E/M service levels (and the codes that describe them) are assigned according the elements of patient history, exam, and medical decision-making (MDM) documented in the provider’s encounter notes.

CMS allows you to choose between two sets of guidelines when translating provider documentation into E/M codes: The 1995 Documentation Guidelines for Evaluation and Management Services and the 1997 Documentation Guidelines for Evaluation and Management Services. The guidelines differ in how they define the history and exam portions of an E/M service (the guidelines are identical regarding MDM).

The ‘95 guidelines define the exam component such that specialist providers found it difficult to report higher-level E/M codes, even when services warranted doing so. The ‘97 guidelines addressed this issue by providing bullet points for single organ system examinations, thereby allowing specialists to report higher level services for intensive, problem-specific exams. The ‘97 exam requirements tend not to work as well for general practitioners, however.

The ‘97 guidelines also differ in the history component, and allow “the status of three or more chronic conditions” to qualify as an “extended” history of present illness (HPI). Under the ‘95 guidelines, providers must document four or more HPI “elements” (location, quality, severity, duration, timing, context, modifying factors, and associated signs and symptoms) to attain an extended HPI.

Each set of guidelines has its advantages and disadvantages. For many providers, the ideal guideline would combine the ‘95 exam requirements (which are more subjective, as compared to the ‘97 exam requirements) with the ‘97 history element (which are more flexible than the ‘95 guidelines when defining the history of present illness). For many years, such “mixing and matching” of the guidelines has not been allowed.

Effective since Sept. 10, 2013, CMS has revised its E/M Documentation Guidelines to allow an extended HPI, as defined by the ‘97 guidelines, with the other elements of the ‘95 guidelines. As a result, “the status of three or more chronic conditions” qualifies as an extended HPI for either the ‘97 or ‘95 guidelines. 

CMS announced the change as a “Question and Answer” on its website.

Q. Can a provider use both the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services to document their choice of evaluation and management HCPCS code?
A. For billing Medicare, a provider may choose either version of the documentation guidelines, not a combination of the two, to document a patient encounter. However, beginning for services performed on or after September 10, 2013 physicians may use the 1997 documentation guidelines for an extended history of present illness along with other elements from the 1995 guidelines to document an evaluation and management service.

CMS has also updated its Evaluation and Management Services Guide to reflect the new policy.

Ask your coding staff if they are aware of this change, and if they are measuring E/M services against the revised guidelines. Those physicians who manage patients with multiple chronic conditions, especially, may find that the new rules allow their coding and billing to better reflect the documented level of service provided, thereby legitimately boosting E/M levels and reimbursement levels. If providers are already documenting their services well, they won’t have to change their process to realize an advantage from these revised E/M guidelines.

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3 Things Doctors Can Do to Connect With Patients

3 Things Doctors Can Do to Connect With Patients | Online Reputation Management for Doctors |

Patients have been coming into my office for several years telling me that they looked me up on the Internet and that I have great reviews. I always dismissed these comments, as I knew that these reviews were influenced by many factors and not necessarily accurate. Plus, the reviews were favorable so I gave it little thought. Eventually, I took the opportunity to Google myself and was amused by much of what I read. Patients often made strong statements about me without much evidence. Again, it was largely complimentary so I let things be.

Over time, it dawned on me that virtually every patient was looking me up. I went back to the Internet and tried to picture what I would think if I were a patient looking me up. I realized I was passively being defined, as opposed to actively defining my own image -- and the method of others defining me was often incomplete and arbitrary.

I decided to launch my own website so I could define my online image. I wanted to project what I believe in, and how I practice medicine so that patients who research me can more accurately see if my philosophy truly resonates with theirs.

Of course, it's not so easy. Just putting something out there doesn't assure that it will be what patients find when they search. More importantly, it got me thinking about the doctor/patient relationship. It is clear that patients want to connect with their doctors. Doctors, however, seem more ambivalent about making such a connection. To some doctors, it is as if forming a connection will somehow undermine the traditional relationship which is best kept as formal, paternalistic, and standoffish. We are running our practices the same way they were run 30 years ago. This is a terrible mistake.

I believe I can gain more by giving, learn more by listening, and influence more by connecting.

1. Doctors should focus on connecting with patients.
The world has changed. Most other businesses have changed. Every physician should have his or her own website which patients can easily access. If the physician boldly puts his or her personality and philosophy out there for scrutiny, there will be some who like what they see and some who don't, but the patients who make appointments and ultimately come in to the office will have more productive experiences.

2. Doctors should provide content.
Consumers want content when they do research. Consumers of health care are no different. The best way to advertise is not to yell about how great you are, but simply, to teach. Patients are attracted to content, and particularly, to how the content is presented. You don't have to tell consumers of your value, when you can provide them with content of value.

3. Doctors should embrace social media.
Most doctors pride themselves in getting patients from word-of-mouth. This has always been considered the most desirable method of growing a practice. But word-of-mouth is not as useful as it has been traditionally considered.

Think about researching a restaurant. What is more likely to draw you to a particular restaurant: hearing from several arbitrary people that it is great or not only hearing from these several arbitrary people, but hearing from some specific people who have a track record of making good suggestions about restaurants and also having access to the menu, the restaurant's philosophy on cleanliness and the rigor with which food is selected and procured?

Social media is more than simple word-of-mouth. It enables patients to access meaningful opinions, and then make informed decisions about doctors' practices. Social media gives physicians the opportunity to help empower patients. If a doctor does not embrace this burgeoning technology, his or her prospective patients will end up elsewhere.

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5 Tips for Improving Your LinkedIn Profile - CompHealth

5 Tips for Improving Your LinkedIn Profile - CompHealth | Online Reputation Management for Doctors |

Do you use LinkedIn to connect with colleagues? This social network is a great way to display your work experience, showcase your unique skills and find a new position at a hospital or other healthcare facility. Whether you’re looking for a new job or just want to make your work history more appealing, these five tips can help you improve your LinkedIn profile:

  1. Include a professional headshot with your profile. The first thing people will notice is your photo, so make sure it’s high-quality and reflects the industry in which you work. While it’s not necessary to have a studio-quality photo, your profile picture should have a simple, monochromatic background and be cropped from your shoulders up. Business attire such as a blazer, collared shirt and tie is recommended, but a photo taken in your lab coat is also appropriate.
  2. Use the headline section to list your current position or promote the job you’re looking for. By default, LinkedIn will fill this section with your current job. However, you can customize it by clicking the Edit button at the top of your profile. If you’re in the market for a new position, include a description with specific keywords employers are looking for. For example, you could write “Family practice doctor with 20 years of clinical experience” so that your profile would show up in both LinkedIn and Google search results.
  3. Write your descriptions in clear, conversational language. Though your colleagues may be familiar with technical terms and medical acronyms, a hiring manager at a hospital or clinic may find these confusing. Spell out even the most common abbreviations, like PA or NP, on first reference and list all relevant experience in the summary section of your profile. Be sure to write in the first person at all times to keep your descriptions friendly and easy to read.
  4. Be sure to include contact information on your profile. Prospective employers and other friends can get in touch with you through InMail (LinkedIn’s email system), but the contact information section on your profile is a great place to list an email address, relevant blog link or even a cell phone number if you’d like to be contacted. Remember that everything you post in this section is public, so keep your contacts (and prospective contacts) in mind as you update it.
  5. Set a customized profile URL you can share easily. If you haven’t already done so, edit your profile URL so it includes your name instead of letters or numbers. Doing this makes your profile more professional and also allows you to add the link to your signature line or blog so others can connect with you on LinkedIn.

These simple tips can help your profile stand out to both colleagues and employers — and they can also help you gain more confidence in promoting the unique talents you bring to the healthcare industry.

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Google+ for Physicians: A Free Tool for Reputation Management

Google+ for Physicians: A Free Tool for Reputation Management | Online Reputation Management for Doctors |

With the expansion of rich information found on social media and review websites, the modern patient is empowered like never before. Researching physicians is as simple as browsing for a car or laptop: search engines and rating websites provide current or former patients a platform for sharing their experiences. Reputation management is a global process that begins and ends with networking sites like Google+. Social media is changing the healthcare game into something much more interactive. That is an exciting concept for professionals looking to amp up their referral systems.

Doctor review websites

Why Online Reputation Matters in Healthcare
People are increasingly referring to mobile devices to perform research online. A study by the Pew Research Center suggests that one in five people who use the internet to find a doctor rely on physician ratings.

The flip side of an internet presence is the potential for damaging feedback – that is the basis of reputation management. Any brand or physician should habitually search its name on Google to look for negative reviews or comments. In the medical world, this is how doctors keep up on what their patients are saying about them and what future patients see.

How does Social Media Fit into Healthcare?

A social media page on Google+ adds a way for doctors to better connect with the public. It’s an upbeat way to manage professional reputation and improve patient care. Patients see the bond with their physician as a very personal one. They appreciate the opportunity to vocalize their satisfaction or frustration with a specific physician or experience. Social media creates an e-patient scenario that allows the physician to promote healthy living, generate trust, and market the healthcare brand. For a doctor, time is in short supply, but fostering a positive reputation online allows you to stay ahead of the curve.

Building a Social Media Voice

The process of developing a “voice” will differ among physicians and service lines. A doctor with a full practice might spend only one hour a week on Google managing his online reputation, while a new cosmetic surgeon will need to commit much more time to creating a brand. Other doctors use their online voice to educate and promote wellness as a way to further their patient’s quality of care. Most businesses, medical or otherwise, realize the power of a professional website. Social media is just another tool to amplify that voice.

Doctor on twitter

What about Referrals?

Engaging with one person through social media translates into interaction with friends and family at the same time. Social media takes word of mouth to the next level. Consider some practical tips for using social media healthcare to enhance referrals:

Research your options – This is critical factor. Many healthcare facilities and organizations have specific rules and guidelines about social media. Take the time to investigate social media polices that affect your strategy to build an online presence.

Privacy is key in social media – Patient privacy is paramount, but it is easy to lose sight of that fact when interacting with a computer screen. Keep in mind the number of eyes that see posts on a social media page. This includes other patients and family members in addition to healthcare administrators, government bodies and content journalists.
Disclaimer, disclaimer, disclaimer – Include an upfront disclaimer on all social media healthcare pages and posts. If communicating with patients through social media, such as during an hour-long Q&A on Twitter, point out that you are not providing a medical diagnosis or treatment.

Seek expert advice – Companies that specialize in reputation management are popping up every day. Find a firm that creates strategies to develop a social media voice. They can handle some of the preliminary legwork and ease you into the process.

Don’t mix business with pleasure – Keep separate social media accounts for your personal communication. If you use Facebook or Twitter to stay in touch with friends and family, don’t use them to foster a professional online reputation. This is as much a safety concern as business advice.


There is a new generation of patients out there, and they are more than just internet-savvy – they are internet-reliant. Doctors need to understand that reputation management and generating referrals online are now a concrete component of digital marketing. The internet, and specifically social media, is part of the modern medical practice.

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Six Ways to Improve Patient Satisfaction Scores

Six Ways to Improve Patient Satisfaction Scores | Online Reputation Management for Doctors |

Large physician practices and hospitals already have a portion of their payments linked to patient satisfaction. Over the next few years, it will be an integral portion of physician payment, including penalties possibly dwarfing those under meaningful use. More about this program, known as the Clinician & Group Consumer Assessment of Health Providers and Systems (CG-CAHPS) can be found on the Agency for Healthcare Research and Quality's website.

Here's the government's hypothesis in a nutshell:

• Patients who like their doctors are more likely to be compliant patients;

• Compliant patients are healthier patients;

• Healthier patients are less expensive; so

• Physicians with satisfied patients should be paid more than physicians with dissatisfied patients.

The Affordable Care Act introduced a different set of quality metrics than used by the Institute of Medicine (IOM): quality, patient satisfaction, and payment. Quality is a key element with both programs, but there's an important difference with the reform law: your patients are the arbiters of quality. Quality more or less equals patient satisfaction.

What's being measured?

CG-CAHPS measures the patient experience, an expansive proxy for quality that takes into account the following:

• Timely appointments

• Timely care (refills, callbacks, etc.)

• Your communication skills

• What your patient thinks about you

• What your patient thinks about your staff

• Your office running on schedule

I have been in enough medical practices — both as a patient and as an administrator — to know there's a method to this madness. It's less about the care and more about the caring. Here's what I suggest for improving your quality measures via these proxies.

1. Hire sunshine.

I can train anyone* to do anything in our office, but I can't train sunshine.  Look to hire positive and happy people, particularly for roles with lots of patient interaction. Your patient satisfaction — and thus, your "quality" — will improve. You'll also find a cost-saving benefit to this hiring tactic: employee turnover will shrink.

2. Start on time.

CG-CAHPS asks patients whether they were seen within 15 minutes of their appointment times; it's even underlined for emphasis. Physicians who start on time are more likely to run on time, so have your feet set before you start running.

3. Set patient expectations.

It's helpful to share with patients the FAQs about your practice so that they know what to do for refills, after-hour needs, appointment scheduling, etc. By making these answers available on your website, on your patient portal, and in your print materials, you'll better align patient expectations with patient experiences and thereby score better on quality surveys.

Some patients gauge quality by whether or not they get the antibiotic they think they need. It's helpful for primary-care physicians to include education on antibiotic overuse in their patient education materials.

Along these lines, it is important for your patient to know what to expect after their visit in terms of test results, follow-up visits, etc. I receive more complaints about the back end of our patients' experiences than anything else. Make sure you and your staff do not drop the ball as you near the goal line.

4. Listen with your eyes.

Nothing says "I don't care" like having your physician focus on a computer screen rather than on the patient. This is particularly true in the first couple of minutes of each visit, and especially important with new patients. One virtue of using medical scribes is that you can listen with your eyes a whole lot more.

5. Put your staff in their place.

Your staff has an important bearing on the patient experience. I'm a big fan of letting them know their actions influence quality. It's pretty cool, for me as a mere bureaucrat, to know that I can improve quality simply by being friendly and helpful to our patients. Make sure your staff knows that making a patient's day is a beautiful act.

6. Monkey see, monkey do.

Staff will follow your lead. If your thoughts and actions emphasize running on schedule, being kind to patients and their families, and not dropping balls, they'll be stronger teammates for you.

Patient satisfaction has always been a gauge of quality, just as patient referrals remain the lifeblood of most practices. Treat this next wave as an opportunity to show off the caring that has always been a big part of the medical care you offer your patients.

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This surgeon embraces social media. Here's why she converted.

This surgeon embraces social media. Here's why she converted. | Online Reputation Management for Doctors |

I am converted. Like many doctors, I was very leary of social media, wary about using it, skeptical of its professional value. Especially Twitter, but really all of the platforms. No longer: I have embraced social media, and it has embraced me.

I feel a little bit like Dr. Strangelove, only the subtitle is now “How I Learned To  Stop Worrying and Love Social Media.”

Like most converts, I find myself an enthusiastic proselyte, spreading the good word to friends and colleagues, regaling them with my new-found experiences using Twitter, Facebook, LinkedIn and the like. Discovering more sites and platforms, like Sermo, Doximity, Docphin, and Medstro, to name a few. (Disclosure: I have no financial or other arrangement with any of these, but have written for both Sermo and Medstro, and am a discussion panelist later this month on Medstro.) The list goes on and on, and keeps growing. Websites and apps abound; they all go mobile, so much content to explore. So much time to waste!

“Waste of time” is the most common and scathing criticism leveled at social media by my physician friends and colleagues who have not yet seen the light. It is true: One could get lost for hours. But you can set limits. I find that when I have gotten carried away and eventually come up for air, my getting drawn in was because I have been engrossed in the content, the opinion pieces, blogs, journal articles, and medical news. I have been connecting, networking, even discussing important topics (as with a virtual journal club).  Social media has yielded much more value and content per unit of time spent than the same time spent rifling through a journal, or surfing the Internet, cozying up to a textbook. I might also add that I am much more likely now to engage in reading this kind of content via social media than before, when faced with the stack of journals next to my desk.

There is a growing body of content — meetings, lectures, webinars, articles — extolling the benefits and raising the cautions for physicians venturing in to the social media landscape. Surgical blogger Skeptical Scalpel was published recently in a scholarly journal, summarizing the benefits of blogging and tweeting, with excellent advice as well. This recent post by The Doctors Company is also an excellent introduction and guide to social media for doctors, collaborating with KevinMD who himself provides rich content and advice on his own blog. (Disclosure: Several of my own blog posts have been re-shared via KevinMD.) Both of these posts are a great introduction. I urge everyone to avail themselves of any of the abundant seminars and lectures introducing doctors to social media, whether at medical meetings or via physician-focused websites and platforms like Sermo (the sponsor of the most recent webinar I attended). There is rich content on the Internet, and even on social media itself.

It is important to be careful of the pitfalls, but those are not sufficient to bar adoption of social media or prevent use. Be mindful of privacy and HIPAA, and aware that content once posted can never really be deleted or retracted. Be careful that private and professional content do not mix, although the reality is that there really isn’t any such thing as truly private content (except maybe for internal messaging applications, but even this content is likely “discoverable”). Cautionary tales and horror stories abound. In reality, this is not terribly different than how we comport ourselves as professionals IRL (in real life), on a smaller scale, with a smaller audience, and less exposure than the Internet and social media.

The benefits are pretty compelling, and I broadly characterize them as scholarly content, news, networking, and opinion. But one final and surprising benefit has not been written about that much, and it has been a pleasant discovery. That discovery is the sense of professional community I have found via social media. I noticed, bit by bit, as I began to blog and tweet, I have been able to find my own community of peers, my “kindred spirits” (borrowing from Anne Shirley, the heroine of Anne of Green Gables). Like the orphaned Anne, it is important to identify and find one’s own community, which in turn helps navigate the (professional) world, find meaning, support and sympathy, a place to share.

In medicine, this sense of community was fostered by the formation of our medical societies and organizations, even if it was not their primary purpose. But times have changed, and interest and involvement in these organizations has been on the decline for myriad reasons. The traditional construct of meetings and conferences, taking time away from patients and practices, is not viable for many physicians. Time is limited, and expenses add quickly, so the numbers of meetings physicians are able to attend are limited as they are compelled to be frugal with both time and money. In addition, these traditional methods of connecting — for networking, communicating/collaborating, and even educating (CME/continuing medical education is a big part of medical meetings) — are viewed as cumbersome and less relevant to doctors today, especially the younger generations.

Therefore, I also see social media as part of the solution to reestablish this sense of community and collegiality among doctors. Technology and the platforms being developed and tailored to physicians may re-create that space, where communication and collaboration can grow.

As doctors enter the world of social media in greater numbers, it is clear that rules and regulations, codes of conduct, parameters and boundaries will be established and enforced. We need be a part of this, as participants, so that we are not disenfranchised by others who would do this for us. We need to protect our voices, our communication, and ultimately our patients.

Times are changing. Change happens all the time, all around, inside and out. It is random, with no direction, both good and bad, like genetic mutations. This is our opportunity to engage and participate, to direct the change, and to make it progress.

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Marketing Your Practice Online

Marketing Your Practice Online | Online Reputation Management for Doctors |

In previous years the conversation around marketing your medical practice centered on "Should I market my practice?" and "How much should I spend on marketing my practice?" Which then evolved into "Should I be online?" and "Is Facebook or social media really necessary to market my practice?"

Not anymore.

The conversation is now "How much time and money should I invest in online marketing?" It is now accepted that online marketing is not just an option for practices any longer; it is something they must do to attract new patients and stay competitive.

Determining cost

When determining a budget for your online marketing, it is best to start with the end in mind. Begin by looking at what your goals are for your online marketing program. I think it's best to frame them within short-term and long-term scenarios.

Here are some examples to get your creative wheels turning:

In 90 days, I would like to see an established and engaged audience of X number of people.

In 120 days, I would like to see my audience at X number, and receive X new patients per month from online efforts.

Once you have your goals set, you can determine the cost to achieve them. There are a number of factors to consider when determining the cost:

• Where does your ideal patient hang out?

Hint: Almost all practices should start with a website and Facebook.

• Who is managing the online effort — in-house vs. an outside firm?

There are many different levels of service available; from assistance with in-house efforts to complete outside management.

• What is the cost to reach your ideal patients?

Do you want to reach the 22-year-old diabetic patient in Boise, Idaho? You can, and often times for pennies. If you want to make your message more specific, it may cost a little more or less depending on the characteristics you seek.

• How will you stay in touch?

All of these variables, and many more, factor into what kind of investment you will need to make to reach the patients you want to see.

Compare these figures to what a single patient is worth to your practice to calculate how much time and money you should invest in online marketing efforts.

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The Ever-Full Yet Fulfilling Days of Being a Physician

The Ever-Full Yet Fulfilling Days of Being a Physician | Online Reputation Management for Doctors |

Monday morning began with the “hurry up and wait” chaos so common on labor and delivery, followed by three deliveries in just under 24 hours. The last one occurred a mere 40 minutes before my first patient was scheduled Tuesday morning. Fortunately, this week I had the forethought to bring office clothes with me to the hospital so that I did not have to grace the clinic in my ever-fashionable scrubs.

While downing my Starbucks, I plowed through my morning schedule. I placed an IUD, checked a C-section scar, pondered the implications of my patient calling out an ex-boyfriend’s name during sleep sex, reviewed diabetes medications and glucose control in light of new peripheral neuropathy, had a required “face-to-face” appointment to replace medical equipment that had already been approved twice before for a permanent condition, and then ended the session with a 21-year-old already plagued with chronic back pain who has exhausted two neurologists, one neurosurgeon, and a pain management specialist. Thank goodness my first two patients had to reschedule and one cancelled or I would have been running even later than usual.

As the last patient checked out I tried to keep my eyes open to review the ever-growing number of tasks in my box alerting me to prior authorizations that I had to complete for medications my patient has been on for many months, paperwork for a child that had not been seen in over two years, and stat refills for a patient who ran out of his medications four days before. I had not yet started my billing for that morning’s session.

Tuesday afternoons usually permit some administrative time, however, residents were streaming into my office with myriad questions, my prenatal coordinator had concerns about a new OB patient’s hepatitis C test results, and one of the rotating medical students asked for a letter of recommendation.

I meant to bring home the day’s notes and billing to do at home after the kids were tucked into bed, but once dinner was done I collapsed in bed, intermittently interrupted by the baby waking up at one and three and five.

Wednesday morning I did not see patients, instead I sat in the preceptor room and reviewed ambulatory patients with residents. I was hoping again to get to the billing before the office manager started complaining. However, the residents had challenging patients and I spent the morning explaining the need to correct for prematurity when looking at developmental milestones, reviewing Pap smear screening guidelines, and identifying who actually needed blood work that day. The last resident patient was scheduled for just before lunch and as I sat waiting for the residents to finish, one of my advisees popped her head in to ask if we were still meeting during lunch. I assured her that I would be in my office in about 15 minutes and made a mental note to remind myself to write those types of meetings down because I had completely forgotten.

This resident is in her last year of training and that day we discussed outstanding items for her to complete before graduation, tallied up how many office visits she needs to complete before July, and talked about her career goals. The conversation continued until I realized that the lunch had taken us 15 minutes into my afternoon patient session. Wrapping up, I stepped out of my office to huddle with my nurses, finding a fourth-year medical student waiting to work with me. I sent her in to see the first patient while I reviewed previsit planning with my team.

The afternoon patients were intermingled with residents coming to discuss prenatal patients, as well as my office staff looking for my signature on a variety of paperwork. Additionally, the school guidance counselor called to discuss my middle daughter’s schoolwork. The medical student helped immensely that day, as she gave extra attention to my patients. We had a two-month old needing immunizations coming in with her 16-year-old mother whom I had just placed a hormonal implant last week. This visit let me check on both mom and baby. When I finished with the last patient and reviewed with the student, I still had phone calls to make and results to verify.

Thursday started with a faculty meeting running 15 minutes into my morning patient session. Fortunately, the first patient didn't mind waiting. Again I seemed to whirl through patient rooms, reviewing a urinalysis here, ordering blood work there. I had a new prenatal patient that day. It was her first pregnancy after struggling with infertility for years and I spent more time than I should, or perhaps more correctly, more time than I was allotted with her, so again I fell behind.

Friday is looming for me. There is still charting and billing to complete. It has been a long week with seemingly endless paperwork and phone calls. But over the course of the week I helped three babies into the world, taught young doctors, and took the extra time my patients needed me to take.

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Is Your Hospital Embracing or Ignoring Social Media?

Is Your Hospital Embracing or Ignoring Social Media? | Online Reputation Management for Doctors |

At this point, I don’t think there’s any argument that social media influencers our health choices. In the above mentioned survey, 40% of them realize that it’s impacting them. Trying to say that social media doesn’t influence health decisions is like trying to say that your friends and family don’t influence your health decisions. Social media is the new way we communicate with friends and family. They influenced our health before social media and are still doing it, but in the new social media medium.

We know that social media is influencing health decisions, but is your hospital embracing the power of social media or trying to ignore it? I bet most hospital CIOs have no idea. I bet most hospital CMO (Chief Medical Officers) don’t know much better either.

There’s a simple way for you to know how well your hospital is embracing social media. Just ask yourself the question, “Is social media in my hospital considered a marketing and PR task?”

If the answer to that question is yes, then you have not embraced social media in your hospital. Certainly there is a lot of opportunity for a hospital marketing and PR department to use social media and they should (Side Note: I have a conference focused on hospital social media, so I intimately know the power of it in marketing and PR). However, if social media is only considered a marketing and PR task, then your hospital is missing out on so many benefits that can come from a hospital using social media.

The first step to embracing this culture is involving your hospital CIO and hospital CMO (Chief Medical Officer) in social media. They’ll have ideas and insights into how to use social media that go well beyond marketing a hospital’s services. In the new value based reimbursement world, this new form of outreach and connection to patients is going to be critical.

The second step to embracing hospital social media is to put budget and resources (ie. people) behind the initiatives that are created by your marketing/PR team, IT team, and medical team. There’s very little value that’s created from a meeting of these people without the ability to follow through on the ideas and suggestions they create.

Sadly, most hospitals have never even had this meeting (possibly because they don’t want to commit the resources). Those few hospitals who have had this meeting haven’t committed the resources needed to turn their ideas into reality. I think these are both failed strategies for hospitals that will catch up to them in a big way. I think a hospital’s approach to social media will soon tell us a lot about a hospital’s approach to patient care.

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Simple Ways to Ward Off a Lawsuit

Simple Ways to Ward Off a Lawsuit | Online Reputation Management for Doctors |

The other day, a very good friend of mine and I were creating training material for my residents. Tony is an attorney, but he's the good type. Almost all of his law practice is medical malpractice defense. During the brainstorming session, he gave me a few important nuggets that I would like to share with you.

First and foremost, be a good physician, because outcomes do matter.

Always practice good, sound medicine. Even the very smartest, most brilliant physicians will get sued. It's the nature of our business because we deal with the most precious thing people have — their life. We are also human and sometimes things don't go as planned or as hoped. It's really how we handle the less than satisfactory outcomes that will really determine our malpractice risk. A good physician is a good communicator. Take the time to discuss the expected outcomes with the patient and his family. Be honest with them. Don't tell them what they want to hear, but what they can expect to occur. I know we don't want to crush their hopes or make them despair. However, if we set or allow for the establishment of unrealistic expectations, we actually can do more harm than good for everyone involved.

Be nice, patient, and compassionate.

Outcomes may matter, but what really influences people the most is how we make them feel. It is very likely patients will not remember most of what we share with them. It can be difficult for laypeople to understand the foreign language we speak sometimes. Frequently, the words and stuff will get jumbled up, words will be switched around, or brand new words will be created. However, I guarantee they will always remember how you made them feel. Those feelings are based in emotions, and emotions are what drive decisions and ultimately lawsuits. Take time with your patients; solicit their questions, express compassion and understanding for what they are experiencing. That honestly is one of the best defenses against a lawsuit.

Documentation can only help you.

In our hectic worlds, making certain we document events, conversations, and decision processes can easily be skipped. We think we will get to it later but ultimately forget. Get things down on paper soon after they occur, so the details do not fade. This serves to help record your decision-making process. Hindsight is always 20/20, but we operate with imperfect data sometimes trying to make the best decisions for our patients. Recording the data available and the decision-making process used to arrive at a particular decision is important. It can help prevent a lot of the armchair doctoring that goes on.

Always call your attorney first.

Many good physicians have been unwittingly dragged into lawsuits because they didn't seek legal counsel first. If you are served with papers or if an attorney who doesn't represent you phones, you should immediately call your attorney. Nothing is worse than becoming a fact witness against the defense or being named in the lawsuit because of the way you answered an objectionable question. Lawsuits are serious and they lie outside our area of expertise. Always call an expert.

Remember, healthcare is two distinct parts: the process and the outcome. The latter can get you sued, but how you handle and behave during the process can protect you.

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Physician Beware: Delayed Annuities with Guarantees

Physician Beware: Delayed Annuities with Guarantees | Online Reputation Management for Doctors |

Forgive me for the somewhat arcane topic, but I see a constant stream of delayed annuities with guaranteed withdrawal benefits sold and advertised, and I think this needs to be addressed.

Here are some of the key things physicians should know about annuities, and why they may want to proceed cautiously when considering delayed annuities with guaranteed withdrawal benefits:

The two types of annuities:

Annuities are instruments that involve giving an insurance company your money and then hopefully getting some or more of it back in the future.  The two broad types of annuities are immediate annuities and delayed annuities. 

Immediate annuities occur when you give the insurance company money and it immediately begins giving you regular (usually monthly) income for a period time or for your lifetime (or even for a joint lifetime with your spouse).  You receive a return of your principal, some interest on the principal, and a small "mortality benefit" of money that comes from people who buy such an annuity and then die earlier than expected.

A delayed annuity occurs when the insurance company keeps your money for a while before you are allowed to take your investment back. 

Delayed annuities with guaranteed withdrawal benefits:

Currently popular are delayed annuities with guaranteed withdrawal benefits.  You will hear them advertised as a product in which you cannot lose money no matter what the stock market does. You may even hear that such an annuity allows you to make gains in a good market.

Those selling these products may promise that you can take withdrawals after 10 years on twice the amount of money you initially deposited, guaranteed.

So, you give the insurance company $100,000, and are guaranteed a given withdrawal rate (usually 4 percent to 5 percent at age 65) on $200,000 after 10 years. 

If you are considering one of these products, just assume this is the absolute best you will do.  Realize that you may not withdraw the $200,000, but only get the guaranteed withdrawal amount. 

Although it appears that you are receiving up to a 10 percent return on your initial investment as an annual withdrawal, the financial math actually reveals a low single-digit return (remember the insurance company has the use of your money in full for 10 full years, then is paying you back completely with your own funds over the next 10 years of withdrawals while still having the majority of your funds to invest for itself).

These products have such high internal costs (especially including very fat commissions up front for the salesmen that push them) that any promise to participate in stock market gains is a very iffy promise indeed.

If you are contemplating buying such a product, I'd recommend you get some fiduciary and impartial advice. 

Ignore the selling points and assume that you are giving an insurance company money that will be paid back many years later with a very small return (assuming the insurance company remains solvent).

There remains no "free lunch."


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A Physician's Role in Team-Based Patient Care

A Physician's Role in Team-Based Patient Care | Online Reputation Management for Doctors |

With Medicare-eligible citizens now representing the fastest-growing segment of the American population, it is more important than ever to find fresh approaches and new models of care to effectively manage the health and well-being of this group. Physicians, hospitals, and health plans need to find ways to work together if they are to provide patients with a higher quality of life and better care coordination while lowering overall healthcare costs. This is particularly true as it applies to low-income seniors, dual eligibles, and others with complex medical and social needs.

One tactic that is proving to be successful in this area is a high-intensity care-team approach outside of the hospital setting. Such an approach goes well beyond traditional care coordination and is consistent with a recent Avalere Health study, which reported that to be successful in today's environment, health plans and physicians need to not only focus on treating a person's medical condition but must also have strategies in place for managing a broad array of care needs across multiple settings.

For primary-care physicians, participation in a care-team program can ease the burden associated with the management of complex-care patients. It also provides a way to better manage the cost of these patients by optimizing their health and functional status, decreasing excess healthcare use, minimizing emergency department visits and other hospital utilization (including readmissions), and preventing long-term nursing home placement. 

Central to an effective care-team program is a support team overseen by a nurse practitioner and a social worker that work in concert with the primary-care physician to comprehensively address a patient's health conditions and achieve a patient's goal from the comfort of their own home. To be successful it is imperative that the team provides patients with healthcare education; medication management; and coordination of care between specialty physicians, the emergency department, hospitals, and a broad array of community support services.

In addition to better serving patients from a clinical and social standpoint, there are strategic reasons for primary-care physicians to consider programs such as these. For those physicians who participate in an accountable care organization (Medicare and/or commercial), take capitated risk, or serve a significant Medicare population (and are at risk for adverse events such as readmission and other penalties), this type of coordination can be a significant element in the move from fee-for-service to value-based pricing while generating cash flow and cost savings.

It is no wonder then that the Avalere study said that enrolling members into an effective care-transition or care-coordination program "can help … reduce their members' healthcare utilization and subsequently their spending." In a model presented in the study, Geriatric Resources for Assessment and Care of Elders (GRACE) Team Care™  from Indiana University Medical Center produced annual savings for high-risk members of nearly $4,300 while producing a ROI for the health plan of 95 percent per year.

Physicians looking to participate in a care-team approach outside of the hospital should be sure that their program includes:

• In-home assessment and care management by a team of experts.

• Specific protocols to manage common geriatric conditions.

• Integrated EHR documentation.

• Web-based care management tracking.

• Integrated pharmacy, mental health, hospital, home health, and community-based services.

• Individualized care planning and implementation of a care plan consistent with the participant's goals.

• Frequent inter-professional team conferences.

• Nurse practitioner and social worker meetings with the primary-care physician.

• Ongoing care management and caregiver support.

• Protocols to ensure continuity and coordination of care including smooth transitions from one point on the healthcare continuum to another.

Older patients with chronic conditions and functional limitations require more medical services and social support than do their less complex or younger counterparts. And beyond their physical healthcare challenges, these patients often must deal with a host of socioeconomic stressors including low health literacy, limited access, fragmented healthcare, and poor communication and coordination of care.

The combination of all of these factors makes it imperative that physicians, hospitals, and health plans continue to look for even better ways to serve these citizens in need. By moving the traditional concept of care coordination to a new level, the entire healthcare system can be more efficient, more patient-centric and more responsive to improving the entire patient experience.

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The Fundamental Challenge of Building a Healthcare-Provider Focused Startup

The Fundamental Challenge of Building a Healthcare-Provider Focused Startup | Online Reputation Management for Doctors |

Over the past few years, the government imposed copious regulations on healthcare providers, most of which are supposed to reduce costs, improve access to care, and consumerize the patient experience. Prior to 2009, the federal government was far less involved in driving the national healthcare agenda, and thus provider IT budgets, innovation, and research and development agendas among healthcare IT vendors.

This is, in theory (and according to the government), a good idea. Prior to the introduction of the HITECH act in 2009, IT adoption in healthcare was abysmal. The government has most certainly succeeded in driving IT adoption in the name of the triple aim. But this has two key side effects that directly impact the rate at which innovation can be introduced into the healthcare provider community.

The first side effect of government-driven innovation is that all of the vendors are building the exact same features and functions to adhere to the government requirements. This is the exact antithesis of capitalism, which is designed to allow companies to innovate on their own terms; right now, every healthcare IT vendor is innovating on the government’s terms. This is massively inefficient at a macroeconomic level, and stifles experimentation and innovation, which is ultimately bad for providers and patients.

But the second side effect is actually much more nuanced and profound. Because the federal government is driving an aggressive health IT adoption schedule, healthcare providers aren’t experimenting as much as they otherwise would. Today, the greatest bottleneck to providers embarking on a new project is not money, brain power, or infrastructure. Rather, providers are limited in their ability to adopt new technologies by their bandwidth to absorb change. It is simply not possible to undertake more than a handful of initiatives at one time; management can’t coordinate the projects, IT can’t prepare the infrastructure, and the staff can’t adjust workflows or attend training rapidly enough while caring for patients.

As the government drives change, they are literally eating up providers’ ability to innovate on any terms other than the government’s. Prominent CIOs like John Halamka from BIDMC have articulated the challenge of keeping up with government mandates, and the need to actually set aside resources to innovate outside of government mandates.

Thus is the problem with health IT entrepreneurship today. Solving painful economic or patient-safety problems is simply not top of mind for CIOs, even if these initiatives broadly align with accountable care models. They are focused on what the government has told them to focus on, and not much else. Obviously, existing healthcare IT vendors are tackling the government mandates; it’s unlikely an under-capitalized startup without brand recognition can beat the legacy vendors when the basis of competition is so clear: do what the government tells you. Startups thrive when they can asymmetrically compete with legacy incumbents.

Google beat Microsoft by recognizing search was more important than the operating system; Apple beat Microsoft by recognizing mobile was more important than the desktop; SalesForce beat Oracle and SAP because they recognized the benefits of the cloud over on-premise deployments; Voalte is challenging Vocera because they recognized the power of the smartphone long before Vocera did. There are countless examples in and out of healthcare. Startups win when they compete on new, asymmetric terms. Startups never win by going head to head with the incumbent.

We are in an era of change in healthcare. It’s obvious that risk based models will become the dominant care delivery model, and this is creating enormous opportunity for startups to enter the space. Unfortunately, the government is largely dictating the scope and themes of risk-based care delivery, which is many ways actually stifling innovation.

Thus is the problem for health IT entrepreneurship today. Despite all of the ongoing change in healthcare, it’s actually harder than ever before to change healthcare delivery things as a startup. There is simply not enough attention of bandwidth to go around. When CIOs have strict project schedules that stretch out 18 months, how can startups break in? Startups can’t survive 18 month cycles.

Thus the is paradox of innovation: the more of it you’re told to innovate, the less you can actually innovate.

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How to Apologize for a Medical Error

How to Apologize for a Medical Error | Online Reputation Management for Doctors |

Apologizing to a patient when an error occurs is critical to reducing malpractice risks, says Sue Larsen, president and director of education at Astute Doctor Education, Inc. "They always say that anger and not injury is what drives a patient to sue, and everybody hates a cover up," she says. "So when something goes wrong and the physician goes missing, that's when the patient feels deserted and they suspect that something has gone wrong." Ultimately, Larsen says, that anger and the resulting broken relationship with the physician can propel the patient to sue.

Of course, apologizing for a medical error is not easy, and Larsen says how you say sorry is crucial. Make sure your apology is:

• Sincere;

• Empathetic; and

• Indicates mutual disappointment.

"As a doctor, you are disappointed in the outcome and you are sorry the patient is disappointed as well," says Larsen. "This isn't admitting fault, it just is a way of showing the patient that you care and that you understand."

Once you make the apology to the patient, emphasize that you are committed to ensuring this error will never happen again, and that you are going to follow up to determine why the error occurred.

Then, attend to the patient's immediate needs that you can address, says Larsen. "Avoiding the patient or deserting the patient is absolutely the worst thing you can do, and it's going to put you at a much higher risk of having a claim made against you."

To help you determine the right approach next time you need to make an apology, Larsen shared this example of the proper phrasing to use:

"I'm really sorry this has happened to you, it's obviously not the outcome that any of us would have liked to have seen. I'm disappointed. I'm disappointed that you have had to go through this. I know that you are feeling very upset and frustrated that this has happened and perhaps even quite angry, and I can understand that you'd be feeling that way. All I can do is say I'm sorry that you are in this situation and we are going to do everything we possibly can to try and understand the events leading up to this so that we can avoid it happening again. In the meantime, I'd like you to know that I am here for you, if there is anything I can do."

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