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 Bra ve  Ne w  Pr

ac t ice

 K r i s t in  S tor y  H

e ld,  M. D.

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Brave New Practice

 Time to be a Trailblazer!

 Trailblazer: a erson wo ma"es a new trac" tro#$wild co#ntry% a ioneer% an innovator: He was atrailblazer for many ideas that are now standard fare.

&rab yo# $#mtion not yo#r an"les!

mtion: co#ra$e and ener$y% initiative%reso#rce'#lness: It took a lot of gumption to do a jobthat hard. ()' #ncertain ori$in.*

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Mission

Preserve Hiocratic, etical medicine centered onte atient+ysician relationsi

Based on Tr#st+ liberatin$, innovative

&et $overnment o#t o' medicine, 'or$e alternate#niverse otion to sin$le ayer, socialized medicine

Based on ear, ab#sive, sta$nant

Save te atients, ractice, and '#t#re o' ro'ession

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State o' Practice

)talmolo$y and )talmic s#r$ery 'or over - years,to#sands o' loyal atients wit valid, lon$+standin$ atient+ysician relationsis

/ombination o' o0ce and s#r$ical ractice 'or atients o' alla$es sannin$ 1 $enerations

Most common oeration+ cataract s#r$ery wic isredominantly in Medicare o#lation

New tecnolo$y not covered items or services

 23S4K and re'ractive s#r$ery not covered by ins#rance

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5ere 4 was

inised residency otalmolo$y, 6oined 'ac#lty at 7THS/S3 inDeartment o' )talmolo$y, remained in academic medicine 'or 8years. 9#ality 3ss#rance, /PT, ;7s evolvin$

Started Solo Private ractice, o0ce sarin$ wit establised soloractitioner. Too" o#t

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5ere 4 was

)bama elected (-A*, )bamacare assed (-=*

/an$ed Medicare stat#s to Non+articiatin$ (-* (8AC o'ractice was Medicare*

/an$ed o0ce mate 'rom older asin$ o#t to yo#n$er revvin$# (-=-* (1AC o' ractice was Medicare*

-=1+ Be$an to wean o@ commercial ins#rance, re'#sed to be innetwor" 'or )bamacare lans+ 'o#$t 3TN3 'or a year

)ctober =,-=8 oted o#t o' Medicare and all E rd artycommercial ins#rance (1=C o' ractice was Medicare*

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 Transition Process

7nderstand yo#r ractice 'romincome?eFense standoint

7nderstand yo#r ayer miF+ Medicare,Medicaid, /ommercial, Private ay, /arity

7nderstand Erd arty ayer dynamics

7nderstand ealtcare law

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 Transition

)t o#t o' Medicaid+ rovide tr#e carity#ncained

/an$e Medicare stat#s to Nonarticiatin$+$ets atients and sta@ #sed to eFcan$in$ <and seein$ wat item and services act#allycost? $limse o' s"in in te $ame

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 Transition

val#ate ayer miF+ Medicare and commercial

Ma"e sreadseet 'or to (-* codes and all ayers./omare i$, low, avera$e, Medicare, and yo#rassessed val#e 'or eac.

/reate yo#r own c#stomized 'ee sced#le

Dro te lowest ayer, let tin$s re+eG#ilibrate

/omm#nication wit and ed#cation o' atients is "ey

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 Transition

e+determine wat ercenta$e o' yo#r reven#e andwat ercenta$e o' atients come 'rom eac ayer

)nce a$ain, dro te lowest commercial ayer.

Noti'y atients yo# are committed to tem and

enco#ra$e tem to stay in yo#r care #tilizin$ teir o#t o'networ" benets.

Pa#se, re+eG#ilibrate, reassess, and reeat+ #ntil tey>reall $one+ let last 'ew $o at once

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 Transition

Ne$otiate 'ees wit s#r$ery center+ Medicareas re'erence oint

Ne$otiate 'ees wit anestesiolo$ist

/reate billin$ models+ direct ay v. ybridmodel

/omm#nication "ey+ 2etters, 'ollow+# letters,one calls, social media, website

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 Transition

;isit wit 'amily

;isit wit ban"er+ ta"e o#t line o' credit (4 avea line o' credit 'or

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&o Time!

Saddle 7!

ollow 33PS )t )#t instr#ctions and ab#ndantreso#rces and s#ort systems

)t )#t+ )ctober =, -=8 'or me. How abo#t yo#I

 Terminate o#tside billin$ comany (sad,#nintended conseG#ences*

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5ere 4 am now

3ssess reven#e

3ssess eFenses

)n$oin$, relentless ed#cation+ sta@, atients,

collea$#es/oays, cost+sarin$, remi#ms, ded#ctibles, in+networ" vs. o#t+o' networ", billable vs. allowable,transarent 'ee sced#le

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5ere 4 am now

Seven Months Post Opt Out vs. Seven Months Pre Opt OutJ o' Patients J o' Patient nco#nters &ross /ollections

Pre )t )#t =C =C =C

Post )t )#t E.8C .=C E.L8C

 Total /an$e(-L.8C* (-.C* (L.E8C*

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5ere 4 am now

Collections and Billing Service&ross /ollections Billin$ Fenses Net /ollections

Pre )t )#t =C C EC

Post )t )#t E.L8C E.L8C

 Total /an$e (L.E8C* .L8C

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5ere 4 am now

Post opt Out vs. Pre Opt Out (Billing service efect)J o' Patients J o' nco#nters Net /ollections

Pre )t )#t =C =C EC

Post )t )#t E.8C .=C E.L8C

TotalChange

(26.5) (2!.!) ".65

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5ere 4 am now

4 am wor"in$ EC less and collectin$ =C more. Myatients and sta@, my 'amily and 4 are te beneciaries. Tr#e access and G#ality care.

How can 4 s#stain and imrove tisI How can yo# do tistooI

/#rrent system sG#andered my otential to care 'or moreatients.

4 miss bein$ in te ) more as a s#r$eon at tis sta$e o'my career

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5ere 4 am now

Medicare # o$ PatientsPre )t )#t Post )t )#t  Total /an$e

Medicare E.AC -.EC (=.8C*

Not Medicare L.1C .C =.EC

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5ere 4 am now

Medicare # o$ Patient %ncountersPre )t )#t Post )t )#t Total /an$e

Medicare 1=.AC E-C (.AC*

Not Medicare 8A.-C LAC .AC

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5ere 4 am now

Medicare o$ CollectionsPre )t )#t Post )t )#t Total /an$e

Medicare 1=.1C -8.-C (=L.-C*

Not Medicare 8A.LC 1.AC =L.-C

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5ere 4 am now

Medicare Patient %ncountersPre )t )#t Post )t )#t /an$e

Me 1=C E-C (C*

3ssociate(articiatin$

M/ rovider*

E8.1C 1-.C .8C

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5at 4 m#st do

4denti'y stren$ts and wea"nesses

5y do atients stayI 5y do tey leaveI

d#cate sel', sta@, atients, 'amily

Stay vi$ilant+a$$ressively stay abreast o' state and 'ederallaws, r#les, and en$a$e+ M3/3 r#les imossible

5at are tey # to nowI

Protect yo#r a#tonomy and stay o#t o' tro#ble

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5at 4 M#st Do

Stay 'oc#sed on mission

Don>t let yo# 'eelin$s or e$o deter me

5at we do is li"e notin$ else+ we are invested in o#ratients to o#r very core+ ris"y b#siness on call -1?.

Don>t #nderval#e tat.Be a victor not a victim+ say no to b#rno#t and ab#se

3lternate #niverse+ wor" wit collea$#es to be te aradi$msi't, tin" o#tside te boF, be te li'eboat

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5ere am 4 $oin$I

3ction 4tems+ stay on to o' o#t o' networ"? oted o#tcaveats+ secondary vs. s#lement vs. relacement vs. Tricare. P#rs#e best tar$ets.

)n$oin$ ed#cation o' atients, sta@, and collea$#es

ene transarent 'ee sced#le

ene website, social media, letters, one calls

Branc o#t+ 3lt 7, Healtsarin$ ministries, Networ"in$(Medibid, Doc /ost, local connectionsO*

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  My 'ees vs. /ollea$#e in $eneral vicinity+ ybridmodel

2aserQ 2aserQ 2aserQ2aser 3sti$matism 3sti$matism 2ens

M#lti'ocal 2ens

Medicare Particiatin$ S#r$eon

Patient m#st ay tis additional

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Pearls and Pit'alls

Set my ractice aart+ send < on innovation over$overnment comliance and data collectin$

)n$oin$ eval#ation o' atient trends

New atientsI 3m 4 attractin$ new atientsI How can 4 dobetterI

2oyalty vs. te lon$ $ood+bye. 3m 4 retainin$ atientsI Howcan 4 do betterI

;al#e in relationsi vs. entitlement. 3m 4 a artner or a#ncin$ ba$I

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Hay Trails

Stay 'oc#sed and vi$ilant

Protect and P#rs#e increasin$ 3#tonomy+rescrition writin$? disensin$, M)/,licens#re, ysician owned 3S/>s, contacts O

Medical ed#cation+ '#t#re ysicians+ ioneersvs. indent#red servants, liberty vs. oression

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Hay Trails

 #st Do 4t! Pro#dly! No one else can do wat we do, norwill tey do it 'or #s. )nly we are G#alied andeG#ied. rom one rite o' assa$e to te neFtO

 Trailblazer

mtion

It took a lot of gumption for physician trailblazers to resistthe insolvent government takeover of medicine and createa viable ethical system that puts the patient rst.

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 Tan" o# 33PS

 Te 3ssociation o' 3merican Pysicians andS#r$eons is te #ltimate reso#rce 'or rivateand asirin$ rivate ysicians and te#ltimate rotector o' te atient+ysician

relationsi.)mnia ro ae$roto+ 3ll 'or te atient

nco#ra$e all ysicians to become a

member.

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/ontact 4n'ormation

Kristin Story Held, M.D.Stone )a" )talmolo$y

E-8 Sonterra Blvd., S#ite =

San 3ntonio, TeFas A-8A

  www.Stoneoa"eyes.com 

www."riseldmd.wordress.com (atient lettersO*

  www.3mericandoctors1tr#t.or$ 

Messa$e me on Twitter+ Kris Held,MD U""seld

http://www.stoneoakeyes.com/http://www.krisheldmd.wordpress.com/http://www.americandoctors4truth.org/http://www.americandoctors4truth.org/http://www.krisheldmd.wordpress.com/http://www.stoneoakeyes.com/