QUESTION I have started to receive a tremendous amount of denials for OPTUM patients that I see and perform a stroboscopy on the same day. The letters from the company deny my E/M and pay for stroboscopy, stating that the E/M falls under the global period for the procedure. Interestingly, the global period for stroboscopy […]

CAN THERE BE DIRECT PAY “HAPPINESS” WITHOUT THE NEED TO CUT YOURSELF OFF FROM INSURED PATIENTS? As specialists increasingly encounter administrative burdens, excessive patient volumes, and prior authorization challenges that hinder patient care, many wonder if transitioning to a direct pay model is a viable solution. Could this shift alleviate burnout and enhance professional satisfaction? […]

HOW TO COMPETE AGAINST SOLO, GROUP PRACTICES, AND REGIONAL HEALTH SYSTEMS IN THIS ERA OF HEALTHCARE (Ex)pertise What surgery do you want to be known for in your region? (P)atients What better strategies can you use to effectively find your ideal patient? (E)ngagement How can you better become the preferred choice for patients? (R)epeatability How […]

Combined Otolaryngology Spring Meetings (COSM) 2024 At this year’s COSM in Chicago, I had the pleasure of engaging with many medical device executives and thought leaders in surgery to discuss the ethical use of AI to mitigate prior authorization denials. It is a timely topic as 86% of physicians now identify prior authorizations as a […]

The Challenge of Automated AI Denials Automated AI denials in surgical prior authorizations have become a pressing issue in healthcare. Initially intended to streamline and enhance the efficiency of prior authorizations, AI systems like Cigna’s PxDx and UnitedHealth’s “nh Predict” have led to an increased rate of denials. While these systems were designed to expedite […]

HISTORY IS REPEATING ITSELF Imagine how epic EHRs would have been if the current companies were founded by healthcare providers, designed by healthcare providers, and owned by healthcare providers with controlling interests in the companies. As a nation we might have actually seen meaningful use achieved. The promise of less administrative burdens, improved efficiency, and […]

If AI is rapidly transforming many sectors of our economy, why is it not revolutionizing surgery? I had this question raised to me at the Health 2.0 Conference held recently in Las Vegas. In reality, where it is correctly applied, Artificial Intelligence (AI) has indeed been transforming the surgical marketplace for years. How has AI […]

Change Health’s Loan Program is Not Enough In the aftermath of a significant ransomware attack on Change Healthcare, the organization has initiated a temporary loan program aimed at supporting physicians facing halted insurance reimbursements. This strategic move has been seen as essential for maintaining operational cash flows and ensuring uninterrupted patient care during the critical […]

Key performance indicators (KPIs) are the cornerstone of any successful business strategy. However, it’s crucial to focus on the right metrics. Traditional KPIs like Relative Value Units (RVUs) and patient or case volumes might seem indicative of a practice’s performance but fail to directly correlate with financial health. These metrics do not account for the […]

“When I finally understood the root cause of the administrative burden tied to surgery everything changed. I thought it was the EHR, but it’s not. This underlying issue, which has been prevalent for at least five years, is now clearly out in the open. It’s disheartening to witness the adverse effects of such systemic challenges […]

Let’s take a look back at one year ago… Burnout and depression were an issue before the pandemic and continue to have a negative impact on physician well-being; this year’s Medscape report shows that the problem is only getting worse,” said Leslie Kane, M.A., Senior Director, Medscape Business of Medicine. Physicians are looking for substantive […]

“Marketing a virtual medical practice can cost anywhere from $600-$5,000 per month. It’s hard to know which package or which company to choose. The best way would be to talk to a fellow physician who has started a virtual practice and immigrate their marketing program. A $5k a month commitment makes sense if there is […]