Frequently Asked Questions about Practice Management

Below are some initial questions many clients have when they first contact Top Practices. The questions below may address many initial concerns you may have. If you don't find the answers here, you should contact us for answers to questions specific to your case. The consultation is free.

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  • What is MIPS?

    MIPS, or the Merit-based Incentive Payment System, is a part of the big shift from the fee-for-service model to the Value Based Medicine model for medical reimbursements. It’s how MACRA will actually play out practically for your bottom line. In January of 2017, the government will begin measuring doctors’ effectiveness in giving patients quality care while lowering costs using four main criteria: quality (currently PQRS measurements), the advancing care initiative (currently Meaningful Use), clinical quality improvements, and cost relative to your peers. The composite score will then be used with MIPS to define your Medicare reimbursements.

    That means that, in 2019, your Medicare reimbursements could potentially receive a bonus, remain flat, or be penalized. This will be determined through your composite scores using data that begins in 2017. If you score well, getting above a set threshold and doing better than your peers, you could potentially have your reimbursements adjusted with a bonus of up to a 4% increase (this will go up to a potential 9% increase by 2022 and beyond). If you score around the threshold, your reimbursement pay will not be adjusted and will remain flat. If you score too far below the threshold, your reimbursements will be adjusted with penalties that could be as much as 4% (but will increase to up to 9% by 2022 and beyond).

    If this sounds overwhelming, don’t give into fear. While this definitely presents a challenge to doctors, the key is to think of it as a business decision for your practice. You have to determine how much it costs for you to comply versus how much it will affect your reimbursements. You don’t have to face this decision alone, though. Top Practices is partnering with Collaborative Practice Solutions to provide you with guidance and management coaching through our Virtual Practice Management Institute (VPMI). Don’t get caught by MIPS unprepared when you don’t have to. Contact us for more information about VPMI and getting started today by calling (717) 725-2679 or e-mailing [email protected]

  • What is MACRA?

    MACRA is an acronym that describes the shift from the traditional fee-for-service model of medical reimbursements to a “value-based medicine” model. MACRA stands for Medicare Access and CHIP Reauthorization Act. It will determine your unique reimbursement pay-scale for Medicare and Medicaid patients, starting in January of 2017. At that time, the government will begin using four components to measure a doctor’s compliance, then composite a “score” from each of these components to determine how much you will be reimbursed from the year 2019-on forward. These four components are:

    • What is MACRA?Quality – This replaces the current PQRS measures. Doctors will continue submitting these measures for this score.
    • Advancing Care Initiative – This replaces Meaningful Use. Again, doctors will continue reporting that same information to receive this score.
    • Clinical Quality Improvements – This is a data measurement that will be specific to individual specialties. (It hasn’t been well-defined for podiatry yet.)
    • Cost – This measures how much it costs the government for you to see a Medicare or Medicaid patient.

    These four numbers are composited together and compared to your peers’ numbers to formulate your score and determine your reimbursements. Compliance could potentially result in bonuses (if you do better than your peers), while noncompliance could decrease your final reimbursements.

    This can seem complicated and overwhelming, but with the right data and information, you can determine how you can—and to what extent you should—comply with MACRA. This is where programs like the Virtual Practice Management Institute (VPMI) can help you. With your unique Virtual Practice Optimization (VPO) analysis and coaching from experts who understand what you’re going through, you can make the best decisions for your practice and your needs. If you’d like to learn more about MACRA, or you’d like more information about the VPMI program, contact Top Practices! You can reach us by e-mailing [email protected] or calling (717) 725-2679.

  • Which of the VPMI plans is right for me?

    Choosing a Virtual Practice Management Institute (VPMI) plan doesn’t have to be difficult—you simply have to decide what you really need.

    With the changes toward Value Based Medicine and all the challenges that this brings, Top Practices has teamed up with Collaborative Practice Solutions to bring you a new Virtual Practice Management Institute (VPMI) program. This program is designed to help you identify your management strengths and improve your weaknesses so you’re equipped and able to succeed through these changes. It’s also tailored with “plans” so you only pay for the services you need most.

    There are two plans for you to choose from:

    • VPMI SILVER ($299/month) – At this level,  you receive your monthly Virtual Practice Optimization (VPO) report -  an analysis of your entire electronic medical records, which compares your standing against nearly 2,000 of your peers. All the important numbers you need will be analyzed and laid out in a detailed and easy to read report that you can then use along with an interpretation of your data from Collaborative Practice Solution’s own Dr. John Guiliana and Dr. Alan Bass. You are also able to join their monthly coaching teleconference calls. This provides an opportunity for you to receive direction about how to use your data to make management changes in your practice.
    • VPMI GOLD ($499/month) – This plan level is actually based around the Top Practice’s own Practice Management Institute program. In addition to the monthly VPO analysis and coaching call with Dr. Guiliana and Dr. Bass, you work closely with practice management experts Tina Del Buono and Dr. Peter Wishnie. You have access to regular coaching, mentoring, and training with these experts and you collaborate in a special mastermind group where you can meet other medical professionals who are working on their management as well. Through this program, you and your staff all get access to Top Practices’ extensive practice management library and training courses to work through. You can find a lot more information about this program through its own dedicated area on our website.

    Which plan is best for you really depends on what you need. Most doctors and their staff find the access and support in the Gold Program is what they need to truly get their practices under control and profitable. You can talk to our experts to help you make the right choice.

    Changes are coming to medical reimbursements and all you can do is be ready. Now is the time to equip yourself to handle these changes. Don’t wait until you’re losing money. You can easily contact us for more information about the program and how to get started by e-mailing [email protected] or by calling (717) 725-2679.


  • Isn’t a newsletter old-fashioned? How is it used effectively?

    When most people think of newsletters, they think of an outdated marketing technique that died decades ago. They can’t help but ask, very skeptically, “Do they even work?” The short answer is yes, they do work and no, they aren’t old-fashioned. They can be one of your most valuable marketing tools and help you connect more effectively with your current patients, reach out to your potential patients, and encourage personal referrals to patients’ family and friends.

    We’ve discussed this in-depth many times—you can read more about it on our blog—but here is the short version: your patients are too busy to remember you unless you stay in contact with them. They have too much else to worry about in their lives. A well-crafted marketing practice newsletter is interesting, engaging, and comes regularly enough that your patients won’t forget you. A print version also hangs around a house for a while and is easily passed around to friends and neighbors who have health issues you can handle. This encourages people to think of you first when they or someone they love have a problem you can solve.

    Using your newsletter effectively means both crafting it well and sending it out often enough that your patients remember you and look forward to receiving your newsletter. Both the electronic and print copies have to be visually appealing and branded for your practice. All the articles have to be interesting and should cover more topics than just your specialties. And your newsletter should go out about once a month to keep you and your practice fresh in patients’ minds.

    Newsletters are an excellent tool that many doctors are already using effectively. But you don’t have to take our word for it—you can take theirs! If you’re at all interested in using this incredible tool to grow your practice, contact us for more information about Top Practices Medical Newsletter Program and how you can get started. You can reach us by emailing [email protected] or by calling (717) 725-2679.

  • How can I get my charts done?

    Charting, especially in the age of electronic medical records, has gotten more comprehensive while growing more complicated, slow, and confusing. It can be hard to feel like you’re able to give your patients the attention they need in the exam room while still completing your charts. Many doctors end up taking fast notes and doing part of the chart while they’re with the patient, then finishing the charting and rounding out the encounter notes later in the day. This has given rise to the unfortunate reality that faces many doctors: cutting into their family time to stay and finish their charts. This is the single biggest frustration and challenge our doctors report to us when we first begin working together.

    There isn’t an easy answer to help doctors improve their charting experience. Of course, most electronic medical record programs allow templates that can help you fill in some fields more quickly. Often they have shortcuts to filling out certain parts of an exam as well.

    While there isn’t an easy answer, there are answers that do make it possible to leave your office on time with all your charts complete. These same answers do make it possible to take back your weekends and enjoy your life more fully.  To be truly successful in solving this problem you need to use your staff differently than you have in the past (and you will need more medical assistants to accomplish this). You also need to arrange your schedule and manage your treatment rooms differently as well.

    There ARE answers. Making these and  other management adjustments is  what you need to to do to complete your charts in a timely fashion and reclaim your day. The Top Practices Practice Management Institute is designed precisely to provide you with the resources and coaching you need to defeat this frustrating roadblock to success and fulfillment in private practice. Our practice management experts, led by  Tina Del Buono and Dr. Peter Wishnie, understand this specific challenge facing doctors, and can show you the way out of your frustration. You don’t have let charts control your day. Visit the Practice Management Institute to learn more about how effective management can improve your practice. Contact us with questions about the Institute through e-mailing [email protected] or by calling (717) 725-2679.

  • How do I use the Goal Worksheets?

    The Top Practices Goal Worksheets are a key part of succeeding and seeing the changes you want to make in your medical practice. The important thing to remember is that this is not some list that you make and then occasionally glance at over the course of the year. That’s not how you use these worksheets. These worksheets, designed and refined over the years to help doctors define their goals, are the starting point for enactable plans to actually achieve the things you need and want to do.

    You start by setting aside time to really think about goals for all areas of your life—not just a half-hour over lunch before you rush back to your busy day, either. Spend dedicated time and figure out everything on your life to-do lists. Not just your work lists, either: cover finances, family life, health plans, hobbies, and so forth. The work sheets will help you organize all of these to-dos and prioritize them. From there, you use these lists to focus in on just a couple goals at a time for limited bursts. Then you actually take steps to achieve them within the time frame you are allotted. When that time is up and your to-dos are accomplished, you move on down your list. This requires you to not only look at your Goal Worksheets constantly, but to cut out the things in life that will prevent you from achieving everything you want to do.

    Our Mastermind members have been using this approach to making changes in their practices for years now, so we can say with authority that this really does work. If you’d like to know more about how to use these worksheets, or about our Mastermind group program, just let us know! Contact us at [email protected], or call (717) 725-2679.

  • Do I have to feel overworked and underpaid to have the "best practice"?

    Many doctors are working too hard and aren’t making the income they should be making, but the good news is that you can have a growing, thriving practice without feeling overworked or underpaid. So why do so many doctors burn out working so hard without seeing the result they want? The answer is that many of them don’t know how to appropriately organize and manage their practices. This is actually quite common—podiatrists (all doctors actually) are never taught how to properly manage their office so that it runs smoothly at all times, whether they’re in the office or not. If you feel like you’re the only one motivated to improve your office, struggle to stay organized, or find your job is controlling your life, you absolutely need to take a closer look at your management!

    That’s why we are proud to offer the Top Practices Practice Management Institute, designed to help you to learn from the very best and set up your own office for success with tried and true techniques.

    If you have questions about The Practice Management Institute or the Top Practices Mastermind Group you can email us at [email protected] or call us at (717) 725-2679.