Medicare, Medicaid, managed care, Out-Pocket expense, payer contracts, coding guidelines, compliance guidelines, employee retention, and let’s not forget the patient off course. So how do you treat heart disease? If you say exercise, healthy eating, and aspirin a day you are probably on the right track. But if you want to do it professionally. You’ll need to know that Medicare and Medicaid doesn’t cover for cardiovascular screening. You will also have to know that most managed care plans don’t cover it either. And when ordering the test for your patients you will have to consider that most patients are now walking around with high deductible plans. So, if you order a Stress test to properly diagnoses the patient’s shortness of breath and chest pain during their morning workout. Will the patient be able to comply with the test since their out-of-pocket might make this test too expensive? What is your compliance obligation for this patient if he chooses not to have the test? And if you are going to do the test in your office do you know how to properly code for the test with the appropriate ICD-10 that will allow your practice to be seem as appropriately ordering medical exams.

You spend four years at medical school, another 3-10 in residency, and then you have to be the CEO of an Medical Doctor practice with very little business experience. The hospital has administrator that spend 4-8 years training on the business of medicine. The insurance companies have administrator that have spend the same amount of time learning the business of medicine. And think about it medicine is collegial. Your learned from your mentor, your senior resident, and all those who have come before you. Well so is healthcare administration. The insurance company and Hospital administrator have hundreds of trained educated professionals ready to bounce idea of each other, develop new business lines, and new guidelines. They participate in workshops, seminars, and conference all dealing with the business of medicine. As a physician, you are lucky to make to your annual CME conference to renew your license and still take the family on decent vacation.

 A billing company, joining a larger group, Management Service Organization (MSO), or hiring a healthcare consultant can be helpful with some or all of these issues. It can better prepare you for the business of healthcare. Just like eating healthy, exercising, taking an aspirin, a day will make your patient less likely to suffer a heart attack, but the truth is that some patients will never follow your professional medical recommendation but every single one that didn’t will wish they have if they are lucky enough to wake up in the emergency room next to their love ones after a heart attack. By the way I didn’t mention the new rage in the business of healthcare Quality Payment Programs or Value Base Reimbursement. Most physicians I know would not be where they are if they had not been practicing quality valuable medicine, but translating that into the business of healthcare has create a whole new business industry in healthcare.

So now the question is doc how will you treat this illness of the healthcare business? Or even more important that hospital or insurance company your negotiating with how do you think they want you treat it?