Posts Tagged Microsoft


How Are Physicians Returning to Private Practice?

Cresting Wave

The healthcare industry has gone through a lot of change very quickly in the past five years, with still more to come. Independent practices and smaller physician groups have a lot of reason to “seek higher ground” in mergers, partnerships, and buyouts by larger groups and hospitals that have the resources to better deal with lower reimbursement and increasing regulation. Still, just as we are seeing the crest of the wave of physicians selling their practices to hospitals, we are also beginning to see a lot of the reverse trend – physicians leaving hospital employment and starting their own practices.

We have a number of new solo physician practices among our clients and each of these practices can make the numbers work for the three reasons outlined below. Their new practices may look much different from the practices they once had, but they now can bypass the crushing financial burden of start-up costs and find ways to cut expensive overhead. As hospitals ratchet down physician salaries and present new hoops from them to jump through, more and more physicians will look to these new tools for independence and financial viability.

Free EMR

In 2008 I was living in Seattle and I attended a conference at Microsoft in Redmond, Washington. It was there that I met Dr. Bill Crounse, the Senior Director of Worldwide Health for Microsoft. He was kind enough to sit down for a few minutes and talk to me about the future of physician practices. He told me something at the time that I didn’t really understand. He said, “Something is about to happen that will be  game changer for physicians.” At the time I didn’t understand what he meant, but today I believe he was hinting of the pending launch of Practice Fusion, the first free electronic medical record (EMR.)

The free EMR has indeed been a game changer for physicians. The ability to e-prescribe and report PQRS to avoid Medicare financial penalties and to collect the EHR Stimulus money (aka Meaningful Use) without the typical $25 -$30K outlay per physician has been a boon for many practices. How can an EMR be free? With advertising and the agreement that they blind and sell your data to third parties. (Have EMR companies been doing this all along and not telling you? A topic for another post.)

Physicians still need a billing system to run their businesses, but today software vendors are bundling billing packages with practice management and/or EMR software. For anywhere from 2.9% – 5% of net revenue, physicians can use the software and receive insurance billing services as a package. The two largest vendors providing this service are Athena and eClinical Works.

Social Media

The second reason physicians can start a private practice is the replacement of traditional (quite expensive) traditional marketing with social media. For a fraction of the cost of a direct mail campaign, a physician can use social media to establish a digital presence via a website, blog, YouTube and Facebook. These mediums are not free, but they are long tail, meaning that they will continue to drive patients to the practice long after a direct mail postcard has been thrown in the trash.

New Practice Models

Physicians and other care providers have a choice of self-employed practice models today.  Here are a few choices they have:

    • Concierge – concierge can mean different things to different people, but I am using it to describe a practice that accepts insurance and also requires an additional fee from all patients on top of insurance payments.
    • Medicare Subscription – similar to concierge, but applies the additional fee for Medicare patients only to pay for additional services not covered by Medicare, particularly an annual physical examination.
    • Direct Pay – this is a primary care model where patients pay a monthly fee each month that covers unlimited primary care (sick and well visits) and some in-house laboratory services. This model also includes direct-contracting with employers.
    • Telemedicine – gaining popularity for more than just rural specialty care, telemedicine is seeing patients via a secure video connection.
    • House Calls – this model is coming back as a pure practice model because physicians and other care providers do not have to invest in a brick and mortar office. Coupled with the ability to accept payments via their smartphones and the influx of baby boomers, this model is gaining popularity quickly.
    • Nursing Home – Another “rounding” type of practice like the House Call practice, physicians spend 100% of their time in nursing homes seeing patients.
    • On Call Specialty Practice – specialty physicians, typically surgeons, see patients pre and post-surgery in the office of the referring physician and have no brick and mortar office.
    • Cash Practice – this is a 100% cash model with no insurance payments accepted. Typically, physicians will provide patients with what they need to be reimbursed from their insurance plan. Because insurance is not filed, the practice can afford to discount their prices.
    • Co-op Practice – this is a time-share-type practice where one practice or a non-physician owner leases space to physicians, providing everything for one fee except billing, EMR and a medical assistant.
    • Micropractice – an even skinnier form of the co-op practice, the physician works without any assistants and does everything him/herself with just a computer, utilizing one exam room. Micropractice physicians see on average 8 to 10 patients a day.

For more information on different practice models, see our posts Yes, You Can and Should Start a Solo Medical Practice in 2013!How Physicians Can Offer Direct Primary Care to Employers: An Interview with Dr. Samir Qamar of MedLion,  The Direct Pay Physician Practice Model: An Interview With Scott Borden and Physicians are Leaving Hospital Employment and Starting New Practices on Their Own Terms.

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(Photo Credit: nathangibbs via Compfightcc)


Posted in: General

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2.0 Tuesday: HealthCamp RDU Approaches, Cloud Updates in Healthcare, A New King of the Web Browsers

visualizing large amounts of binary data

As managers, providers and employees, we always have to be looking ahead at how the technology on our horizon will affect how our organizations administer health care. In the spirit of looking forward to the future, we present “2.0 Tuesday”, a feature on Manage My Practice about how technology is impacting our practices, and our patient and population outcomes.

We hope you enjoy looking ahead with us, and share your ideas, reactions and comments below!

HealthCamp RDU and Health Innovation Week DC Bring Stakeholders Together for Conversations on the Future of Healthcare

Over the next two weeks two separate events will give stakeholders from all ends of the healthcare spectrum a chance to be a part of an open-ended conversation about the future of care. HealthCamp RDU on Wednesday May 23rd in Raleigh, North Carolina, and Health Innovation Week, beginning June 2nd in Washington D.C. will be fantastic gatherings for providers, patients, advocates, managers, and vendors to come together, engage in conversation, and share their own experiences and visions for the future. With the large-scale changes taking place in healthcare today, more than ever it is critical to share your point of view, and events that bring together such a wide range of attendees offer fantastic opportunities to do just that. Check out their sites for more information on these great events!

(via The Health Care Blog , Triangle Business Journal)

Overheard in the Healthcare Cloud


Posted in: 2.0 Tuesday, Innovation, Learn This: Technology Answers

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Learn This: MP3 Players (Do You Like Good Music?)

This is the first of what I hope will be many posts from my talented technical consultant, Abraham Whaley.  I’ve asked Abe to demystify the technology that is intuitive if you’re under age 30, but Greek to those of us slightly over that age.  I can’t repeat enough that I think it’s important for managers to stay current on technology to stay fresh, stay marketable, and be able to translate world technology into technology for your practice.

Abraham welcomes your questions and comments.

Do you like good music?

How do you listen to it?

It seems every few years the electronics companies come up with a faster, cheaper, better-sounding something, and they begin anew the job of convincing us that it’s the ultimate in sonic enjoyment.

But seriously, what is all the MP3 fuss about?

MP3 is a file format. MP3 files have “.mp3” at the end, so your favorite song looks like “yourfavoritesong.mp3” on your computer. Just like “.doc” means a Microsoft Word document, and “.exe” is an executable program file, “.mp3” is a sound file- i.e. music. MP3 files are a way to “compress” sound files. Compression is a common computer technique, where something is packed into a smaller space than in originally fit into in order to make it easier to use, and send to other people. Maybe you’ve downloaded or created “.zip” or “.rar” files for sending over the Internet. MP3 is just a way to make it easier and faster to send sounds to each other.

In order to make the sound file smaller, the programs that compress them find pieces of the sound data that people never hear, or can barely notice, and removes them. For the most part, this doesn’t affect the sound quality- although some sound mavens people heartily disagree!  And since most MP3 files tend to be between 5 and 10 megabytes, they’re pretty quick and easy to send in emails, download, and transfer from a computer to a music player.


What can I do with MP3s?


Listen to them! Any part of your life that would be enhanced with a little music can be enhanced with MP3s. First you’ll need something to play your MP3 files. That means either a piece of software that can turn the MP3 file into sound, or a hardware device with that software already on it (ie. an iPod).

The most popular choices for MP3 listening software are iTunes and Winamp.  iTunes is the Apple software that comes with the purchase of an iPod- but you can download it regardless and use it for free anyways. Since so many iPods have been sold (more than 150,000,000 as of this March, FYI), iTunes has become the standard in MP3 software for many people. If you’re thinking about buying an iPod, downloading and trying out iTunes is a great way to try the software before you buy the hardware that goes with it. iTunes also allows you easy access to the iTunes Store, where you can buy MP3s of music, audiobooks, and free, Internet radio shows that update and download automatically. Winamp has been around longer, and is a smaller, lighter program- but is still packed with a ton of features.

Also, both software programs allow you to “burn” CDs. Since every song is an individual .mp3 file, you can very easily make custom CDs that have only the songs you want, in the order you want. This was perhaps the most exciting development for me when I discovered MP3s- that I could make my own CDs to listen to in the car or at friends’ houses.


Where can I get MP3s?


First of all, you can make them! Both iTunes and Winamp allow you to (cool slang alert!) “rip” CDs to MP3. “Ripping” is just taking music on a CD and having the computer compress the sounds into MP3 files. Once this is done, the music stays on your computer and you can now play the music on your computer without the CD. You’ve probably just realized another pretty nice use for MP3 files- they can be used to back up your music collection. “Ripping” CDs is completely legal if you own the CD already, or are ripping music that is in the public domain.

Amazon has pricing comparable to the iTunes store, but made headlines by offering “DRM free” MP3 files. DRM (Digital Rights Management) is a way to stop people from sharing MP3s with each other by making them so they only play on certain devices, at certain times etc…But since Amazon offered files without the restrictions, their downloads can be a lot easier to use and enjoy. Apple does offer some, but not all downloads are DRM-free. Buying my first MP3 from Amazon was a delightfully quick experience. I didn’t even have an account with Amazon and in less than five minutes I was enjoying “Wily” by the British reggae band “Greyhound”. Amazon recommends you use their small download manager program, but once you download the program, it’s easy to keep track of the songs you downloaded.

Other services, like Rhapsody and the infamous, but now totally legal and legitimate Napster offer subscription-based programs. For a monthly fee, you can access and download music on your computer, on other people’s computers over the Internet, and onto some, but not all portable music players. The catch is that you aren’t buying the music, you’re paying for the right to access it. So if you decide to cancel your subscription, the music you downloaded doesn’t work anymore.

Additionally, many websites offer free, legal MP3s to download. iTunes usually has a free MP3 of the week, and websites like CNET’s have plenty of free music that aspiring artists and hopeful record labels have released to get you excited about new songs and albums.


What if I want to take my music wherever I go?


So, you’ve downloaded an MP3 software program, ripped a few CDs (making sure to use the word “rip” to impress your kids), and even found some free MP3s online that you really like. Maybe you even organized some songs you like to regularly listen to into a “playlist” so you can hear your James Brown in the morning to get going and your Jackson Browne in the afternoon to relax. Sadly, you can’t take your laptop on a nice jog and shouldn’t browse the web while driving to work.

It’s time we liberated those MP3s from your computer! This is where a portable, hardware MP3 player comes in. There are a lot of choices to be made for those in the market, so here’s how to cut through the mumbo-jumbo.

First, the numbers. The two main things that a portable MP3 has that set it apart are its storage capacity and its extra features. Most everything else is negligible. Storage capacity is just that- how much music and sound you can store on the player.  Storage on players is measured in gigabytes. Now, if we assume for simplicity that most MP3 files are about 5mb (megabytes), we can get a picture of how much storage you need. A gigabyte of storage is roughly 200 songs. So, how many songs do you think you’ll put on a portable player? Are you going to listen to the same music over and over? Probably not. If you have 20 albums that you like to hear, and that’s it, a few gigabytes will be just fine. But if you are always on the hunt for new sounds, you’re going to want a lot more storage. Also keep in mind what else will be on the player- if you want to download movies, then those are much larger files. How about keeping photos on your player? Do you subscribe to any podcasts? The best way to figure out how much storage you need in a player is to start downloading and listening to MP3s so you can get a feel for how you’ll use one, and what you need.

Then there are the extra features. MP3 players are almost like digital pocketknives these days, and you should know ahead of time which tools you want if you’re looking to buy. For example, Apple now makes an iPod that is also a cellular phone (the ubiquitous iPhone), as well as an iPod that can surf the web, and send email but isn’t a cellphone (the iPod Touch). Microsoft’s entry into the market is called the Zune. The Zune has a larger screen, with a more detailed user interface, and some interesting features like the ability to share MP3s between Zune users. If you have a song on your Zune, you can “beam” it to another Zune close by so they can play it too. This feature has a major drawback though- beamed Zune songs are only good for three plays over three days. My neighbor has a Zune, and he loves it. Also, some MP3 players are really more like portable televisions that can also play albums. Examples of these are the Archos 5, and the Cowan O2.

Lastly, if you’re a little overwhelmed by all these choices, I would suggest CNET’s MP3 Player Finder. CNET’s site will ask you some questions, and make some suggestions as to what might suit your needs.


There’s more out there than MP3s!


Don’t limit yourself to just MP3 downloads either. There are a ton of ways to listen to music online, and a ton of different startups trying to “solve” online music. Although I own an iPod, and love finding new MP3s, I also regularly listen to custom radio stations on Pandora, search for songs on Songza and Seeqpod, and I’ve heard great things about MOG, Imeem, and Last.FM.  Plus, almost every new college-rock band and aspiring singer has a Myspace page, usually with music to listen to.

On a cautionary note: beware of getting something for nothing. One doesn’t have to look very hard to find illegal MP3s for download. The ethics of copyright law in the digital age entail more discussion than this column has room for, but suffice it to say, the laws regarding copyright are quite real. Do you know anyone whom has had the FBI knock on their door for stealing music? I do. It wasn’t fun for him.

Also, many of the websites that offer these illegal MP3s also offer other things – viruses, spyware, and things your mother wouldn’t approve of on a healthy computer. Be careful, use common sense, and if something seems too good to be true, it probably is. Except of course, the goodies at =).

To Recap:

  1. Music is good.
  2. Download free MP3 software.
  3. Download free or not-free MP3s or load your own CDs onto your computer using the software.
  4. Make your own CDs or playlists with your favorite songs. (Great holiday gifts!)
  5. To take it with you, purchase a MP3 player after assessing your style and your needs, and load your music onto the player. 1 gig storage = 200 songs.
  6. Don’t steal.  Your Mama would know.

Have fun out there!


Posted in: Learn This: Technology Answers

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Totally Geeky: I Am All Agog When I Visit Microsoft

Okay, I admit it. I am a Geek. I was so happy to be attending my first conference at Microsoft Headquarters in Redmond, Washington, that they didn’t even have to really impress me.

But they did.

I can’t say I was agog at the actual Conference Center; although everything is well-done, it is also simple and unassuming. I was very agog at the people who presented at the Health Users Conference (HUG, which is a users group alliance program sponsored by HIMSS), and with the Christmas morning of information that rained down on my head at the Developer track I chose to attend (other track choices were IT Pro, Health Plans, and Clinical Informatics.)

I have lots and lots I want to report on from the conference and will be doing so over the next few weeks:

* Interview with Bill Crounse, MD on what Microsoft has to offer the private medical practice and his predictions for the future of EHR pricing
* Interview with Melissa Markey, healthcare attorney specializing in technology on why practices come to her for advice and counsel
* Some fascinating demos of products being created with MS technology
* Some interesting perspectives of MS people and my brief experience with the MS culture
* An eye-witness report on “Surface” and how it will be used in healthcare (it went on sale today but I failed to bring my checkbook with me and my cards are all maxed out)
* Heard while at MS: some very interesting statements that I didn’t expect to hear
* My own wild ideas for my practice after being exposed to some gee-whiz products at MS

But first, back to work and the real world tomorrow, then some vacation time to spend with my daughter who’s visiting from 3,000 miles away, and hopefully, some serious posting on my blog, which is about to change from “” to “” Either name will work.

Posted in: Innovation

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Learn This: Game Systems for Those Of Us Who Don’t Know the Difference Between Nintendo, Sony and Microsoft Consoles

Twenty years ago we bought our son a Nintendo.  That was the last time I felt up-to-date on the game system world.

Today gaming isn’t just for kids anymore.  It’s for kids and adults of all ages; it’s for fitness, eye-hand coordination, relaxation, sports improvement, strategy-development, cooking and much more.  I recently asked my 21-year old daughter to give me some insight into the current world of gaming.  Here are her descriptions of the three competing gaming companies and her comments on each.


  • Japanese Company
  • Translated from Japanese to English, Nintendo means “leave luck to heaven.” (Potential Jeopardy question.)
  • Product evolution is Nintendo (NES), Super Nintendo (SNES), Nintendo 64, GameCube (GCE), Nintendo Wii (pronounced “we”) which was introduced in 2007 as the world’s first interactive gaming system.
  • Handheld players evolved from Gameboy, Gameboy Color, GameBoy Advanced, GameBoy SP, to Nintendo DS (Dual Screen.)
  • Least expensive systems.
  • Most famous game of all time from any company is made by Nintendo: the Mario series.
  • Add-ons include the cross-bow and the steering wheel.
  • Comments: More family-oriented; games are colorful and happy.  The Wii took the company from competing on graphics to competing on interactivity.  My favorite games because there’s never been much blood.


  • Japanese Company
  • Product evolution is PlayStation 1, PlayStation 2 and PlayStation 3, introduced in 2006.
  • Widely recognized as the gaming system with the best graphics.
  • More premium systems can play older version games.
  • PlayStation 3 has a Blu-ray high definition DVD player.
  • The handheld player is the PSP (PlayStation Portable.)
  • Comments: I never had a strong attachment to this player; I watched my brother play but never wanted to play myself.  I think the games available are limited.


  • US Company
  • Product evolution is XBox and the XBox 360 introduced in 2006.
  • The XBox 360 has a DVD player and an HD DVD player can be added.
  • Music can be uploaded from CDs and can be listened to regularly or instead of game music.
  • MS introduced the Halo series, which is a first-person shooter game and is one of the best-selling games of all time.
  • The system allows play by Internet with players around the world.
  • No handheld is currently available.
  • Comments: Cool that you can play your music through it, but I despise Halo because of its violence.

Now go impress your kids, your grandkids, your neighbors’ kids, and that new doctor you just hired.

Posted in: Learn This: Technology Answers

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Prepping for a Microsoft Field Trip: Watching House Calls for Healthcare Professionals

Yep, I’m heading to the Microsoft campus this week to take part in HUG, the Health Users Group Conference. I’m doing my homework and trying to get the most out of my visit by catching up on what Microsoft is doing in the healthcare sector.

I found two great videos by Bill Crounse, MD (hope I get to meet him!) talking about the cool stuff going on at Microsoft Research. Bill is Senior Director, Worldwide Health for the Microsoft Corporation and according to his site HealthBlog, he is responsible for providing worldwide thought leadership, vision, and strategy for Microsoft technologies and solutions in the healthcare provider industry.

It takes a few minutes to download these videos (about 15 minutes long to view each) to your favorite player, but it is worth it, IMHO. I will also consider showing these videos, particularly the 1st one, at my next staff meeting as something to stimulate ideas and give everyone a flavor for what our future might be.

Look for links to his videos in his post and at the bottom of his post: Microsoft Research: How we watch the computer, how it watches us

I’m going to take a leap of faith and try to record a video during my two days at the HUG Conference. Check back to see if I’ve been successful!

Posted in: Innovation

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