• Guest Editorial

    Practice Hacks Offer Simple Ways to Resolve Complex Issues

    April 26, 2022, 8:47 a.m. Jennifer Bacani McKenney, M.D., F.A.A.F.P. — I’m Jennifer Bacani McKenney, M.D., F.A.A.F.P., and I own and manage a group practice in my small rural town of Fredonia in southeast Kansas. (And by small, I mean there are only about 2,500 residents!) The practice includes three other physicians — one of whom is my dad — and one advanced practice RN. Together, we provide full-spectrum family medicine minus obstetrics, along with sports medicine services, general surgery, osteopathic manipulation and more.

    family medicine practice hacks logo

    I have my dad to thank for my decision to become a physician and for showing me that family medicine was the specialty for me. Although he’s a general surgeon by training, he has delivered primary care services throughout his more than four decades in practice. As a kid, I helped out in the clinic when I could, shuttling patient charts around and helping out with filing. (Of course, this was long before EHRs came on the scene!) I also joined him on house calls sometimes and even on rounds occasionally.

    Fast forward to 2009, when I joined the practice as a full-fledged member of the medical team. The lessons I gleaned from managing a practice efficiently while building professional satisfaction far surpassed my medical school and residency experiences and were light-years ahead of what I had imagined as a kid.

    Whether you’re in independent practice like me or employed by a hospital or health system, we probably face many of the same challenges. As host of the AAFP’s Family Medicine Practice Hacks, a video series that tackles a wide range of practice issues, I want to share three of the many lessons you’ll find in our Practice Hacks series. I encourage you to watch the videos for yourself to learn more — you’ll find links to each of them below — and get support for your practice and career.

    Lesson One: Fight for Your Value in Contract Negotiations

    Take it from me: Few decisions you’ll make in your lifetime are as important as choosing where and how you’ll practice family medicine. If you’re looking for an employment opportunity, it’s critical to ensure your employment agreement recognizes your value. Even if you’re not looking for a job, you may know a colleague who is and could benefit from some advice on negotiating a contract. The Practice Hack “Negotiating Your Employment Agreement” can show you how to get started by showcasing these four tips:

    • hire an attorney and a financial adviser
    • weigh job pros and cons while identifying red flags
    • ask the right questions of the right people and
    • understand termination provisions.

    In addition to the Practice Hack, the Employment Contracting webpage is where you’ll find links to FPM’s September/October 2021 career issue; an FPM supplement devoted to navigating employment contracts; a comprehensive, members-only guide to employment contracts; a member-exclusive letter template created to help you advocate with your employers for fair compensation; and more.

    Lesson Two: Tweak Your Workflow to Streamline Prior Authorizations

    With more than eight in 10 physicians saying the burden of prior authorizations is high or extremely high, it’s no surprise that their impact on us family physicians — who, after all, provide the most comprehensive care possible — is profound. The best-case scenario? Eliminate PAs that are not clinically relevant (which is most of them), standardize those that remain across payers, and automate associated processes wherever possible. The AAFP is striving to make that happen, but in the meantime, these strategies featured in the Practice Hack “Prior Authorizations” may help lighten the load:

    • designate a single staff member to be your “PA pro,”
    • standardize your PA workflow to include everything each payer requires and
    • develop PA “cheat sheets.”

    Get hands-on help managing PAs with another key resource created just for members, the Prior Authorization Cheat Sheet Workbook. Use the workbook’s many templated tabs to create a customized form for each of your payers that includes information such as type of service, relevant CPT or other codes, and clinical documentation and diagnosis details needed for PA approval.

    Lesson Three: Empower Your Team to Find Success in Value-based Payment

    By accounting for patient complexity and associated care costs, risk adjustment is fundamental to succeeding in value-based payment arrangements, so it’s important to make accurate diagnosis coding a team affair. The Practice Hack “Using Team-based Strategies to Improve Risk Adjustment” outlines how you can help ensure that risk adjustment accurately reflects the health of your patient population by fostering a culture of ownership and autonomy. Invite all team members to take these steps:

    • focus on coding specificity,
    • utilize all available data and
    • view every patient visit as a chance to provide needed care.

    Be sure to explore other useful resources you’ll find on the Hierarchical Condition Category Coding webpage alongside this Practice Hack, including FPM articles titled “Is Your Diagnosis Coding Ready for Risk Adjustment?” and “HCC Coding, Risk Adjustment, and Physician Income: What You Need to Know,” as well as an FPM supplement dubbed “Understanding and Improving Risk Adjustment in Team-Based Care.” You can also view an exclusive webcast, “HCC Crash Course: Absorbing the Impact.”  

    I’ll be bringing you more Family Medicine Practice Hacks this year, so keep an eye out. It’s all part of the effort to simplify your life, support your practice and enrich your career!