The Economics of Medicine – Challenges Still Exist

The Economics of Medicine – Challenges Still Exist

So what are the top ten challenges facing
physicians and healthcare practitioners in 2018 and looking forwards to 2019? Whether you are a heart surgeon, brain specialist, or a doctor that treats a patient’s nose or toes, here’s how to avoid being stuck in the middle and suffering from burnout.
Torn between patients and paperwork? Fighting with payors? Read on…….

1.    Too Much Time on Uncompensated Tasks
– you should not be grinding your way through tasks such as prior authorizations, EHR data entry and non-clinical paperwork. Avoid anything that does not require a medical license and minimize distractions that pull you away from revenue generating work. Learn to delegate and you will increase your income.

2.    Third Party Problems – Hate when insurance companies tell you how to practice medicine and require prior authorizations? Interference from insurance companies costs you time and money, so document the details of symptoms and prior treatments, have a cheat sheet of meds that are triggers, have staff start a list of tests and meds that create difficulties with payors and track the types of care being denied.

3.    Demands of EHR Data Entry – Information technology can improve care and patient outcomes, but don’t stress over dividing your time between engaging the patient and pounding the keyboard. Engage with your patient and you will keep that patient! Hire a scribe to transcribe notes and complete your templates. Additional staff can increase revenue by freeing up physicians to see more patients. Not an option? Have the patient history cut and pre-pasted in the record to get a head start, and keep your laptop on a movable cart instead of a counter where your back has to be turned.

4.    Managing Quality Measures – Have a MAP for MIPS! Focus on what you do well when picking measures for evaluation. Think about where there id room for improvement over time. Select what types of care you provide the most so there is a large enough sample. CMS is working very hard, correctly, to nullify the impact of MIPS. Physicians or groups with $90,000 or less in Medicare Part B charges or 200 or fewer Part B patients will not be required to participate in quality metric reporting.

5.    Family Interference - Asks families to accompany the patient to appointments. When the patient is present, in some instances you can bill for the time spent counseling family members and answering questions.

6.    Lack of Patient Adherence to Regimens and Protocols - Costs of prescription drugs, greater deductibles and co-pays for visits and care, are making the task even harder. Prescribe generics where possible and offer info on the financial assistance major pharmaceutical companies now offer, or what’s available from community non-profits and government orgs. GoodRx and OneRx, that enable comparison shopping for co-pays and/or provide access to discounts for certain medications. Partner with pharmacists where practical.

7.    Realities of Reimbursement – The shift from volume to value continues, ACOs and bundled payment arrangements are not going away – although they may be “in limbo” as the CMS drags its feet on alternative payment models (APMs) data, claims, value definitions and goals. CMS has pledged to physicians that it will reduce regulatory burden.

8.    Changing Doctor & Patient Relationship. Welcome to the era of Telemedicine. Did you ever want to say to a patient, “…don’t confuse your Google search with my medical degree???!!!” If respect is lacking in the exam room, and your diagnosis and treatment is questioned because of what someone saw on social media, remember to keep your compassion and don’t take it personally. Patient awareness can be a good thing.

9.    Staying Independent – Maybe it’s time to change your practice model? If insurance reimbursements are down and costs are up, consider contracting directly with patients via a direct primary care model where patients pay a flat monthly fee to the doctor in exchange for expedited access. You can eliminate a lot of documentation, billing and coding. Or look into joining an ACO. You might want to offer ancillary services where appropriate like therapy, estheticians or dietitians (just to name a few) to boost your bottom line and add much needed revenue.

10.    Banning Burnout -  As you can see from all the above, the challenges are many, but don’t let the busy waiting room, or difficult patients, or dealing with payer rules drag you down or depress you. See our prior article on physician wellness here for top tips: Physician Wellness – Fuoco’s Fast Five to Thrive

As you work for the health of your patients, the professionals at Fuoco Group work for our physician clients’ financial health. If you are worrying about cash flow, internal controls, staff and equipment issues, perhaps the prescription is customized accounting and financial services from a CPA firm well versed in medical practices. Our “New Financial Dialogue” includes a 360 degree business advisory program designed to take the burden off you because worrying about costs, reimbursement, margins, operations and finances shouldn’t be keeping you awake at night!

Contact us today – offices in New York, Long Island, and South Florida. Call 855-534-2727 to learn more or visit

This article is not intended as medical or financial advice.


In The News

The New York Real Estate Journal recently featured a "Ones To Watch" Spotlight, focusing on both up and coming professionals as well as industry veterans across all areas of real estate. Congratulations to Lou Fuoco CPA, CEPA, for being included in this prestigious group of “OTW” for 2019!

Press and Events

Fuoco Group and TFG Related Entities are proud to announce that Managing Partner Lou J. Fuoco, CPA, CEPA, CVB, has received the 2020 Palm Beach Post Community Choice Award for Best Accountant in Palm Beach County. Lou Fuoco and the Fuoco Group won this award in 2019 as well.
Fuoco Group and TFG Related Entities are proud to announce that Fuoco Group’s Hauppauge Office, was voted #2 overall in the category of “Accounting Firm Less Than 100 Employees” in the 2019 Long Island Business News Reader Rankings. The Firm was also honored to be recognized as a “top three” Best Accounting Firm Finalist.