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Work Smarter, Not HarderTemplated Forms for Independent Physicians

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Audio Transcript

Speaker: Hello and welcome to the AMA STEPS Forward® podcast series. We'll hear from health care leaders nationwide about real-world solutions to the challenges that practices are confronting today, solutions that help put the joy back into medicine. AMA STEPS Forward® program is open access and free to all at stepsforward.org.

Taylor Johnson: Hi everybody. My name is Taylor Johnson, manager of physician practice development at the AMA, and I'll be your guest host today. Today we are joined on the podcast by guest, Dr Carolynn Francavilla, family medicine physician in Colorado. Dr Francavilla, thank you so much for being here with us today. And why don't we start with you telling the listeners a little about yourself and your background?

Carolynn Francavilla, MD, FOMA, D-ABOM: Thank you. I'm excited to be here. I am a family physician and I also have a focus on obesity medicine, and I started my practice about a year after residency because I really felt like independent practice was the best way for me to serve my patients and be able to go into more depth with them, focus on things like weight that really need longer appointments. So private practice is very important to me and as a result, I am the chair-elect for the AMA's Private Practice section now, which I'm really excited about and very happy to be here and talk about some of the really cool resources the AMA has created.

Johnson: That's awesome. And with your experience starting your practice out of residency so early, I'm sure that you probably had to figure out a lot of things on your own and experience some of these pain points that we hear about firsthand and now being chair-elect for the private practice physician section, I'm sure that you just get even more feedback from the private practice docs on their pain points.

Dr Francavilla: Absolutely. It's funny, some of the things that were overwhelming when I went to start my practice because in hindsight, those are things that often have simple solutions. But in the case of the forms, so I think we're going to focus on talking about today, that was something that continued to overwhelm me. And one of the things that happens in medicine is there's continually new legislation, new policies, updates to things, and when we're busy doing the day-to-day of taking care of patients, it can be hard to keep up with some of these changes in legislation. None of us want to break the rules. We all want to do the right things for our patients. And I think that definitely is a pain point that a lot of us see in private practice is keeping up with regulatory changes.

Johnson: Exactly. So yes, we're here to talk about the Private Practice Playbook, specifically the sample forms appendix, which is a collection of templated forms for independent physician practices, and it covers patient, employee, and administrative needs. So can you tell our audience how this project came about and what the pain point or the problem at hand was that you were seeing in physician practices?

Dr Francavilla: Yes, absolutely. So many pain points that we have in private practice, but some of them seem to have simpler solutions than others. And one of the things that I had found was always a bit of a stressor and that I was worried I wasn't doing right was if I had the right forms and it felt like there was more and more that needed to be out there. So things like our HIPAA form, but then we had new things like the No Surprises law that passed, things like financial agreements and keeping up to date with those was something that I found a challenge for my practice. And when I interacted with other physicians, it was something that it seemed like they always wanted to double check on. They wanted to see someone else's form. What are you using? It was a resource that people were wanting to share.

So that was something I saw from my practice. And I also heard from my colleagues that is this the right form? Is it written right? Again, I think we all want to be doing the right thing, but we're not lawyers, we're not experts at creating forms. We want to focus on taking care of patients and do the right thing. So this felt like a problem that would have a simple solution if we could have someone help develop these resources for doctors.

Johnson: Exactly. And it's quite a long process back and forth if physicians were to take this on themselves and go to an attorney. So not only the time commitment for that, but also the cost associated with it to have these forms written for them from scratch is a huge burden.

Dr Francavilla: Absolutely. So then people would do a couple of things. They would just take a form they found from another clinic, which may or may not be right or optimal, or they would pay a service or a lawyer often a lot of money to develop a form. And that just starts to add to overhead and add to this administrative burden that can make having an independent practice really challenging. So I think that those were the challenges as you were either dealing with, forms that you felt like were maybe not ideal, not perfect, you were just hoping they were good enough, or a significant amount of investment of both time and financial resources to be able to have forms that you felt were the best for your office.

Johnson: And you were such a great resource in helping us identify which forms we should include. We have employee documents, administrative documents, and then the new patient packet, and other patient documents. Could you walk us through how a private practice might tailor these documents to suit their own needs?

Dr Francavilla: So I think that there's probably two different ways people would use this. One would be a new physician practice. So if you are starting from scratch, this is just a huge resource to give you everything you might want to start with as a starting point. And then you might bring that to a lawyer in your area to make sure that it is following specific statutes that may be relevant to your state. But then you at least have a really strong basis of forms, or you might compare them to what colleagues are doing in your area as well. And then I think for those of us who have established practices, this can be an excellent time to review the forms that you have and make sure that they are the most up-to-date and that they are written optimally.

So that's what we just did at our practice. I was so excited for these forms and we were updating one of our forms anyways at our clinic. And so we used this as an opportunity to just take a look at all of the paperwork we were offering as a new patient as well as our follow-up forms, our HIPAA forms, making sure we're being compliant with the No Surprises Act. And we're able to, in some cases, use these sample forms as our new form. And then in some cases we just compared the form we were currently using to these and said, "These look really similar, these look good enough." And then of course, also can customize these forms.

So for example, I keep talking about No Surprises, but I think that's a newer thing that we're all trying to comply with. And the form that is in the packet from this resource is really long, really extensive. So that's one that a practice may want to adapt for their workflow and make sure they're using the key points from it, or they may just want to use it exactly as is. So I think lots of different ways that you can use this. I don't think there's one right way to use these forms. I think that they again, are a one-stop shop if you're starting a new practice.

But if you have a practice already, great chance to review what you have or supplement or if you're looking to update your forms or your processes anytime soon, use these as a resource because they've been vetted and that they are a credible form that you can utilize. To have these all in one place, I think you can easily review these and compare them to the forms you have and get things optimized in one or two hours. And I know for me, optimizing this has been on my to-do list for years and to have that one-stop shop, a couple of hours investment of time versus dozens of hours and not being sure that I have a good product, is definitely a huge value.

Johnson: You worked really closely with the office of general counsel at the AMA to make sure that these forms really included everything from a regulatory standpoint at the national level. And that's why we always say your state may have different requirements, so we always want physicians to check their specific state regulations, but from a federal level, we really took a magnifying glass to these and made sure that we were covered from that end. And I also just want to note that the attorney at the AMA from our general counsel, he actually has a history of helping private practice physicians. So he was also a great resource. He's very familiar with creating forms like this specific for independent practice. So I thought that was just another great addition to the review process for these.

How do you think that these forms would still be valuable to a physician that is using those digital forms? A lot of them kind of come out of the box from an EHR vendor or you can download just a whole bunch of them, and they're automatically uploaded to your EHR if you are using one. How do you think that these forms would still be valuable to a physician that is using those electronic forms?

Dr Francavilla: Well, certainly you can turn these all into electronic forms. So we've been using electronic forms for several years through a software that works really well for our clinic. So that particular one can read a PDF file and turn it into a form. It's a really robust tool. So you could certainly just use these forms or again, I think using these forms to compare to what you have. So if you have a form you created yourself or that you got from a colleague or maybe got through your software, this may be sort of a good double check. I think as physicians, a lot of times we're perfectionists, we like to follow the rules, but sometimes the rules on the business side of medicine can be a little overwhelming. And I think this is such a tremendous resource to just feel confident that the forms you're currently using maybe are correct. And if they're not, then now you have a go-to resource where you can use a really optimized form.

And you guys really went above and beyond with this project, with all the employee resources that were created. That's a workflow I know we have always tried to optimize in our clinic, is how often do we do employee reviews and how do you really do an employee review? That's not something that we're taught. So to have a resource, even a starting point, you don't have to use it. There's no rules saying you have to use those resources exactly as they are, but it gives you a starting point and one less thing that you have to do on your own in order to feel like you're running a successful practice.

Johnson: I was so surprised by the feedback that a lot of practices didn't even have a request off form for their employees, which is something that seems like it's so overlooked and it's something that is so essential, but no one really considers creating that form. It's always just send me an email or they jot it down on a piece of paper. Especially as we're dealing with a staffing shortage.

Dr Francavilla: Those HR resources are really helpful because most of us are not big enough to have a full-time HR person. And for small practices, oftentimes the owner is the HR department, and we're physicians, we trust people. We tend to do things a little bit more on the honor code. So I do think this helps solidify some of those processes on the HR side, and again, without having to reinvent the wheel or spend a lot of time on Google trying to find a form or make one yourself, easy way to get that process started. And again, you can add to it over time, so if there's customization that you need for your clinic, but at least you have a starting point, which is just I think a tremendous resource for physicians.

Johnson: Well, that's awesome. Do you have any other tips or pearls of wisdom for any other physicians who might want to take these forms and run with them?

Dr Francavilla: This is something that again, can be an overwhelming task for some people, especially the sort of classic type A physician who likes to make sure everything is right. So if you've been using forms for a while that you are not sure are optimal, again, maybe in the next year, make this part of your workflow to review them and make sure that the forms you're using are the most up to date and appropriate forms that you can be using for your clinic. And if you don't have some of these HR workflows in process, this may be a great way to start that. And I think that you'll find that investing a small amount of time in reviewing these is going to potentially save some pain points later on with your practice. So again, I'm just so grateful for this team at the AMA for creating these forms. I think that these are the sort of resources we need to just streamline and make independent practice easier.

Johnson: That's great. And we wouldn't be able to do a lot of these things without the input from all of the members. So thank you so much, and thank you for joining us today. It's been great.

Speaker: Thank you for listening to this episode from the AMA STEPS Forward® podcast series. AMA STEPS Forward® program is open access and free to all at stepsforward.org. STEPS Forward® can help put the joy back into medicine by offering real-world solutions to the challenges that your practice is confronting today. We look forward to you joining us next time on the AMA STEPS Forward® podcast series, stepsforward.org.

Audio Information

Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

If applicable, all relevant financial relationships have been mitigated.

Disclaimer: AMA STEPS Forward® content is provided for informational purposes only, is believed to be current and accurate at the time of posting, and is not intended as, and should not be construed to be, legal, financial, medical, or consulting advice. Physicians and other users should seek competent legal, financial, medical, and consulting advice. AMA STEPS Forward® content provides information on commercial products, processes, and services for informational purposes only. The AMA does not endorse or recommend any commercial products, processes, or services and mention of the same in AMA STEPS Forward® content is not an endorsement or recommendation. The AMA hereby disclaims all express and implied warranties of any kind related to any third-party content or offering. The AMA expressly disclaims all liability for damages of any kind arising out of use, reference to, or reliance on AMA STEPS Forward® content.


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