Intro (00:01):
Welcome to Health Law Talk, presented by Chehardy Sherman Williams health Law. Broken down through expert discussion, real client issues and real life experiences, breaking barriers to understanding complex healthcare issues is our job.

Conrad Meyer (00:21):
Good morning. Good afternoon. Whenever you’re listening to this. This is another edition of Health Law Talk here at Chehardy Sherman Williams, Conrad Meyer, Rory Bellina, bringing you the latest and greatest in healthcare legal discussions here in mere Louisiana, overlooking a beautiful, gorgeous day pre jazz fest. If, if, you know , if you know what that means, if you’re a local, or even if you come here. And today we have a special guest in the studio, Dr. Katherine Williams, a an ob gyn OBGYN on the North Shore, right? Correct. Okay. Who was, he was heated to talk to us. This is sort of a follow up to a, to a podcast, Rory, I did on vendor agreements. And Dr. Williams has a very unique experience, and over the years in her practice, as she’s watched it grown, and I’m gonna get her to talk a little bit about that. So, Dr. Williams, for for the listeners here who don’t know you, introduce yourself, tell us a little bit about your practice, your background, and, and give them an idea about who you are and why we’re here.

Dr. Katherine WIlliams (01:16):
Okay. Thank you. And thank you for the opportunity. I am a practicing ob gyn on in the North Shore. On the North Shore in Covington, Louisiana. Actually started my practice on the South shore, but relocated in the North Shore in 2003. I have built my practice to now employ two doctors and three nurse practitioners. So it’s been a journey and I’ve learned a lot about running business and about running a successful practice. And so I’m happy to be here to share that experience with your listeners. I hope that it does benefit them. No,

Conrad Meyer (01:52):
It, I’m sure it will. I’m sure it will. So, let’s let’s get to the meet. Tell, tell us, tell us what ha, tell us about sort of where, why we’re here and, and what, what are the takeaways that, that visitors will learn once they get to listen to this podcast?

Dr. Katherine WIlliams (02:05):
Right. so I also wanna say that I am past president of Louisiana State Medical Society. So I’ve been in a unique position to watch and recognize that many physicians who enter private practice struggle with the, the idea of running a business. It’s a little overwhelming. And also the lack of knowledge base to really know the pitfalls and the things that you need to be aware of. I will say this, and this is not necessarily a play for you, but my best friends are my accountant and my attorney, because you have to make sure that you have them on your side so that you make a good decision that small, I’m not gonna say small investment for your attorney, and your accountant will pay tenfold, because if you make a wrong decision, it could cost you a fortune. And I will share my experience with you on that. . I,

Conrad Meyer (02:57):
I love that. Well, I mean, I gotta tell it’s hard for us because, well, number one, Rory, I’m sure Rory and I would, would, would both agree with you that having competent counsel and having that relationship is very critical for your practice.

Dr. Katherine WIlliams (03:10):
Yes, absolutely. So I started I finished my residency at LSU in 1998. Mm-Hmm. . Originally I was self-employed for a little while, joined a group in on the South shore, but relocated to the North Shore, as I said, in 2003, and went into private practice for myself. Again, started off by myself, solely sole practice, very difficult. And as I started to grow, I built an office, and then I hired a nurse practitioner and ultimately hired a physician. This was about, I believe, 2010. Shortly thereafter, we, we understood that to have equitable reimbursement fair reimbursement from the insurance companies, there was a mandate that you had to have ehr, especially if you wanted Medicare reimbursement, or you would have a fine or penalty or reduced percentage. So it made financial sense for us to then implement ehr Prior to this we’re strictly paper charts, right. Not knowing much about it. And there were a few vendors out there did some research and found different companies and did online consultation with them and discussed what products they have to offer.

Conrad Meyer (04:26):
Okay.

Dr. Katherine WIlliams (04:27):
We signed our first contract thinking we were getting the – a great product. Within two years, we realized that we were basically sold a box of pancake mix, and that we had to make all the pancakes ourselves. And when I say it was bad, it was really bad. So

Conrad Meyer (04:46):
Let’s, let’s, let’s call that vendor one. All right. Vendor one, vendor one for ehr. So, mm-hmm. , I mean, you know, obviously you’re, you’re smart, you’re mm-hmm. , you’re, you’re, you’re entrepreneurial. What, what did you learn? In other words, what research did you do? And then what sort of did you start to realize, like you said, you, you got the pancake mix, but then suddenly you realize that you’re doing all the work. How did that evolve? Well, what,

Dr. Katherine WIlliams (05:07):
What we, what we learned then is that there are different companies with basically different stages of development. So just because somebody says, we offer all this, you really have to ask more questions. How long have you been in business? What templates do you have? How many OBG line customers do you have? These questions we didn’t understand mm-hmm. and come to find out, they were basically a beta and that they did not have a fully established product. So they were relying on us to create templates and mechanisms within their EHR for it to function properly, and yet paying a lot of money. And so when, whatever you enter in whatever product you choose, keep this in mind, it’s going to cost you a lot of money to implement mm-hmm. . So regardless of how much you’re paying for that product, go ahead and, and add on a few hundred thousand dollars, because that’s how much time it’s going to take. It’s going to cost you patience. You will not be able to see your full patient load, and it’s going to cost you staff hours to do all the, the computer work, whether it’s scanning your paper charts. So I’m talking a couple hundred thousand dollars investment now in the long run, it’s gonna pay off.

Rory Bellina (06:23):
When you onboarded this company, what did you, how did you find them, I guess, did you hear from them from other colleagues? Was it simply, did they reach out to you? What’s that process like? Because I, I just got this question last week from an up and coming practice, and they said, you know, we want to know which ER vendors or EHR vendors to go with. And I was like, well, I know who, you know, some of your competitors essentially use, and these are like the big names. But besides that word of mouth, you know, how did you approach it?

Dr. Katherine WIlliams (06:53):
Right. So, understand that when I first looked, it was the beginning of the EHR movement. I, I don’t believe that there was that mandate in place yet, but it was the beginning of it. Sure. So the resources back then were limited. Most of it was online searches, reviews, but most of that has been doctored by those companies. You know, that they’ll pay for that promotion. Right. I’ve learned a lot about that. Now, the best way to find out about it today is to talk to your peers. I hope through L S M S, this is one of the programs I’d like to develop as chairman of the private physician section for L S M S, that we do have ways for physicians to learn more about EHRs that are out there, have maybe doctors that have it that they can talk to. And also working with attorneys to make sure they know how to properly represent their patients. Because it’s complicated. I’ve learned even so much more since last time we talked. So

Conrad Meyer (07:50):
Mo, most of those standard billing contracts require some percentage. Right. And, and, and then they have either, they have a percentage fee only if you meet certain types of, of BA benchmark receivables, and then if not, then it’s a flat fee underneath that. Is that what you started with?

Dr. Katherine WIlliams (08:05):
Not necessarily. So that’s what I’m gonna tell you about the different product lines that are out there and the different types of billings Okay. That they can do. And then the questions you need to ask moving forward in that company, we did get out of it. We ended up having to sue them be, and it was, oh, it was, it was terrible.

Conrad Meyer (08:23):
So, wait, lemme get this straight. So you create the templates for their billing people to then submit the claims. Then who, who worked the claims? In other words, who worked the denials, who worked the recruitments, the refund, who did all that? We

Dr. Katherine WIlliams (08:34):
Did all of that.

Conrad Meyer (08:34):
So, in other words, they, they didn’t even work the claims.

Dr. Katherine WIlliams (08:36):
All they did was given us an electronic record that we would basically document on, and then that was it. We had to do everything else

Conrad Meyer (08:44):
After that. So you move into the pays yourself too. Yes.

Rory Bellina (08:47):
So getting,

Dr. Katherine WIlliams (08:47):
So again, this was the beginning of the Noel? No, no. Let, let me, let me correct that. We had a separate billing software program. Okay. Okay. But they, and they were, they, they were integrated but not fully integrated. So again, not it, what we realized was there were significant limitations and that,

Conrad Meyer (09:05):
So you had to produce the claims within the ehr, then move to the billing program to submit to this payers, is that

Dr. Katherine WIlliams (09:10):
Right? They were integrated but not fully integrated. Yeah. And so that, that, again, that’s a problem. But they promoted integration. But if you, what I’ve learned is it’s really best to have the same company do both to really have an effective Yes. EHR program. Sure. Right?

Conrad Meyer (09:27):
Mm-Hmm. , I’m

Rory Bellina (09:27):
With you. Okay. I know, I know a few practices that still do paper claims. A lot of ’em are obviously shifting cuz you want that higher reimbursement and that, that mips and it went on to stage two and three. You talked about the, the burden on your staff and like the lost revenue. What, what was that process like for you and your staff when you said we’re switching from paper to electronic? How did, how did that go? Oh, they handle

Conrad Meyer (09:48):
It. Right. That’s a good question. So

Dr. Katherine WIlliams (09:50):
That was the beginning of my, you know, again, that was the, when I had one nurse practitioner, myself and one other doctor, we had a smaller staff. I mean, everybody, we have a great staff and they really, we just all work together to get the job done. And they, they really do take good care of me. I’m, I love my staff. So

Rory Bellina (10:10):
Once they, once they knew that they had to do this and, you know, learned how to do it, they, they, they rolled with it and

Dr. Katherine WIlliams (10:15):
They did roll with it. But of course I had to pay overtime incentives. So again, it cost money. You’re paying money to implement. Correct. Yes. Moving forward, we then started looking at other EHRs and learned a lot more about how to vet and research and knew the right questions to ask. Okay. This would be vendor number two,

Rory Bellina (10:37):
. Okay,

Conrad Meyer (10:38):
Here we go. All right, here

Dr. Katherine WIlliams (10:39):
We go. And I would say that for the most part, we were, I mean, we were in a honeymoon phase. We just thought this was the best. They, so what we did is they, this is an EHR that included billing and practice management.

Conrad Meyer (10:56):
Okay.

Dr. Katherine WIlliams (10:56):
Now, when you were asking me about paper claims and about billing programs, you can have anything from the basic where it will create a ticket that that will be then sent to the, to the insurance company for billing. But you can also have other services that will really save you money and time and allow for more efficiency in your office, such as insurance verification, so that your, your schedule then is looked at by the EHR or the vendor that you’ve hired to make sure that all of them have valid insurance policies. Oh, wow. Goes even a step further. It will tell you what their copay is so that you’re getting your money on the front end. You’re

Conrad Meyer (11:39):
Collecting the proper copays, you’re verifying.

Dr. Katherine WIlliams (11:42):
And if you look, I wanna say, I’m sure the numbers have changed, but for every bill that you have to submit to go try to get paid for service, you had provided it’s like $9. But if you get the, and it might be more now with inflation. Sure. But if you get the money right, when the patient presents, you’re then also s you’re, you’re, you’re, you’re, you’re, you’re keeping that money, which you should. Right? Right. Because you’re not getting extra money. It’s your money. It’s your money. Exactly. Your money. So to collect money on the front end is of the, the utmost importance. Sure. The other thing that they do is they will then submit it to the insurance companies that almost a majority of the cases will find some reason to deny it. Sure. This number’s not right. This code’s not right. This is gonna, we’re not gonna pay for this code with this this e this procedure code with this diagnosis. So they have companies that also offer service to what they call fixed denials or sweep to make sure they’re clean claims. That’s what a clean claim is. And, and,

Conrad Meyer (12:43):
And, and that’s what I tell physicians when we talking about payer agreements. That definition of a clean claim is so

Dr. Katherine WIlliams (12:49):
Important. So important. Because otherwise you have your staff sitting there trying to figure out what’s wrong with it. Okay. Yeah. So now we’ve saved money on your check-in, people not having to verify benefits, knowing how much to collect upfront. You save money on your billing people, and now you’ve also saved money on your billing people not having to go fix a claim. All right. And then the, it’s submitted to the insurance company and you receive payment, it goes into a clearing house. Mm-Hmm. , they collect all the money for you, and then they move it into your bank account. But there’s one other part to this. It is posting payments. So they also can offer service where they will look and see what you got paid and which visit or patient that’s assigned to, instead of having your person at the, in the building department, have to go through every claim, which sometimes you, in a practice in my size, you know, there’s several under day. Right. Right. They’ll go in and, and have to manually do that. Now, these programs, these, these EHR practice management programs can do that for you.

Rory Bellina (13:52):
And you mentioned practice management. So this is also, it also handles like your scheduling and coordinates kind of your, your flow of your day or what other practice No. Or

Dr. Katherine WIlliams (13:59):
Does not do. All they do is they provide a template for that. You still have your office people that Okay. That does take the phone calls, schedules, the appointments. Okay. there’s even other components Sure. To an EHR that you can pay extra for. Like one of ’em will let you, which we have some of these where on presentation, the patient takes an iPad and they will check off everything in the review of systems list. And then it’s automatically downloaded into the ehr so that now you’ve saved money with your nursing staff not having to sit there and get that, you know,

Conrad Meyer (14:34):
Or it generates the super bill automatically.

Rory Bellina (14:37):
I just, that’s, I’ve been to somewhere recently that had that. They, they give you the iPad on the check-in. That’s nice.

Dr. Katherine WIlliams (14:42):
So yes. It really, it really is. It really is a nice service that we also utilize. There’s a there’s also anothers, I’m, I’m just telling you this because this is, this is basically, you can go anything from just the basic ehr, the basic building to something that really helps you reduce your staff.

Conrad Meyer (14:58):
You go to the platinum package. The

Dr. Katherine WIlliams (14:59):
Platinum package. Exactly. All right. There we go. And, and then there, I was gonna say

Conrad Meyer (15:03):
This, we’re the wrong business, Corey. I

Dr. Katherine WIlliams (15:04):
Mean, no, really you’re not. But there’s another one that it actually will I was getting get distracted where it will call your patients and give them reminders the day I’ve seen this text before. I’ve seen, so those are all upgrades. Upgrades.

Rory Bellina (15:21):
Right. Okay. Okay. Now, so it sounds like number two’s been great.

Dr. Katherine WIlliams (15:24):
Not necessarily. Okay.

Rory Bellina (15:26):
Not number two necessarily has not been great. Okay.

Dr. Katherine WIlliams (15:28):
Not necessarily. So here’s where I learn more. Okay. Okay. Number one is that,

Rory Bellina (15:33):
Oh, I have, I have one question before we get to that, because this always comes up when I’m reviewing vendor agreements and I always PT this back to the client. When it gets to the hardware section, they say, your computer must be this, or you must have this type of server, this type of internet speed. In, in choosing those, is that pretty easy to handle? You just give that to your IT person and they usually are? Right. Okay. Or is there anything that’s really you gotta look out for?

Dr. Katherine WIlliams (15:54):
Right. Yes. You definitely wanna have a very competent IT person who is experienced in healthcare. We have had a couple the most recent one actually does it for other healthcare institutions and really knows what needs to be done, the firewalls and such. So don’t rely on ehr, they, they’ll tell you you need this equipment, but you must get an IT person to make sure that you are HIPAA compliant. Cuz if not, you’re also facing

Conrad Meyer (16:21):
OCR

Dr. Katherine WIlliams (16:22):
Big fines. Sure. Yeah. Sure. So that, that’s a big pearl that I would

Rory Bellina (16:25):
Wanna share. Okay. So no real hardware issues besides just making sure that you’ve got the right

Dr. Katherine WIlliams (16:29):
Hardware? No, what we do, you can choose there’s many different ways you can do it. Some people prefer iPads and they’ll walk in with their iPad to do it. What we do is we have a computer in every clinic. Sure. I’m sorry, in every exam room. And then we also have laptops outside that the nurses use are a little bit more mobile and at the nursing station and at triage. And of course all the check-in people have computers. And I prefer it that way. My partner, she likes to go in the room, talk and then come out and do her work at her station. But I like to open and complete my visit in front of the patient.

Conrad Meyer (17:03):
So this, this new event, we’re from a vendor number two now. Mm-Hmm. . Right. Right. And you’ve got all these, these packages, these, these add-ons mm-hmm. , how has it improved your patient encounters with respect to time with patient?

Dr. Katherine WIlliams (17:16):
Right. So let me just say vendor to number two was more of an all-inclusive thing that there wasn’t, like you could, there was a couple add-ons that we did, such as the iPad,

Conrad Meyer (17:24):
Just, just take it or leave it all inclusive. This is where we

Dr. Katherine WIlliams (17:26):
Majority all inclusive. The only things that were add-ons were the, was the, the one with the, the the, where they took the iPad and they did their review assistance. So we’ll have a different vendor that does that. Okay. But they, but they’re they are approved vendors that have relationships with this EHR company.

Conrad Meyer (17:44):
So, so it then very it is compatible Yes. If you get, okay. Got it. Gotcha.

Dr. Katherine WIlliams (17:47):
Okay. So what, what we, when we interviewed this company we didn’t just interview them. We were interviewed several of them. We chose this company because they had we had, they had the majority, they had the most clients in our, in our state that we knew. And everybody that was using them was happy with them for the most part. Okay. so we didn’t get any complaints or concerns.

Conrad Meyer (18:11):
She did your homework. You called your peers.

Dr. Katherine WIlliams (18:13):
Yes, I did. That’s really important. Then even in the contract negotiation, I did not use an attorney. And so I handled it most myself, but I felt fairly competent that I knew what I was talking about. This time.

Conrad Meyer (18:31):
, I’m not gonna, I’m gonna put you in a penalty

Dr. Katherine WIlliams (18:33):
Box. Yes, you should. You should . And so, but what I did do is I did negotiate a reduced percentage. Now this company takes a percentage of your collections. Yes. And so, you know, right now, at that point we had not utilized our product and we’re like, no, this is too much money. This is not what we think it’s worth. And so you can negotiate. I just wanna put that out there. You can negotiate. The contract was pretty straightforward. It was like three pages, maybe four pages at most. Right. It didn’t seem very complicated. I did see that. It said that if I had a dispute that I had to use a lawyer or mediation in the state that they were located, I didn’t think that was the issue. It would be an issue. I, now looking back, I wish I, I had gotten counsel and I wish that that would’ve been changed because living in Louisiana it’s just cumbersome as a physician to go and get an attorney in another state. You don’t know ’em, you don’t feel comfortable doing that. And so it really puts the physician at a great disadvantage if they have a problem.

Rory Bellina (19:38):
And maybe this will make you feel better. I don’t know if Conrad will agree with me on this, but when I get to those provisions in these vendor agreements, that’s always the one that I ask to be changed. But I rarely expect for it to be changed because some of these companies are so big or they’ve spent so much time, money, and resources in developing their, their systems and yeah, they’re based out of New York or Pennsylvania or Ohio, wherever it may be. And they’ve got their in-house council or their legal team, and they’re not gonna wanna hire if something goes wrong. They don’t wanna hire someone here. So I, it just depends on, I think who it is, how much the vendor agreement’s worth. Like if it’s the cleaning company that’s coming in, yeah. They’ll probably agree to go with Louisiana cuz they’re cleaning everything in Louisiana. But on the, on some of the bigger stuff, I’m, I don’t have a ton of success on a track record from getting a change.

Conrad Meyer (20:26):
I’ve got of success. They don’t wanna change that at all. I I agree with you on that. So,

Dr. Katherine WIlliams (20:29):
So then I would say as a, as a physician or as a physician advocate, how do we make sure empower physicians that they don’t, they’re No, they’re not always on the, the, the, what’s the term, but they’re on the bottom. Sure. not in a good place to negotiate after they sign the contract.

Conrad Meyer (20:46):
Well, I say the, the strength in numbers. So if, in other words, let’s just say the vendor number two is used by, you know, 50% of the market share here in Louisiana and say this, you know, maybe with, you know, other powers that be through LSMs or somebody else, you can collectively get everyone together and then, you know, collectively argue that, hey, we, for these 50% market share, then we’re gonna require you to have venue here. Now. I mean, that’s, every contract’s different, every renewal’s different. But maybe empowering through the market share and using some other avenue to collectively coalesce everyone together might be helpful. I don’t, I don’t

Dr. Katherine WIlliams (21:19):
Know. Or legislate

Conrad Meyer (21:21):
Well, well we could, yeah. Now we could do that too.

Dr. Katherine WIlliams (21:23):
Alright. We’ll be working on that

Rory Bellina (21:25):
. That’s just, that’s just a tough one because, you know, that’s really tough. Know they’re people like their servers, their customer support, they’re probably all in that state that they’re picked. Yeah. So I just, I don’t know if, I don’t know if that made you feel any better or not. Have you ever had

Conrad Meyer (21:37):
Success in changing

Rory Bellina (21:37):
That? I’ve had it, I’ve had success in changing it when it’s been a, a smaller, a national company with like a smaller sub franchisee. Right. Like a clean, like a, like a, a national cleaning company, but nothing like, and then they’ve got franchise or a, but no, with those, they always billing company. No, no. Those, they’re always, they always want to stick with It would be where

Dr. Katherine WIlliams (21:57):
They are. It would be really great if there could be some provision just that would allow an avenue that was easier for the physician. And I, I put this out to you guys as the attorneys. Sure. Just whether or not it’s that you can have a representative that they would be willing to work with. Sure. I or some reco, you know

Rory Bellina (22:17):
Maybe a fairground a middle ground would be, you know, prevailing party would get the attorney’s fees. So in your case, you have to go outta state. That’s a great, that’s a great, you have to go outta

Conrad Meyer (22:25):
State. We see that. We could do

Rory Bellina (22:26):
That. You would’ve to go outta state to New York, but if you’re successful, they have to pay. They have to pay all your learning fees. I that

Conrad Meyer (22:31):
And costs.

Dr. Katherine WIlliams (22:32):
Yeah. Yeah. So after, after having a relationship with this EHR for I would say seven years mm-hmm. and my practice is thriving, doing very, very well. We’ve actually gone on to hire another doctor and two more nurse practitioners. So we have six. That’s fantastic. We have six of us.

Conrad Meyer (22:54):
This is veteran number two still, right? Mm-Hmm. .

Dr. Katherine WIlliams (22:56):
Okay. Yeah. All right. We received a notice without warning that they were increasing our percentage rate due to inflation

Rory Bellina (23:06):
And percentage of collections. So there, yeah.

Dr. Katherine WIlliams (23:07):
So that the way they bill is percentage of collections. Okay. There was nothing in the contract that previously provided for that. And so the only way that it could be forced upon us would be that they would then throw the termination clause at us. That they have to give us 90 days notice and they will terminate us. Which we were told if, you know, we didn’t agree, that would be the avenue, they would probably go down. It really opened my eyes. I didn’t realize how beholden I was to a company that I now relied on to deliver care to my patients. Right. And that

Conrad Meyer (23:45):
They had you over barrel.

Dr. Katherine WIlliams (23:46):
They did. Yeah. They really did. And that, that’s a problem for physicians. And that’s because you are mandated to use this product, but then the product, you’re, these companies and some of ’em, predatorial, you know, companies are then seizing that. Right. And then keeping us Sure.

Conrad Meyer (24:07):
At bet. Yeah.

Rory Bellina (24:08):
And they know what their competitors are charging, so they’re probably staying in that range. But they also know that if you were to, you know, if you were unhappy enough, sure. You could leave and go to vendor C your third one, but you’re gonna have to start over again with all

Dr. Katherine WIlliams (24:23):
Exactly. Which will cost mm-hmm. at least a couple hundred thousand dollars. Sure. Correct. At least so that, that’s where the dilemma is. You know, and they know that. They know that. The other thing is, and I,

Conrad Meyer (24:33):
It’s like the donut hole. Right.

Dr. Katherine WIlliams (24:34):
And I have to say, it hasn’t been a perfect relationship. We’ve had some issues. We have, we’ve current issues that we’re trying to work through. They are eagerly trying to fix it. I, I’m, I’m, I don’t want to say that this company’s bad. I’m not happy about this percentage. I do not think it is right or fair. Well, let

Conrad Meyer (24:50):
Me ask you this, aside from the percentage, one of the things that I know that, that, that I would track as an administrator for a hospital was my days receivable. I wanna know that number. Mm-Hmm. , I wanna know how many days am are my days receivable because I, I’m trying to get it back. This is before ehr. Back when I, when I was doing it, we were trying to get under 60. If you were under 60 on paper days receivable, you’re doing phenomenal. Now, I don’t know what the number is, but do you look at now your days receivable number from your billing before your billing and ehr?

Dr. Katherine WIlliams (25:20):
Absolutely. So this program and almost all programs allow you to do that. You can put filters in and see what your days receivable is for like 30 days. 90 days. More than 90 days. And so this is what we learned about this vendor. Number two. Okay. When I said that they do everything we learned, they didn’t really they okay. We, we thought, okay, they’re gonna do billing, they’re gonna do, but they, what we found out is that when the claim came in, yes they did correct claims that weren’t clean, but things we didn’t get paid on, we had to go hire other billing people to go get that money.

Conrad Meyer (25:57):
So they would not what I call work the claims.

Dr. Katherine WIlliams (25:59):
No. Okay. So it, so then I was like, oh, what, okay,

Conrad Meyer (26:05):
So wait, once was denial. That was it. And then you had to go. So

Dr. Katherine WIlliams (26:08):
I had to go hire two more billing people who then had to have an, have to knew how to work this, eh, r to go collect the, the money. And so that, so then that was more money. So what was percentage? So when it, so, but it was not promoted as such. It was, Hey, we’re, we’re, we’re practice management. We’re gonna do everything. But that’s not true. You have to go work your receivables.

Conrad Meyer (26:29):
Yeah. Cause I’m sure if you put in the, in the contract, you know what happens for a denial, right. Or a recoupment. Right. Or a refund. How, how, how are we, how are we doing that? Who’s working that? How often are they working that

Dr. Katherine WIlliams (26:45):
Your sta in, in this, is it,

Conrad Meyer (26:46):
Did they go to the second level appeals? How, how far do they go down? And, and none of that is ever addressed in the contract. But

Dr. Katherine WIlliams (26:52):
I haven’t met a vendor that would do that. Right. But that is not the way that they marketed their product. I see. So that, and even doing research, cuz I do have a, another vendor that I’ve looked at and, and I’m gonna tell you about that vendor shortly. But the, in this, in this situation we, we learn, we have to basically do all of our denials and then try to collect that money.

Rory Bellina (27:15):
So has it been, have you been happy with the switch to EHR since going from paper to this?

Dr. Katherine WIlliams (27:21):
It was an adjustment, but now, yes. I can say I’m very happy and I couldn’t see myself going back to paper.

Rory Bellina (27:26):
That that’s what I would,

Conrad Meyer (27:26):
Everybody says that too.

Dr. Katherine WIlliams (27:28):
It was, it was really hard at first. But now just the fact that I can just press a couple of buttons and look at a trend or a visit that was just two years ago and now go, oh, just let me click that button and look

Conrad Meyer (27:42):
At that piece. Well, one thing, if, if they’ve already pre pre-approving or, or or authenticating insurance coverage and you’re collecting the copays, then you’re maximizing in your mind all of the cash flow operations in the practice to the best of your ability. Even though now you’re having to work the denials.

Dr. Katherine WIlliams (27:58):
Right. Well, but it, it, it’s also a little bit more complicated than that. You have to be on your toes at all times. You need to make sure you look at your receivables and see if there’s any things that stand out that do not seem right. I will give you an example, Owen say this was about three years ago. We all of a sudden notice I’m not gonna say the insurance company, but at one of the biggest insurance companies in Louisiana. And that all of a sudden our payments went down significantly. Made no sense. Now we then contacted our ehr. They’re like, no, I don’t know. So we, we then had to go investigate on our own cuz they were not aware of this. Turns out that that insurance company changed a number. So all of a sudden we weren’t getting paid on any of our claims. We don’t see any other reason why that don’t change.

Conrad Meyer (28:43):
When do you see change a number? You mean like on a C P T code or, or on a fee schedule? What, what happened?

Dr. Katherine WIlliams (28:49):
No, on a physician ID number like Oh, okay. In other words, you have a Medicaid provider number. Right. Like, they’ll change that number so that all, all claims had denials. Oh, wow. Now isn’t a wonder that all this happened in December.

Dr. Katherine WIlliams (29:07):
You know, it’s, it’s the end. This is just one example. I could give you a few others of these little glitches that happened. And so then we caught it. So

Conrad Meyer (29:15):
Wait, so wait. So, so people understand what that means though, in December, toward the end of the year, your patients have run through their deductibles and so then it, it’s incumbent upon the insurance companies to start paying out of pocket.

Dr. Katherine WIlliams (29:25):
Yes.

Conrad Meyer (29:26):
Yes. So that, so for those of you, why we’re saying, remember, remember December, you know, it’s because that end of the year, Q4 is always the same thing. Mm-Hmm. ,

Dr. Katherine WIlliams (29:35):
You know mm-hmm. , there’s quite a few little, what we believe tactics to help slow down payment to the physician. And so you need to continuously have an advocate who’s going to look at your numbers to make sure that you are being paid. Do not rely on your EHR to do that. So you have

Conrad Meyer (29:53):
A practice manager actually

Dr. Katherine WIlliams (29:54):
Then? I have an office manager, and then yes, I have a bu I have, wait, I call her my chief operating officer, but she oversees everything. . That’s great. Yeah. so after skip four, but after dealing with vendor number two and this mm-hmm. proposed rate increase, then we started researching alternatives. Okay. You know, to see are we paying too much? I don’t know if it’s appropriate to say how much I actually pay for my ehr, but the numbers are astounding. What did

Rory Bellina (30:27):
You, so what did you find when you looked at other vendors is Yeah. Vendor number two comparable to what other vendors are

Dr. Katherine WIlliams (30:33):
Well found out from, so I went, so I decided to research vendor number three. That is, and we don’t

Conrad Meyer (30:38):
Want talk about, let’s not talk about percentages or anything like

Dr. Katherine WIlliams (30:40):
That. Yeah, I wanna No, no, no. So we’ll just keep, let’s keep generic. Yeah. No, but vendor number three is the largest EHR provider in the entire state. Okay. So I decided to go ahead and research that one. Okay. All and see what I could find out. And it, the, if I actually use that eh program, I would have significant savings. Like Okay. I would say 80%.

Rory Bellina (31:03):
Wow. That’s a big deal. Based on, because their percentage is lower. What, what are the savings from?

Dr. Katherine WIlliams (31:07):
So, so what’s interesting is how this product works. This product basically pays you, you pay an in a fee to start up and what they call I guess installation.

Rory Bellina (31:20):
Like an onboarding Yeah.

Dr. Katherine WIlliams (31:21):
Initial initiation. Yeah. Gotcha. And yeah. And then you pay an annual fee, which is then paid quarterly. Okay. Okay. Significant savings. But here’s the problem. It is again, a very basic, that’s all they do is it’s a place to record your ehr, and then it would then create a superbill to submit to the insurance company. Okay. But all of the clearinghouse, the insurance verification, posting, all that, none of that’s done. So

Rory Bellina (31:45):
That’s how they’re getting away with a flat fee because they’re not collecting. So they don’t take, they don’t work.

Dr. Katherine WIlliams (31:50):
They don’t like it. Right. So, so we’re like, well wait a minute. If we’re gonna make a change, we don’t wanna, we wanna go, we wanna click a Cadillac again, or Porsche or whatever you wanna call it. Okay, sure. So we started looking at, you

Rory Bellina (32:02):
Don’t wanna go backwards, your staff is gonna kill you if you go

Dr. Katherine WIlliams (32:04):
Backwards. Exactly. Exactly. So we started looking at other if this product offered add-ons. Add-Ons, thank you. And we found out they did. Oh. But and there’s two, so far we’ve interviewed two different companies that have told us that, that they basically do it all. Okay. Okay. And they are integrated with this vendor number three. Okay. They charge by oh gosh, now I’m a blank. But they charge based on submission. So not percentage, but every time they, they, so

Conrad Meyer (32:39):
Per click?

Dr. Katherine WIlliams (32:40):
Yes.

Conrad Meyer (32:40):
Okay. Like every time we submit a claim, it’s X. Yes.

Rory Bellina (32:43):
Okay. What about, so sometimes you’re on the positive, sometimes you’re on the negative, just depending on the

Conrad Meyer (32:48):
What about verification posting and working denials? How does that work

Dr. Katherine WIlliams (32:53):
Based on cl number of clicks?

Conrad Meyer (32:56):
Oh,

Dr. Katherine WIlliams (32:56):
So he, but here’s, here’s where you have to, so we, we got the numbers. We’re like, oh, wow, this is so much less. But you gotta ask the questions. Okay. So this is for 2000 encounters. Okay, well what if we exceed 2000? Well, if you exceed 2000, then it’s going to be 30 cents per encounter that we have to work. Or 30. Oh, okay. So, and that is for whether or not you’re doing prior off, you’re doing clearinghouse. Right. You’re doing, posting a payment. Right. So when you add it all up, it was still a savings. Okay. It’s still less, but still leaves some uncertainty. Okay.

Rory Bellina (33:34):
Right,

Conrad Meyer (33:34):
Right. Because how many clicks are we talking about and who does the clicks and how do we counter click?

Dr. Katherine WIlliams (33:39):
It’s based on the number of counters and, and you have to take their word for it, right. That this is what they do.

Conrad Meyer (33:43):
There’s a way to verify.

Rory Bellina (33:44):
So it’s a completely different model, but it, their compensation is different. Right. I guess.

Dr. Katherine WIlliams (33:49):
Exactly.

Rory Bellina (33:50):
Now, of course.

Dr. Katherine WIlliams (33:51):
So instead of doing a percentage of your collections where you sort of always know you’re gonna, there, there’s that shared investment, right? Right. That this percentage, they are gonna be motivated to get your money because they’re getting a percentage of that. Sure. Okay. But this click is that gonna be the same thing? And I don’t know, I don’t know how I feel about that. You know, I have to think about that some more.

Rory Bellina (34:11):
Right. Whether they, they they do it or not, they might not get any or they’ll, they’re automatically getting paid for.

Dr. Katherine WIlliams (34:16):
Well, they’re not, it’s not as exactly. Sure. Exactly.

Conrad Meyer (34:19):
Is there a way to track like clean claim percentage?

Dr. Katherine WIlliams (34:23):
That’s a good question. So we’ve actually gone to vendor number two because we have some questions about some claims that were posted and we’re asking for a printout of every single thing that was done. We haven’t received response yet. Mm-Hmm. . But, but again, these are the questions you need to be on top of it. You need to ask those questions.

Conrad Meyer (34:41):
How many doctors would you know though, even though what the, what clean claim is? I could guarantee you most of ’em have no idea. Sure.

Dr. Katherine WIlliams (34:48):
You are absolutely right.

Rory Bellina (34:49):
And I think another big thing that you might be facing, and that I always like to look at is what is this company going to be like to get all of your data out?

Dr. Katherine WIlliams (34:58):
Right. So that’s a good question. That’s a really good question. So what I was told that if I leave vendor number two, I will have to con they will continue to take a percentage of my collections while they, but they won’t transfer those, those encounters that were built through their company. And so I’ll still be paying for that while I make the transition. Okay. The other thing you have to factor in, and this is again, what I have to think about is how much money is it gonna cost me? And how long am I gonna continue to practice? I’m 20. I’ve been, I’m not, I’m not 25, but I’ve been doing this for 25 years. Sure, sure. No, but, and so is it going to be worthwhile for me? And Yeah. You know,

Rory Bellina (35:37):
How, how hard is it to get that, are they going to, because you know, this data migration from one system to another, they probably aren’t gonna be happy that you’re leaving. So they’re pro, I don’t know. Well, well

Conrad Meyer (35:45):
One, well wait, but one thing they do, I do know they do, is they’ll leave access. In other words, you can negotiate this cause I’ve done this. Yes. And say like, look on termination for any reason you agree, you vendor number two, you agree to leave access to the claims data to our folks for a period of one year or however many, many years. Because, you know, once you pass 180 days receivable, I mean, it, it’s your, your, your collection percentage seems to drop significantly. So, yeah. But, but still you have access to the claim data. So if you’re having people you’re paying, working them, they can still work those claims if you decide to do that.

Dr. Katherine WIlliams (36:19):
I was told that that was not possible by vendor number two. Wow. Mm-hmm. . And that we would have to continue to, to basically they would take a percentage of whatever we collected. Again, look, you know, all these things didn’t really think about beforehand. Sure. And now, and that’s why I’m here. I want to share it with the physicians and well, it’s kinda

Conrad Meyer (36:39):
Like getting married. I mean, you’re getting married to this vendor mm-hmm. , and then you don’t think about this cuz you’re so happy that they’re doing the platinum service and all this other stuff. And then you’re thinking about, wow, I don’t, I don’t think I’ll ever leave. But then when you do, you realize, wait a minute, this was not, you never told me this.

Rory Bellina (36:52):
Mm-Hmm. and how do I get, how do I get my stuff Right. And, and how hard is it gonna be to move things around and Uber mm-hmm. . So is vendor number three, because I know this comes up a lot. They’re, they’re gonna help you get your data out of vendor number two, or do they say, no, that’s your problem. So

Dr. Katherine WIlliams (37:08):
Vendor number three, this is interesting. It’s something that needs to be discussed is actually going to be provided to me at a significantly reduced cost because I’m in my hospital’s quality network. Okay. And so they’re gonna pay 80% of the initiation fee. Had I not been in the hospital quality network, I would not be able to afford this product. It also makes me a little uncomfortable because then I have a, I’m my, I’ve, I’m tied to the hospital. What if something changed in my practice? What if I decided to switch all my care to the neighboring hospital Sure. For whatever reason. Sure. So that EHR would, would only be available to me and an affordable if I continue my relationship with the, the, the current hospital that I do most of my business with and I’m very happy with.

Conrad Meyer (37:55):
Sure. Sure. That’s like, like an acl. I mean, that’s just all right.

Dr. Katherine WIlliams (37:59):
Right. Yeah. Yeah. You know, I, I would say that, and, and this is as past President medicine in my position on the board, that all the process of the, the, the whole revenue cycle and running a business, it can be very daunting. I, I will tell you that LSMs has really tried to establish resources for physicians. We actually are hosting a mini-lecture series at the Capitol during White Coat Wednesday where we’ll have three experts come talk about the revenue cycle to start educating physicians. And if it goes well, we’ll start hosting lectures across the state. Because one thing that we did not get in me medical school was enough business training. I don’t know if they do it now,

Conrad Meyer (38:45):
But they, they really don’t. Let me just tell you this, I, I spoke to a fellow group of fellows last week mm-hmm. , and they put on a little mini-series within lsu. And let me tell you, every single one was like, I wish I would’ve known about contracts or vendor agreements, or my personal contract. I wish you would’ve gotten some business acumen in med school and in residency. And it’s all they do was push clinics. Yeah. Yeah.

Dr. Katherine WIlliams (39:12):
You know, the majority of physicians coming out today out of medical school residency are seeking employment. Yes. Majority are. I will tell you,

Conrad Meyer (39:22):
They don’t know the practice model. They, they think the practice model’s dead.

Dr. Katherine WIlliams (39:25):
What they don’t understand is how much freedom and and satisfaction you can get from running your own practice. Right. I run my own practice, I set my own hours. I can go be with my children, not we’re now off to college, but it gives me the freedom to do what I wanna do, and I enjoy that autonomy.

Conrad Meyer (39:44):
Let me ask you this we, Rory and I have seen this in other specialties M D V I P concierge practice mm-hmm. , do you see that coming to OB gyn? Is that even on the radar? The reason I ask that is because I hear how you set your practice goals and, and we do get asked about concierge v i p status. So is that something you see in your specialty area? Is that even possible? Yes,

Dr. Katherine WIlliams (40:06):
Absolutely. Mm-Hmm.

Conrad Meyer (40:08):
, what, what does that look like in your mind? I mean, I mean, I’m not saying you the prices or whatever. What, where, what, how far along down the road, what could that look like for patients? And, and I’m just curious if you, if you thought

Dr. Katherine WIlliams (40:22):
About that. No. Well, so I will tell you that I wear two hats. Okay. I .

Conrad Meyer (40:27):
Okay.

Dr. Katherine WIlliams (40:29):
I run my practice and I am a traditional OB gyn Right. And a robotic surgeon. I have about a 50, no, I do like 40% OB now 60% gyn. Got it. And so then I did start a separate concierge type practice. Oh, wow. Yeah. bec but it’s a, it’s a, like a very, very niche unique mm-hmm. , yes. Mm-Hmm. .

Conrad Meyer (40:55):
That’s very interesting. I don’t, I don’t want you to say anything. You don’t

Dr. Katherine WIlliams (40:57):
No, no. I could say, because I did it because insurance wasn’t paying for this service Sure. For patients. And so it it started off for,

Conrad Meyer (41:08):
I’m having to get to this rabbit hole a little bit. I went down a rabbit hole. It,

Dr. Katherine WIlliams (41:11):
It, it started off for cancer survivors and it was sexual dysfunction. So I started a clinic for survivors of cancer for sexual dysfunction. Got additional training on that. They don’t pay for that. Right. Insurance doesn’t pay for that. Right. So then I, and then I, from there, it’s a cash only, it’s an hour long visit. And so it’s a separate Sure. So do I see concierge developing? Absolutely. As insurance companies basically focus more on population health and reduced reimbursement. If this, if a patient wants that personal experience to really get their problem fixed, it’s not gonna happen in the 15 minute office visit. Right. Right. And it’s also not possible for a doctor to run a successful safe practice with the current reimbursement. And I know patients probably think that we are being overpaid. Let me tell you, we’re not okay. We are being over overworked in some regards. And you, you, and having a concierge practice creates a safer, more personal environment that the consumer patient is

Conrad Meyer (42:15):
Looking for. And I don’t wanna go down this rabbit hole, but, but I, I have said this to my, my, my students in, you know, in, in law school or grad school. And I tell ’em, you know what, what’s the first thing you hear of when you hear a politician get on the stand and say, we’re gonna make sure that you have high quality, low cost healthcare. You know? And, and well, that’s a, that’s a whole nother podcast, but but I think I know what your answer would be, you know, but, but let’s go, let’s, let’s, let me get back on track. Vendor number three. Are you going with vendor number three, staying with number two? Or has that decision been made? And, and what are you

Dr. Katherine WIlliams (42:45):
Honestly, I prefer to stay with number two. I’ll be honest with you. It’s comfortable. I, I’m able to deliver good, safe care with vendor number two, but financially, if the numbers don’t work, I will be forced to change to number three.

Conrad Meyer (43:01):
Well, let, let’s say this, if you and, and Royal, I could get to you too. I, I would say, let’s, what would, what were the takeaways? In other words, give, give us some, some of your top takeaways for doctors giving vendor agreements, your experience. What would you recommend they do, especially those who are, you know, seeking the entrepreneurial private practice route? What would you recommend to the physicians?

Dr. Katherine WIlliams (43:25):
Number one, as I said in the beginning, your accountant and your lawyer should be your best friends. I didn’t understand the magnitude of that, but having been in business now for 25 years, I can absolutely say that is so important. It’s also, and I’m gonna speak to physicians, and you will understand this, that if you go to, if you have cervical cancer, your, your patient is not going to get that fixed by a gastroenterologist. If you have a contract, do not go to your brother or your dad to do it. Go to a contract attorney who understands healthcare law. I cannot say this enough. I actually come from a family attorneys, and I, I, and he, he actually gave me that advice, . So I, that’s, I, I, I, absolutely. The second thing is an accountant. I didn’t share this with you, but I wanna tell this from a business standpoint.

(44:15):
I actually, about year number five in my practice, my practice manager at that time stole from me. I lost about I know that’s a whole nother podcast. We can talk about that later. But I lost about probably quarter to a half a million dollars. Wow. Wow. Then one day we’ll sit down, talk about that one. Okay. Okay. But my accountant is my other best friend. And so what I did is I created a lot of checks and balances within my practice. So if you, you ask me do I have a practice manager, I have several practice managers, and I oversee everything. And I think that’s important. Sure, this may seem daunting, but it is not impossible. And you, when you do it, you will have such a sense of pride and satisfaction. The last thing I would say is, is colon use your resources. So Louisiana State Medical Society now has a private physician section. We’re trying to develop it, join, you do not have to be appointed to it to listen to the meetings, offer suggestions, and learn. Also, we are gonna probably start offering conferences to educate and then talk to people who have done it before. You know, I think we need to help each other because private practice is so important because it is a different type of healthcare than your traditional corporate medicine model. And we can’t let that end.

Rory Bellina (45:28):
That’s great. No, that’s a, that’s a great summary. I, I, you know, I think we’re, we’re good to end on that, and I definitely appreciate you coming and sharing all this information with us.

Conrad Meyer (45:36):
Agree. I, I, I, you know what, I, I, I’m gonna have to schedule for more podcasts, . Cause every time Dr. Williams comes in our, our studio, it’s like, well, the, the rabbit hole gets deeper. So we’ll definitely have to have you back for some of these additional topics, so, sounds good. Well, we really appreciate you coming. Thank you very much. Again, this wraps it up for us here at the Chehardy Sherman Health Law Talk studio in mere Louisiana. Send us a comment, email us, let us know what you think. Any suggestions you know, how to get to us, we look forward to the next available episodes. Stay safe, be good. Be well, take care.

Intro (46:07):
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