FEATURE
• insurance issues (15%)
• increasing costs (13%)
• electronic medical/health records
or documentation issues (12%)
In addition, respondents reported
spending an average of 29.8 percent –
or a little less than one-third of their
time – on patient care-related issues
that are not billable.
“I think this is an accurate reflection of
what goes on in a real practice,” Dr. Allen
said. “A large percentage of one’s time is
spent doing work that is not reimbursable.”
Dr. Kleinerman explained that
hematology can be a challenging and intimidating specialty, and that she often
patients who require a lot of thought and
time to assess,” Dr. Allen said. “We have
to call insurance companies to convince
them to give permission for treatment,
fill out disability forms, or return calls to
patients or their families — and, unlike
attorneys, we do not bill for this time.”
Weighing the Benefits
Working within a larger group may help
to alleviate some of the non-reimbursable
issues many hematologists may deal with
in smaller private practices, but every
silver lining has a cloud, so to speak.
Prior to joining the larger Regional
Cancer Care Associates, Dr. Adler said his
smaller 12-person group was able to negotiate decent prices with insurance provid-
” ost practices are not small,
M
community-based practices
anymore. That changes how we
function as a specialty and which
challenges we face.”
—KENNETH ADLER, MD
spends a lot of time explaining and reassuring patients or their family members
about their conditions. In addition to
communicating with patients, Dr. Adler
explained that many of these conditions
also require discussion or consultation
with other physicians or specialists.
According to Dr. Adler, hematologists have been working for years to try
to get reimbursement for their cognitive
work with little success.
Hematologists are also faced with some
of the same time-consuming challenges
facing other medical specialties. Although
Dr. Adler has been involved with the development of many hematology quality measures and is a supporter of the Affordable
Care Act, he is also concerned that time
spent entering data into electronic health
records and forms for quality measures is
“sucking the life out of physicians.”
Dr. Kleinerman echoed these sentiments, adding that the practice of medicine today is not necessarily what physicians signed up for 20 or 30 years ago.
“Physicians are not able to take care of
patients in the same way,” Dr. Kleinerman
said. “Physicians are ordered to document, see a lot of patients, and move fast.”
Hematology, though, does not lend
itself well to this type of practice. “Our
patients are very sick, very complicated
ASHClinicalNews.org
ers or drug companies, but they simply
did not have the same kind of negotiating
power as local hospitals or larger groups.
Billing is another area where the
larger group practice setting affords
some benefit, Dr. Adler noted. Rather
than being completed through 20 offices
spread around the state, billing is now
completed with one Medicare provider
number through one central office. This
simplified approach reduces each practice’s overhead.
Dr. Kleinerman has seen similar
benefits and is relieved to no longer
be dealing with the management of
day-to-day finances of the practice. In
her two-physician practice, there was
constant concern about taking care
of the staff, and, as reimbursement
dwindled, the practice was forced to
stop giving pay increases. As part of
Steward Medical Group, Dr. Kleinerman
earns a higher salary and no longer has
the added pressure of worrying about
providing for her staff. In addition, the
larger group provides her with support
services — for example, help with coding and reimbursement that she did not
previously have access to.
There are drawbacks as well, Dr.
Kleinerman said. As a small practice,
she and her partner made all of the rules
and had more flexibility in patient care
and scheduling. The decision to merge
with a larger group made financial sense
for the practice, but it has also come
with an adjustment period, she said.
ASH Addressing Change
“Clearly, the whole structure of hematology practice is changing. The
Society needs to be aware of that so it
can address the problems people face in
making that transition and working in
that environment,” Dr. Allen said.
To ensure that ASH’s efforts are
aligned with the needs of practicing
hematologists, the survey also asked
respondents what the most valuable
product or service would be that ASH
could provide in the next three years
to help their practice. Among the most
commonly mentioned items were: education (13%), guidelines/pocket guides/
standards of care (11%), and advocacy/
lobbying/political action/support (10%).
According to Dr. Allen, the ASH
COP is act