Monday, September 28, 2015

Financial Pressures Facing Physicians Today

There are several major financial pressures that affect physicians today, from collecting co-payments to rising technology and operational costs. The year 2015 has proved particularly challenging with the cost of ICD-10 and financial penalties for practices that could not attest to meaningful use.

The table below details five financial pressure points facing physicians in private practice today and the solutions to help mitigate these pressures.

Pressure Points
Co-pays & Deductibles
·      Have the receptionist discuss payment with patients at pre-registration before entering the office.
·      Collect co-payments at the time of service.
·      Implement online and mobile payment processing.
·      Schedule automatic or recurring payment plans that collect from bank accounts, debit cards, or credit cards.
·      Ensure the patient’s ICD-10 codes are accurate to prevent Medicare and Medicaid denials of payment.
Claim Denials
·      Develop and implement a pre-billing checklist to prevent errors.
·      Develop and implement a claims manual that documents the requirements and nuances of every insurance carrier in which the practice has a relationship.
·      Consider dropping insurance altogether and becoming a private pay practice.
Technology Costs
·      Use low-cost or free EHRs.
·      Use cloud-based EHRs and billing systems to prevent against data loss and upfront costs of new software and computers.
Rising Operational Costs
·      Implement extended hours to grow revenue.
·      Devise a patient check-in kiosk to streamline patient flow through the office.
·      Emphasize communication, education, flexibility, and understanding of the practice’s needs to employees so they may perform at a higher level.
·      Employ non-physician providers to see patients during regular and extended office hours.
Pay For Performance
·      Report Physician Quality Reporting System (PQRS) data to the Centers for Medicare and Medicaid Services (CMS) in a timely manner. Ensure the data conforms to CMS’s guidelines.
·      Consider joining a shared savings program, such as an accountable care organization (ACO).
·      Under an ACO, contract with a payer to provide care to a designated patient population during a set time period while meeting agreed-upon quality and cost benchmarks.
Maintenance of Certification (MOC)
·      The application fee for the MOC program is upwards of $1,000.
·      To better understand the program’s costs and requirements to prepare for examinations, the American College of Physicians (ACP) has developed the interactive tool ACP MOC Navigator, which is available at

As the table demonstrates, there are workable solutions to help overcome the financial challenges physicians in private practice face today. Additional tips for collecting co-payments include reminding patients before their appointment that a co-pay will be due at the beginning of their appointment and informing the patient of the estimated costs of service. If payment is an issue, offer a payment plan to the patient prior to the patient leaving the office. All office staff should be knowledgeable of the practice’s fees, procedure costs, and payment options, as some patients may feel more comfortable speaking to a medical assistant or nurse than the physician about payment. Always address patients by name and let them know they are valuable to the practice; this helps facilitate a positive discussion about payment.

“The economics of medicine are changing at a rapid pace. It’s important for physicians to remain abreast of these changes in order to keep their practice doors open,” says Dr. Cockerell.

Please read the article Pressures Private Practice Physicians Face Today to learn more about the general challenges physicians in private practice face today.


Cockerell, C. (2015). Lessons for Dermatology from the Tao Te Ching.  Retrieved September 28, 2015, from 
Medical Economics (2015). Top 15 Challenges Facing Physicians In 2015. Retrieved September 24, 2015, from
Medical Economics (2015). Top 5 Challenges Facing Physicians In 2015.  Retrieved September 24, 2015,  from

Pressures Private Practice Physicians Face Today

Practicing medicine today is more challenging than in past years due to increased administrative burdens of operating a private practice, time-consuming regulatory burdens, and hassles with getting paid by insurance companies. The year 2015 has proved to be particularly challenging with increased Medicare audits, ICD-10 implementation, and the focus on Meaningful Use 2 (MU2).

The table below details several of the pressure points facing physicians in private practice today and the solutions to help mitigate these pressures.

Pressure Points
·      Engage staff to build training, testing, and documentation protocols.
·      Install an electronic health record (EHR) system that is user-friendly and able to be used by various staff members.
·      Implement policies to prevent staff and patients from using cell phones in the practice setting to prevent the transfer of photos, video, and other data to sources outside the practice.
·      Monitor the practice’s social media to ensure patient-identifying information, such as photos, videos, and other data isn’t being transmitted to the public.
·      Implement a security risk analysis to identify risks and record security.
Meaningful Use 2
·      Implement EHR technology and a patient portal.
·      Use only EHR vendors that have obtained 2014 certification.
·      Patients are more likely to use the patient portal when asked to do so by the physician. At the end of every patient visit, mention the portal and its purpose to patients. Include information on how to access the portal.
Maintenance of Certification (MOC)
·      To better understand the program’s requirements and to prepare for examinations, the American College of Physicians  (ACP) has developed the interactive tool ACP MOC Navigator, which is available at
Administrative Burdens
·      Streamline prior authorization policies to save time.
·      Record dictation notes into a hand-held recorder outside of each examination room to save end-of-the-day dictation time.
·      Consider hiring a scribe to record the patient history, physical examination findings, and provider notes.
·      Install desktop computers in each patient examination room to save time documenting at the end of the workday.
·      Type the patient history, assessment findings, and provider notes into a tablet, laptop, or desktop computer while in the room with the patient.
Independent Practice Burdens
·      If the costs and administrative burdens of running a private practice are overwhelming, consider joining a larger practice or hospital network.
·      Join an independent physician association (IPA) to align with other physicians.
·      Hire a practice consultant to help save on property, employee, and other practice costs.
·      Revamp billing and collections practices to increase income.
·      Recalibrate fee schedules to increase income.
Payer Audits
·      Document everything within reason. Print the information and keep it in a binder in a safe place in case of future audits.
Patient Satisfaction
·      Be kind to patients and take time to understand them.
·      Encourage patients to address concerns with the physician instead of posting negative information on physician review websites (PRWs).
Staff Retention
·      Hire a successful practice manager to manage staff.
·      Address workplace issues regardless of how minimal.
·      Maintain competitive pay.
·      Reward employees in meaningful and creative ways by providing extra paid time off, gas/gift cards, and tuition assistance for dependent children.
·      Patients don’t sue physicians they like and trust. Build rapport with patients and exercise a positive bedside manner.
·      Maintain boundaries with patients and don’t give in to unreasonable requests for medication and diagnostic tests.
·      Use “reasonable care” when dealing with patients.

As the table demonstrates, there are workable solutions to help overcome the challenges physicians in private practice face today. If the burdens of operating a private practice are overwhelming, consider hiring a consultant to help streamline policies and costs. Another option is to work for a large hospital system. Physicians who are leaving private practice behind and joining hospital systems is on the rise. Large hospital systems are acquiring more patients due to the influx of people from the Affordable Care Act (ACA) and are directing these patients to their physicians. This means that those physicians who are outside of the hospital network may be losing out on market share. Physicians may stand to make more money if working for a large network, but keep in mind that independence and autonomy may suffer.

“Being a physician today has its challenges, but most of us would not trade medicine for another profession. Being able to care for and educate patients is what drew most physicians to a career in medicine in the first place. Being a physician is who I am, and I am committed to helping patients to the best of my ability,” states Dr. Cockerell.

Please read the article Financial Pressures Facing Physicians Today to learn more about the financial challenges physician practices face today.

Cockerell, C. (2015). Lessons for Dermatology from the Tao Te Ching,. Retrieved September 28, 2015, from  
Medical Economics (2015). Top 15 Challenges Facing Physicians In 2015. Retrieved September 24, 2015, from

Medical Economics (2015). Top 5 Challenges Facing Physicians In 2015.  Retrieved September 24, 2015,  from

Monday, September 14, 2015

Cockerell Dermatopathology Presents Poster At NSH Annual Symposium/Convention

The 41st National Society for Histotechnology (NSH) Annual Symposium/Convention, held recently in Washington, D.C., was attended by laboratory supervisors, managers, and directors; histotechnicians; histotechnology instructors; and histology students. In attendance were Mary deBram-Hart, Laboratory Manager and Brenda Wander, Laboratory Operations Director of Cockerell Dermatopathology.

Cockerell Dermatopathology serves as a beta site for Sakura Finetek’s Sakura Xpress tissue processor and automated embedding equipment. This technology is responsible for improving turn-around times on tissue samples, creating healthier employee working conditions by eliminating deep night shifts, and generally elevating the laboratory to state-of-the-art status.

Cockerell Dermatophathology created a poster highlighting the benefits of the Sakura equipment that was displayed in the convention hall and was viewed by approximately 3,000 attendees. The poster depicts the old and new laboratory spaces; describes the benefits of the Paraform Sectionable Cassette System; and details the reduction in hours worked during family unfriendly times.

For more information, please see the poster.


deBram-Hart, M., von Bueren, E., Wander, B., et al. (2015). Continuous Specimen Flow Changes Night Shifts to Day Shifts While Reducing Turn-Around-Time (TAT). [PowerPoint Presentation]

National Society for Histotechnology. (2015). 41st Annual Symposium/Convention. Retrieved September 12, 2015, from

Histologic Diagnosis of Cytomegalovirus Infection

Cytomegalovirus (CMV) is a double-stranded DNA virus that is a member of the Herpesviridae family. CMV is prevalent (90 percent) in high-risk groups (e.g. human immunodeficiency virus [HIV] patients and unborn babies whose mothers become infected with CMV during pregnancy).  Roughly 60 percent of the United States population has been exposed to cytomegalovirus.

The virus is transmitted through the respiratory tract, GI tract, parenterally, or sexually with the incubation period lasting approximately two weeks. CMV attacks non-keratinocytic cells, primarily endothelial cells and fibroblasts.

Signs and symptoms of CMV are not typically apparent, but the few clinical findings on physical examination include:
  •         Fever of unknown origin
  •         Pharyngitis
  •         Crackles in the lung fields
  •         Enlarged lymph nodes and spleen
  •         Mononucleosis syndrome symptoms 

Symptomatic CMV disease can affect the majority of organs in the body, resulting in pneumonia, hepatitis, encephalitis, myelitis, colitis, uveitis, chorioretinitis, adrenalitis, and neuropathy. In patients with HIV infection, cytomegalovirus affects the entire GI tract and the eyes (resulting in chorioretinitis). Additional manifestations of CMV may include Guillain-Barré syndrome, meningoencephalitis, pericarditis, myocarditis, thrombocytopenia, and hemolytic anemia.

Mucutaneous manifestations of CMV involve:
  •         Perianal ulcers: usually secondary to CMV proctocolitis, but are often co-infected with herpes simplex virus (HSV)
  •         Palpable purpuric papules: may be a manifestation of vasculitis, but in neonates the papules represent extramedullary hematopoiesis
  •         Nonspecific ulcers
  •         Unusual hyperpigmentation (“suntan”) associated with adrenal infection

Laboratory diagnosis of CMV includes:
  •         Direct visualization microscopically of virally infected cells
  •         Viral culture of human fibroblasts
  •          Direct immunofluorescence
  •          DNA in situ hydridization
  •          Immunoperoxidase staining
  •          Polymerase chain reaction (PCR)
  •          Nota bene:  Demonstration of the virus is not synonymous with the cause of the lesion, but is evidence that the patient has a viral infection.

Most hospital labs stock antibody directed to CMV just as they do with HSV for direct immunofluroscopy (IF) of CMV. A smear of the ulcer or tissue biopsy on a slide is taken to the lab and IF is performed on the smear. This process can provide a rapid diagnosis of cytomegalovirus.

Cockerell, C. (2015). The Role of the Dermatopathologist in the Diagnosis of Infectious Diseases. Cytomegalovirus. [PowerPoint Presentation]

Medscape (2015). Cytomegalovirus. Retrieved September 10, 2015, from

Sunday, September 13, 2015

CLn Skin Care Products

Dr. Cockerell has co-developed CLn Skin Care, a line of skin and hair products clinically proven to gently and effectively cleanse and soothe skin prone to infection, eczema, acne, psorasis, atopic dermatitis, and other skin conditions. Patients report that the products leave the skin with a radiant, luminous glow while managing the symptoms associated with inflammatory skin conditions.

“Most people don’t realize that the largest organ in your body is your skin.  Without your skin, you could not survive.  There are some people, unfortunately, who have serious problems with large areas of the skin and have a very tough time,” states Dr. Cockerell.

The idea for the products came to Dr. Cockerell and the co-founder of CLn, Dr. Azam Anwar, when Dr. Cockerell diagnosed a red, irritated, and painful spot on Dr. Anwar’s left leg as methicillin resistant Staphylococcus aureus  (MRSA) cellulitis that required antibiotic treatment and regular bleach baths to kill the problematic bacteria and prevent recurrence of the infection. The bleach baths were effective in keeping MRSA at bay, but also cumbersome to execute and drying to the skin.

In an effort to deliver bleach baths in a more sophisticated and elegant manner, the two physicians dedicated four years to the development of a product formulated with sodium hypochlorite into a gentle cleanser that today is CLn Body Wash.

The CLn Skin Care line also includes:

  •         Sports wash
  •      Facial cleanser
  •        Acne cleanser
  •        Two shampoos (regular and gentle)
  •        Facial moisturizer
  •        Hand and foot wash

These products do not contain paraben, dye, or fragrance.  In addition, they are cruelty-free and are not tested on animals.

Speaking of animals, Drs. Anwar and Cockerell have also developed products for them as well.  “The CLn Splash and Splash Plus are similar to the CLn shampoo that is used in humans.  These products also work great on animals with skin conditions,” noted Dr. Cockerell.
For more information about CLn, please visit


CLn Skin Care (2015).  FAQs. Retrieved September 9, 2015, from

YouTube (2014). CLn Skin Care Founders on Bloomberg TV. Retrieved September 9, 2015, from

YouTube (2012). Importance of Hygiene—MRSA and Bleach Baths | Top Docs of DFW—Dr. Clay Cockerell. Retrieved September 9, 2015, from

YouTube (2013). Psorasis and CLn Body Wash with Dallas Dermatopathologist Dr. Clay Cockerell. Retrieved September 9, 2015, from

YouTube (2013).  Skin and Scalp Conditions—with Dr. Clay Cockerell | TopMD. Retrieved September 9, 2015, from

Solavé SPF Cleanser: Why You Should Use It Daily

Just because summer is winding down and cooler weather is on the way doesn’t mean that it’s time to stop wearing sunscreen. Harmful ultraviolet (UV) rays are present year-round even in winter and on cloudy days.

Solavé Daily SPF CleanserTM, invented in part by Dr. Cockerell and co-owned by his wife, Brenda, is a revolutionary cleansing body wash with sun protection factor (SPF) ultraviolet light protection.  The cleanser, used like soap in the bath or shower, provides passive protection against harmful UV radiation that causes photoaging, unsightly skin pigmentation, skin darkening, and skin cancer.

The broad-spectrum sunscreen that protects against both UVA and UVB rays is FDA
approved for use in people of all ages, colors, and ethnicities. Solavé is particularly
appealing to men and children who typically do not like to apply sunscreen. The solution provides a sun protection factor of 24 when applied directly to and then left on the skin, and a SPF of 19 after rinsing.  The unique formulation cleanses the skin much like soap, but when the solution is rinsed from the body, it deposits a fine, cosmetically elegant residue that protects the skin.

 Dr. Cockerell, past president of the American Academy of Dermatology (AAD) and an advocate of increasing public awareness about the need for sun protection, developed Solavé to work much like fluoride that is put in drinking water to help decrease tooth decay, or airbags that are put in automobiles to help decrease injuries sustained from accidents. Not only does Solavé protect against skin cancer, but it also prevents hyperpigmentation of the skin that results in freckles and dark spots and splotches.

More than three million Americans are diagnosed with skin cancer each year, thus making skin cancer the most common type of cancer in the United States. The good news is that skin cancer is easy to prevent, including the most serious form, malignant melanoma. Washing with Solavé Daily SPF CleanserTM every day, even in the winter months, is one of the best methods for preventing skin damage.

According to the American Cancer Society, the risk factors for skin cancer are:
  •        Too much exposure to UV radiation (from sunlight or tanning beds and lamps)
  •         Pale skin that easily sunburns
  •         Exposure to large amounts of tar, paraffin, arsenic compounds, or certain types of oil
  •      History of skin cancer (including family history)
  •      Multiple or unusual moles
  •      History of severe sunburn
  •      Weakened immune system
  •      Advanced age
Dr. Cockerell urges everyone to take skin health seriously and to wear sunscreen daily. For more information on Solavé, please visit


American Cancer Society (2015). Skin Cancer Facts. Retrieved September 11, 2015, from

Cockerell, C. (2015). Solavé Daily SPF CleanserTM: A New Paradigm for Skin Protection. [PowerPoint Presentation]

MD Anderson Cancer Center (2015). Winter Sun and Your Skin Cancer Risk. Retrieved September 11, 2015, from

Solavé (2014). Solavé. Retrieved September 11, 2015, from