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a company that specializes in strategic healthcare initiatives such as mergers and acquisitions, management services organizations, private equity, succession planning, physician partnerships, and strategic planning. He can be reached at 

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While analyzing the competition is an essential component of your strategy, most medical practices don't conduct this type of analysis systematically enough.

Are you working on a 2025 strategy?

Ryne Natzke is Chief Revenue Officer at TrustCommerce, a Sphere Company.

Practices have tools at their disposal that can help alleviate some of the problems that women face with health care affordability and access. 

How digital tools can alleviate health care access and affordability issues for women

Your monthly collection of insights from the Physicians Practice Pearls writers is available now!

Physicians Practice digital edition: Best states to practice

Nance Goldstein, MDc, ACC, PhD, partners with physicians as a leadership coach to find ways through today’s tough times and enjoy medicine more.

Her evidence-based work enables physicians to sail through the challenges of influencing others to deliver excellent care. Her clients learn simple, quick ways to lead high quality, thriving care groups – one conversation at a time. She’s an Affiliate Faculty at AriadneLabs (Brigham & Womens Hospital and Harvard’s Chan School of Public Health), as well as a scholar at Brandeis University WSRC. 

https://www.linkedin.com/in/nancegoldstein/

, curates recent research and stories of physicians making medical practice better – leadership that honors their purpose 

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Physicians Practice® spoke with Scott LaRoque, CEO of MPOWERHealth, about why some physicians may be hesitant to adopt value-based care models and how they can overcome these hesitations.

Overcoming Value-Based Care Hesitations

Physicians Practice® spoke with Chuck Lee, MD, about the complications of low patient health literacy levels and how physicians can improve these levels through communications, partnerships, and outreach.

Increasing health literacy levels in your patient populations

 Continuing our focus on Burnout this month, we are featuring my conversation with Dr. Jonathan Wisen about speciality telemedicine and how it might help reduce increased telehealth burdens reported during the pandemic.

 Dr. Jonathan Wiesen, Founder and Chief Medical Officer of MediOrbis wrote, "Approximately 

 have at least one chronic disease, and 77% have at least two, hence the urgent need to enhance and support the adoption of telemedicine and digital monitoring among Medicaid and Medicare Advantage (MA) patients. The Center for Medicare and Medicaid Services (CMS) has slowly come around to this realization, and cloud-based telehealth-based remote monitoring programs for managing chronic diseases are now 

A helpful place to start for this particular discussion is to identify what exactly 'specialty telemedicine' is and

 Telemedicine, telehealth, general telemedicine, and specialty telemedicine mean different things to different people. In our company, when we refer to specialty telemedicine, we're describing a mode of telemedicine which is nuanced, which is specific to an area, and which requires a higher level of expertise. That might be specialty telemedicine, much as you think of clinical medical specialists like cardiology questions, nephrology consultations, and endocrine issues; or it may be a very specific area of focus, like chronic disease management, which is which is unique and requires a level of sophistication and expertise. So, general telemedicine has been around for a long time. It's a well-trodden path. But developing very specific and specialized areas of expertise is something that we've been working on many Orbis.

 One area in which specialty telemedicine may increase effectiveness is in chronic care management.

 One of one of the issues in medicine that we've been struggling with for years is the “silo effect”. Physicians, care providers, patients, and technology have all been working in their own individual areas and domains and there hasn't been good integration between them.

Specifically, weight loss programs have been around from time immemorial. I mean, I remember my grandmother, starting a weight loss program, when I was just a few years old. And that had nothing seemingly to do with some of the programs that we're seeing now. But it was very specific, and it wasn't with the recommendation of precision physician, it wasn't integrated into overall clinical care. And so, when you have a specialty telehealth program, led by physicians like we [MediOrbis] do, it improves patients—not just their particular program that they're involved in, but the overall clinical and medical picture, because it's integrated with care providers.

Digital health has been around for quite some time, and especially over the last few years, we've seen great growth in that area. But all too often we find that it's a path to nowhere, and you may get an alert or a notification that something is amiss, but there's no one to really help you manage that. And so, by integrating everything under the auspices of a physician, or a specialist who's trained and knowledgeable in the areas that you're working under, you're able to not just monitor clinical conditions and give recommendations, but actually manage them from a clinical medical standpoint.

 Telemedicine may present new obstacles for physicians, and specialty telemedicine—with its unique focuses—is no different.

 I think that in any area of telemedicine, you encounter obstacles. But the truth of the matter is that in clinical medicine you do as well.

I've been practicing clinical medicine now for 15 years, and I've been in resource-poor environments and resource-poor clinics. And I've also been in some of the top medical institutions in the world. And everywhere that you practice there are components of the care that you deliver that rely on your surroundings and others that you have to realize, “Okay, I don't have access to those particular components and therefore have to function independently of the area that I find myself in.”

Telemedicine is no different. There are some areas of telemedicine of clinical care that are much better with telemedicine. I find that sometimes you can establish a rapport more easily with telemedicine because you're sitting down, you're focused, there's nothing else bothering you. You can you also have to take a great history.

I’m a pulmonary specialist and patients come to me all the time with abnormal CT scans. You know, the first thing they do is they hand you a disc and then you look at it and sometimes I don't even get to hear their story. Whereas with telemedicine, you're forced to encounter the patient, to interact with the patient, create a connection with the patient, hear exactly what's going on, and then make your clinical decisions. There are certain limitations—I'm not standing next to you, I can't do a procedure if it's indicated, and it could be that there are certain diagnostic tests that I would like that I can offer as well. At the same time, I think that there are great benefits as well. And just like in clinical medicine, if you know what you have access to and know what you don't have access to, then you can practice appropriately for the environment that you find yourself in.

 For physicians looking to use telemedicine to treat patients with chronic conditions, Dr. Wisen says that there are three things you should be striving for in your telemedicine program.

 It's really, really important to put together a program that's intuitive, that's intelligent, and that's easy for patients. You know, I actually taught for four years in between undergrad and medical school and I learned from a great mentor that he said: “It's not important what I teach, it's important what the students learn.” And it's the same idea in medicine: what I say is irrelevant, what the patient does is important. If I prescribe a million medications, and they don't take a single one, I've accomplished nothing.

So, we designed a program, where it's engaging, where it's simple, where it can be accessed from any device at any time, where everything is presented with a nice user experience that the patients can easily access it, they can easily ask for help with just the click of a button. They can interact with staff very simply through technology modalities, or any means that they prefer some of the elderly patients prefer to call up call us on the phone, younger patients, we just want to send a text message and be done with it. Whatever your preferences, that's what we want to provide. And again, it's not really important, what I say it's important what the patient does. And we designed all of our chronic disease programs and our clinical programs in the specialty realm with that in mind.

That's really important for all patients to know that having digital health solutions is not sufficient, having just telemedicine is not sufficient, but having a health record that that can pull in all the information from the different components that can pull in all the information from your physicians, and that can present it in a manner that's simple and easy to access is crucial and integral.

So again, EHR, and we won't get into all of my feelings about EHRs in general, but an EHR is supposed to be an electronic modality for managing your care. And to the extent that it does that, it'll be useful and to the extent that it doesn't do that it will not be useful. And that's exactly how we designed ours as well.

Physicians Practice® spoke with Dr. Jonathan Wisen, Founder and Chief Medical Officer of MediOrbis, about specialty telemedicine for the treatment of chronic conditions and how these technologies can improve a practice's offerings and patient outcomes. 

Specialty telemedicine for independent practices

 One of the effects of social isolation resulting from pandemic response protocols that has caused great concern is the potential for exacerbation of mental health issues, particularly the risk of self-harm and suicide in at-risk populations.

Thankfully, two recent papers published in JAMA Open in the last few weeks of January indicate that these fears may have not come to fruition.

Suicide-Related Internet Searches During the Early Stages of the COVID-19 Pandemic in the US

", John W. Ayers et. al. replicated the methods of a previous cross-sectional study to examine Google search rates per 10 million searches for the term 'suicide'. The authors found that these searches deceased during the early stages of the pandemic, between March and July of 2020.

Though counter to their expectations, the authors report that their findings are supported by extant literature. They also suggest that the search rates may change and even increase, warranting continued monitoring.

In a second paper published in January, "

Suicide Deaths During COVID-19 Stay-at-Home Advisory in Massachusetts, March to May 2020

" Jeremy Samuel Faust, MD, MS, et. al., assembled suicide death data for persons aged 10 years and older form the Massachusetts Department of Health Registry of Vital Records and Statistics from January 2015 to May 2020. Here, suicide deaths remained at levels previous recorded in recent years, indicating that the early pandemic did not necessarily have a resultant increase on suicide.

However, the authors note that as the pandemic continues, these rates may change, especially as more cases are completed by a medical examiner.

, though we won't be discussing the pandemic's effects on suicide rates, you will hear from Dr. Anisha Abraham, author of the book "Raising Global Teens: A Practical Handbook for Parenting in the 21st Century," about addressing suicide risks in your patients.

Though her book focuses on parenting in general, her insights into addressing suicide risks in pediatric and adult patients remain crucial for all caregivers treating these populations.

In stark contrast to the studies mentioned earlier, the CDC still holds that death by suicide is the second leading cause of death among adolescents between 10 and 24 years of age. The prevalence of suicidal tendencies among teens presents an interesting conundrum for physicians who want to help prevent the worst possible outcome: how and when can you intervene, and what does care look like when one of your patients presents suicidal warning signs?

 Well, there are a number of warning signs that providers need to be thinking about when they're working with young people that can include: someone talking about death, or writing about death, feeling increasingly depressed or anxious. Other signs might be feeling increasingly irritable, having a change in sleeping or eating patterns, and giving away their belongings. These are all things that providers should be aware of when they're working with young people.

 Beyond these behavioral warning signs, Dr. Abraham says that there are also common physical signs and risk factors for physicians to watch out for.

 Other physical facts that I think are really important to look out for are, if there are signs when or certainly in the interview, that they're not giving you good eye contact, if they clearly seem that they're withdrawn, if there are any recent changes in terms of what's happening in their own home environment or in terms of their own physical health.

There are certainly a number of risk factors that we need to consider as well. Young people that have had a history of suicide in the past are at an increased risk for having a suicidal ideation in the future. And many times, people that have actually attempted suicide have come in to see a health provider in the last six months to a year. So being aware of that I think is really important.

Certainly, other risk factors include having a history of depression or anxiety; having a family History of suicide also increases their likelihood. Use of alcohol or drugs or an increasing use of alcohol or drugs puts younger people at higher risk as well. What we do know is if there's been any history of bullying, or particularly cyber bullying, there's been a higher risk of suicide. If young people identify as being LGBTQ—they could also be at increased risk. There's a host of different issues that we as providers need to be aware of.

 If you suspect that one of your patients might be at risk of suicidal tendencies, Dr. Abraham suggestions asking very direct questions when your patient comes in for an appointment.

Physicians Practice® spoke with Dr. Anisha Abraham, author of the book "Raising Global Teens: A Practical Handbook for Parenting in the 21st Century", about signs that a patient may be at risk of suicide and self-harm as well as interventions and communication methods physicians can employ in the clinical setting.

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