January 2013 - Capko & Morgan

13 for 2013 Tip #9: Analyze payer performance

When is the last time you analyzed your practice's payers? Too often, physicians and practice managers feel powerless against health plans -- and don't even question whether to continue to accept a particular plan. Yet, even if your practice is located in a market in which you've found it increasingly difficult to negotiate higher reimbursement, that doesn't mean you must simply accept all other aspects of every payer relationship without question. Even when reimbursement amounts are similar across payers, differences in payer behavior -- what we refer to as 'hassle factors' -- can actually mean that some payer relationships are unprofitable. What are some of the hassle factors that add hidden costs and reduce payer profitability? They include: Consistently slower reimbursement than other plans Repeated requests for referral or authorization Frequent complaints from patients Poor support when help is needed to resolve problems Are multiple hassle factors a reason to drop a plan on their own? Not necessarily -- if you're reliant on a plan for a significant share of your revenue, or it reimburses better than others for important codes, putting up with the hassle may be necessary. (However, in that case, you will also want to do what you can to address some of the ongoing hassles with the payer.) I shared some further tips on analyzing your payers' hassle quotients in this article for Kareo -- and if you need further help evaluating and segmenting your payers, we hope you'll get in touch to learn more about our capabilities in this area.

By Judy Capko|2022-01-01T22:52:35-08:00January 31st, 2013|

13 for 2013 Tip #8: Manager’s report card

Good practice managers understand the importance of regular performance reviews for motivating staff and making them feel appreciated as well as addressing and documenting needed improvements. But sometimes the manager's own review by the managing physician of the practice slips through the cracks -- and, physicians don't always understand the importance of giving structured feedback to their practice managers. If you're a physician who hasn't established a regular schedule for meeting with your manager to provide performance feedback and set goals for the coming year, now's the time to get started. The role of practice manager continues to evolve as the business of medicine does -- is your manager developing the skills he or she needs to keep your practice running smoothly and profitably? Are you supporting your manager to take on important challenges for your practice -- whether in staffing and staff development, reaching out to patients via new channels, or upgrading technology? Is your manager aware of the long-term plans you and your physician partners have for your practice -- so he or she can properly support your goals? An annual meeting to review progress against past goals, and set plans for the coming year's efforts can be an effective way to empower your manager to move your practice's business in the right direction. And, it's essential for retaining and grooming a talented manager as well.

By Judy Capko|2022-01-01T22:52:35-08:00January 29th, 2013|

13 for 2013 Tip #7: Reach out to local employers

Many medical practices we work with focus their marketing efforts (if they do marketing at all!) on physicians who refer to them and direct communication with their existing patients. Yet there is another marketing channel that can be extremely effective for physicians that is often overlooked: your area's major employers. It's common to assume that simply participating in an employer's health plan is sufficient to reach the potential patients that work there. But, if you're in a competitive area, you might need to differentiate yourself against dozens of other physicians -- personal outreach to employees is a way to help them choose you. Moreover, you can't necessarily count on the health plan to promote itself effectively to your patient base. Many employers will also consider wellness programs in the coming year, because the Affordable Care Act promises to provide financial incentives for qualifying programs by 2014. Practices that create wellness programs for local employers can simultaneously market themselves to employers and prospective patients, provide valuable wellness information and training to their community, and position themselves as key wellness program providers as attention and support for this type of effort grows. (What kinds of programs might qualify? Some possibilities include non-discriminatory diagnostic or health improvement programs like tools for coping with and preventing repetitive strain injuries; healthy weight management; voluntary health screenings.)

By Morgan|2022-01-01T22:52:36-08:00January 24th, 2013|

Does Satisfaction Make Patients Sick?

A recent UC Davis study revealed a surprising finding - an inverse relationship between patient satisfaction scores and health outcomes. In other words, those most satisfied with their healthcare providers were, on average, sicker and more likely to die than their less satisfied counterparts! As might be expected from these findings, healthcare costs were also higher - by about 9% - among highly satisfied patients. The study compared health outcomes and patient satisfaction scores of over fifty thousand adult respondents of the Medical Expenditure Panel Survey, a product of the Agency for Healthcare Research and Quality under the U.S. Department of Health and Human Services. The survey is designed to be representative of the U.S. adult population and is the most comprehensive data set of its kind. Response rates for the survey have varied between approximately 60% to 70% over the last decade. Among the possible explanations is that physicians, motivated in part by physician compensation structures that consider patient satisfaction, stray from standard treatments and instead meet patient expectations. Under this scenario, patients are satisfied because tests and procedures are viewed in a more-is-better light, but clinical outcomes suffer, e.g., patients receive treatments that carry risk as a result of false positive lab results. The trend toward elevating patient ratings in measures of quality of care are likely to continue with the Center for Medicare Services (CMS) starting this past December with its initial phase of 1% rewards or penalties for hospitals under Value Based Purchasing. One-third of the evaluation process relies on patient data, i.e., survey data. These intriguing study findings certainly call for further research to solidify our understanding of the value of patient satisfaction ratings. This study and our firm's experience especially calls into question the value of very broad measures of patient satisfaction, e.g, how satisfied are you overall, because patients are notorious for confusing bedside manner with the quality of clinical care. The implications of this study may be far reaching, but enterprising providers can take simple steps to educate their patients, preferably long before they see them in the exam room. With email and social media making communication easier and less expensive,

By Joe Capko|2013-01-24T14:40:12-08:00January 24th, 2013|

13 for 2013 Tip #6: Get educated

New year, new budget, new goals? Now is the time for practice managers to review their skills-building strategies for 2013 -- and to make the case for joining general practice management organizations like PAHCOM, MGMA and POMAA or specialty-specific groups like NERVES and Bones. The world of healthcare is changing. The colleagueship and educational programs offered by established practice management organizations can be invaluable in helping you and your practice stay on top of the changes -- and gather new ideas for managing change. And, these groups can also often help you make crucial connections to vendors who can help your practice, often at discounted rates. The certification programs can help you advance your own career -- and, if your practice's growth requires you to make some key hires, being part of one of these organizations can help you find qualified candidates.

By Morgan|2022-01-01T22:52:36-08:00January 18th, 2013|

Will 2013 be better than 2012? It’s up to you!

A new year has already begun! If you are hoping for significant year-over-year improvement you need to act – and sooner rather than later. Here’s how great practices help ensure that each year is better than the last. Examine past performance. Consider what data points are important to review. As a guide, great practices will compare their performance against at least these benchmarks every year: Total revenue per full time equivalent (FTE) physician Total operating expense as a percentage of total medical revenue Total visits/procedures per FTE physician Percentage of total A/R aged 120 days more Bad debt due to fee for service activity per FTE physician Determine what the numbers mean to you. Compare your performance between 2012 and 2011 to evaluate your year-over-year performance. Are you clearly performing better or worse? Then assess why there is a difference. If you did better was it because you were more assertive? Dit you have clearer established goals to guide you? Perhaps changes in performance can be traced to changes in staff or actions taken to improve contract reimbursement? Did you implement a marketing plan or are differences between years merely chance variation? If there was no change in 2012 or you did worse, you will want to take decisive action to make 2013 a better year. Plan for 2013. Of course, given the challenging business environment, leaders of improving practices make planning a priority. I recommend a strategic planning session be scheduled well in advance. Scheduling an off site meeting in early February can minimize interruptions. If you have a skilled communication facilitator on your staff, and your practice isn't facing especially serious challenges, your practice might conduct your meeting without an outside consultant. On the other hand, a consultant can increase the value of strategic planning sessions by facilitating communications on difficult topics, providing an objective overview of your practice’s performance, helping you understand your position in the marketplace, and assisting leadership in determining goals for the upcoming year. Practice leaders it is not too early to think about the steps you can take to protect and guide the practice’s

By Judy Capko|2022-01-01T22:52:36-08:00January 16th, 2013|

13 for 2013 Tip #5: Review your maintenance contracts

Starting a new year is a great time to review your equipment maintenance contracts and evaluate alternatives. Independent service organizations compete for your business -- if your contract costs keep rising, consider putting your contracts out for bid. In some cases, rising maintenance costs may also mean that replacing outdated medical equipment is more cost-effective than continuing to service older assets. The same thinking applies to office technology assets. If the Geek Squad tech who helps you fix your PCs or your network is on a first-name basis with everyone in the office, you may be better off upgrading. And practice management software that requires costly upgrades may be better replaced with a cloud-based solution that updates automatically.

By Judy Capko|2013-01-15T14:32:54-08:00January 15th, 2013|

13 for 2013 Tip #4: Patient service=patient care

Physicians only need to peek at their ratings on sites like Yelp, Healthgrades and Vitals to realize the unfair truth: patients lump every aspect of their interactions with your practice into their view of your "care." Worse, at times it seems like their reviews give more weight to things like staff courtesy and billing hassles than to their clinical outcomes! The good news is, however, is that this also means that making people feel cared for is a team effort at your practice -- and that means that the burden doesn't fall entirely on the physicians' shoulders. The key, though, is to make sure the importance of patient service is understood by everyone on the team, and that everyone takes responsibility for it. Some steps in the right direction: Educate your staff about the importance of patient service, and reward them for their good work. Let them know that your practice's reputation depends on their contributions -- and that you value it! Invest in training if improvement is needed. Survey your patients. Learning what's on their minds -- before they vent on a social media site or medical directory -- will allow you to address issues before they become problems. And, some patients will perceive your service to be better simply because you took the time to ask their opinion. Strive for a personal touch. Medicine is becoming bigger and more impersonal -- and that trend is only worsening with consolidation. But, this spells opportunities for small practices to stand out! Be sure your clinical routines allow for a bit of personal interactions with patients -- even just stating the patient's name at the start of the encounter conveys a touch of caring. Bring in outside help. If you're not 100% sure of how patients view your service and care, an objective analysis can be very valuable. Contact us* if you're ready for a comprehensive, cost-effective service review and action plan. When it comes to patient service problems, and ounce of prevention is worth a pound of cure! *our San Francisco office works on patient service projects -- contact us via email at "info" at capko.com,

By Morgan|2022-01-01T22:52:36-08:00January 10th, 2013|

13 for 2013 Tip #3: Cash management quick-check

Do you accept cash payments at your practice? The start of a new year is a great time to review how your practice handles cash -- to determine if your internal controls could use some tightening up. With cash, the biggest temptation is to handle these "small" amounts more casually than other payments. When cash payments are rare -- a $30 co-pay here, a $25 co-pay there -- it can seem that they're less important to the bottom line. But, over the course of a year, even a single $30 cash payment per day amounts to close to $8,000! Keeping tabs on those "unimportant" cash payments is actually very important, indeed. The biggest pitfall: mixing cash receipts with petty cash. This all but ensures these amounts won't be deposited and may not be properly tracked. Petty cash should never be more than about $50 or so -- just enough to handle small payment amounts for the office that cannot be handled by credit card or check. Allowing petty cash to grow creates a temptation for misuse -- or worse, theft. Cash should be deposited regularly -- ideally, every day -- for security and for effective tracking for practice evaluation and tax reporting. Receipt stock should be monitored, and the cash received should be reconciled against the day's postings by some at the practice who doesn't collect it and post it to the billing system (in smaller practices, this might need to be the physician/owner).

By Joe Capko|2022-01-01T22:52:36-08:00January 10th, 2013|

Great post about patient service on Physicians Practice’s site today

We've been working on patient service training this month, so this great post on Physicians Practice got our attention. Too many physicians and practice managers still misunderstand how patients perceive their quality of care: it's not just about the results. Patients make judgments about their quality of care from the moment they arrive at your practice. The article on Physicians Practice includes some great advice -- some of our favorites that we frequently share with our client practices include: Don't room patients far in advance. Waiting in the exam room is more stressful and annoying than waiting in the reception area. Warn patients about long wait times. If they're aware they'll need to wait 30 minutes, they'll be less upset about the delay. Use warm greetings, including the patient's name, to establish a connection and convey that you care. Check out the full story by clicking here.

By Morgan|2022-01-01T22:52:37-08:00January 8th, 2013|

13 for 2013 Tip #2: Analyze your E&M code utilization

For most practices, E&M codes represent a significant portion of billings -- and, for some practice types like pediatrics and other primary care, E&M codes can approach 100% of billings. Physicians and non-physician providers are often so sensitive to the risk of down-coding, denial or audit that they develop a bad habit of 'defensive' E&M coding -- i.e., sticking to the lower range of the codes for virtually every patient. Far from being an effective defense, though, this type of habitual coding may actually create more audit risk, since it leads to a distribution of codes that is skewed rather than the expected bell-shaped curve. And, it does so while also leaving thousands of the practice's dollars on the table! The end of one year and the beginning of another is the perfect time to analyze your practices E&M coding patterns -- and set new habits for the new year. Run a report for each physician by code for the full year, and you can create a table like this that totals how many times each provider used each code: code 99201 code 99202 code 99203 code 99204 code 99205 Total Anderson 12 252 900 12 24 1200 Buford 0 132 996 348 0 1476 Cochrane 12 996 96 0 0 1104 Delaney 0 36 732 432 120 1320 Elliott 12 48 1092 156 24 1332 From this data, you can easily calculate percentage utilizations to get a clearer idea of distribution -- and from there create a chart to spotlight any skewed coding: E&M Distribution Chart E&M Distribution Chart Notice the skewed utilizations of Cochrane, Anderson and Elliott? It's unlikely these codes are accurate -- especially Cochrane, who appears to be habitually and defensively under-coding. (Note, also, the addition of the CMS averages to the chart -- available from the CMS website. This is a great double-check to see the typical coding mix based on all practices billing Medicare -- and to get a sense if your coding patterns will look odd (or audit-worthy) to the CMS.) Next step: identify the number of instances of

By Morgan|2022-01-01T22:52:37-08:00January 8th, 2013|

New! Receive our updates via email

We launched something new for 2013 -- just in time for our "13 for 2013" practice management quick tip series. You can now receive our blog posts directly via email. Just scroll down the right hand column to "receive email updates via FeedBurner," add your email to the green box, and click submit -- that's it. If you're a frequent visitor here, you already know that you won't receive tons of mail -- just an update or two per week, always aimed at helping your healthcare business shine. And we'll never share your email with any outside party.

By Morgan|2022-01-01T22:52:37-08:00January 7th, 2013|

13 for 2013 Tip #1: Master the deductible re-set

Too often, patients and practices alike are caught off guard by the resetting of deductibles on January 1. When patients forget they'll be responsible for a larger portion (or all) of the cost of their services, it can be difficult for front desk staff to handle the situation if they're not prepared -- and even physicians and managers find it hard to refuse a request to "please just bill me." The best solution to the problem is to prevent it. Make sure everyone in the practice knows that more patients will be responsible for payment until their new deductibles are met -- and that patients need to be informed and reminded before their visit. That means mentioning that deductibles have re-set when they set appointments, and checking patient responsibility amounts and outstanding balances before reminder calls -- and alerting patients to what they'll be expected to pay at visit time. Knowing that patients have been informed about their responsibility should make it easier for the front desk to collect in a matter-of-fact way. ("How will you be paying today, Ms. Jones?")

By Morgan|2022-01-01T22:52:37-08:00January 5th, 2013|

New series: 13 tips for 2013

All of us at Capko & Company want you to start 2013 off right! We're rolling out a series of quick tips -- short bites that will take just a minute to read -- to help you make the most of all the opportunities of a brand new year. First up: don't let the deductible re-set short-change your first quarter revenue.

By Morgan|2022-01-01T22:52:37-08:00January 5th, 2013|

Monthly Archives: January 2013