Monthly Archives: September 2013

We’ve changed our name to reflect the immeasurable value provided to our firm and our clients over the last five years by Laurie Morgan. If we’ve had the pleasure of working with you over this period, you’ve surely benefited from Laurie’s uncanny knack for uncovering problems and zeroing in on the most effective, elegant solutions.  For her friends and colleagues – some of whom share her stellar academic credentials and many years of experience – she has long been the go-to-source for solutions to seemingly intractable business problems. Few have Laurie’s combination of academic understanding, in-the-trenches management experience, ability to deeply observe, and her resolute determination to find solutions. We couldn’t be more pleased to recognize her contributions and to have her working beside us on your behalf at Capko & Morgan.

by Joe Capko Frequent readers of this blog will appreciate that we consistently recommend that management foster a culture of support and mutual respect toward all staff.  Consistently, the best-run practices  invest in their employees and, correspondingly, reap the benefit of a highly-motivated, creative and responsible staff.  While we still advocate such an approach, one recent study that looked into the effects of electronic monitoring on restaurant workers got us thinking that there may be relevance to the medical practice. As in medical offices, employee theft is a considerable problem in the restaurant industry. It is estimated that 1% of revenues are lost to theft – a huge problem when profits average, as in the casual dining segment studied, about 3.5% of revenue.  The study, Cleaning House: the Impact of Information Technology Monitoring on Employee Theft and Productivity (), found striking changes in staff behavior upon the start of employee monitoring. The employee monitoring was via the algorithm-based Restaurant Guard product sold by NCR and can be integrated with their POS systems.  This electronic system is designed to flag employees that have a relatively large number of suspicious activities within the IT system, e.g., transferring a food order from one table to another, voiding partial orders, etc. To cut to the chase, bottom line revenues increased dramatically – almost a three thousand dollar a week!  What is perhaps most surprising is that the vast majority of the increase to the bottom line was a result of improvements on the sales side – meaning that while employees stole less, they also actively sold more, especially more high-margin drinks. Restaurants are particularly vulnerable to this type of theft because they tend to be high-volume enterprises with a relatively large number of cash transactions.  Nonetheless, with patient financial responsibility being an ever increasing part of your practice, we have to accept that the consequences of theft can be direr than ever for medical practices, too. It’s our hope and expectation that EHRs and practice management systems will eventually offer tools to alert busy managers to irregular patterns in staff behavior that may indicate theft. 

It almost always starts out the same way. A practice (usually a small one) loses its manager, or has its first financial troubles and realizes it really needs a professional manager, and one partner says innocently enough, "What about my wife?  She's got an amazing corporate background, and is getting bored at home with the kids.  She could work for a few months part-time, get us turned around, and then we could hire someone permanently." It sounds like a perfect solution.  After all, aren't the partners' spouses goals the same as the partners?  Who can we trust more than one of our wives (or husbands)?  Besides, it's only temporary .... After those few months, the miracle replacement manager who could be as loyal/smart/affordable as the partner's wife has, predictably, failed to materialize. And everyone is so grateful for the "magic" the temporary manager has pulled off -- it seems like she has literally saved the practice from bankruptcy! -- why would we want to replace her? Years go by.  The manager amasses more and more control over the business side of the practice. Maybe she seems a little insulted when you ask about the status of a particular account, or why a particular vendor has been getting paid so much. Then, little by little, some of the partner discussions that used to guide financial decisions stop happening.  The manager, after all, is "almost like a partner" anyway.  No one feels comfortable confronting or curtailing the manager -- their dear partner's husband (or wife) -- so problems fester.  The manager wants more pay -- argues it's "market rate" -- who will be willing to contest this?  The festering worsens.  The manager's productivity analysis seems to always favor her husband at bonus time.  Resentment is growing, bottled up.  Is the practice earning all the revenue it should?  Are payer contracts negotiated to best advantage? Nobody knows, and nobody feels comfortable asking. And what if the practice has new financial problems a few years down the road?  Where is our heroine now?  She's doing her best to appear neutral and professional, while simultaneously

We're looking for feedback on drug/device/technology rep behavior -- specifically, what kinds of behaviors are likely to trigger the opposite of the reaction reps are hoping for, making you disinclined to want to spend time listening to a pitch?  What's really annoying -- even disruptive to your practice? And, on the flip side, if there are any things reps have done for your practice that have been surprisingly welcome, helpful, etc., we'd love to hear that, too! All responses to the survey will be strictly anonymous (you don't even have to identify yourself if you don't want to), and will help us with an article we're writing that will help reps who want to learn how to connect more effectively (and less annoyingly) with the practices they serve. To complete the survey, click on this link - and thank you!

We're looking forward to participating -- it's open to all, so join in at 10am Pacific/1pm Eastern on Tuesday, 9/10. Follow us -- @CapkoandCompany Follow Kareo -- @GoKareo