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.
Harvard Business Review recently published a "Daily Idea" about leadership that seems tailor-made for medical practice managers and doctors. The idea: the best leaders are both tough and nice. Those of us who've worked primarily in business know that the question of whether toughness or niceness drives more productivity from employees is almost as old as business study itself. Everyone has a theory. But, HBR's analysis suggests that common sense wins out in the end: while a small percentage of employees with each polarized type of boss will ultimately be highly engaged, bosses that blend both styles get employees fully engaged a whopping 68% of the time. Beyond these results, though, the tough+nice approach seems ideal for medicine in particular because it so aptly matches what healthcare is really about. It's a tough field in which errors are much more damaging and crucial to avoid than just about any other business, but it's also a field that people pursue primarily because they are personally drawn to helping and caring for others. It only makes sense that the best physician leaders and practice managers would combine high standards and expectations with compassion and kindness.
I've previously recommended Dr. Christian Terwiesch's introductory MBA-level operations management course on Coursera -- and, great news, it's being offered again this fall. UPenn/Wharton have expanded their selection on Coursera to include four "MBA foundation" courses in operations, marketing, finance and accounting -- an incredible opportunity for physicians and practice managers alike to explore these first-year courses (and maybe learn if further MBA training is right for them). I can vouch for Dr. Terwiesch's operations management course -- I took it to get a refresher on my own MBA training in operations, and was delighted to find that many of his excellent examples were actually drawn from healthcare. The course will provide you with some new insights for evaluating your own practice workflow. Best of all, it's presented in digestible online sessions of 15-20 minutes -- perfect for busy professionals. To learn more about the ops course and the entire MBA Foundation Series, visit this link -- or to see more about Penn's other offerings on Coursera, or the program in general, visit coursera.org.
Did any of you catch the ICD-10 TweetChat Kareo hosted on Tuesday? I participated representing our team(@capkoandcompany); three other panelists from different segments of the medical management world joined in as well (@brad_justus, @modmed_EMA, @hitconsultant). Kareo does a wonderful job reaching out to its clients and the entire practice management community with events like these -- and we were delighted to have the opportunity to participate! (Kareo published a summary on its blog -- and you can also search all the tweets using #kareochat .) As expected, there were many smart, informed comments -- and some really good questions by the Kareo folks in particular. But, I was struck by the relative silence from people who weren't from the billing/practice management/technology expert community (i.e., from actual billers, coders and practice managers) -- especially because one of the themes that emerged from our chat was the sense that small and medium private practices (in particular) have been holding off dealing with ICD-10. Did the audience that could benefit the most shy away from the chat altogether? The drumbeat of journalists, bloggers and other experts about the need to deal with ICD-10 NOW (or face likely disaster!!) has gotten louder and louder in recent months, and I sometimes wonder if it sometimes has some negative unintended consequences. In our zest to create helpful urgency (and dispel the dream that ICD-10 will be delayed again), are we pushing people towards fear-induced denial and procrastination? Seemingly every week, we work with medical practices that have not begun to prepare for ICD-10 at all -- and they're scared. But while their foot-dragging has not been ideal by any means, it's also not a guarantee of disaster. Converting to ICD-10 is not going to be easy, but it's also not something that's beyond the reach of any practice to manage -- especially because so much help will be available from vendors and payers (provided you ask!). It seems from our vantage point that too many practice administrators, billers and coders have already decided -- without even really getting started -- that ICD-1o will be an unavoidable
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 (http://bit.ly/14ylckj), 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