Yearly Archives: 2015

Your practice may be unintentionally turning new patients away

It's almost a new year -- woohoo! Resolution time! Fresh start! And for many patients, brand new insurance! For many patients with new insurance, it's also time to shop for new doctors. When they do, will they find you? By now you probably already know that there are many resources out there to help you with online reputation management (including lots of software products, and publications like this book by yours truly). But an often-overlooked part of online reputation management is especially important early in the year: payer directories. Patients rely on payer directories both when they shop for a new plan (if they want to keep their doctor(s), they'll want to be sure they're in the new plan) and when they start to use the plan (to choose a new doctor(s)). Both of these moments are among your very best opportunities to attract a patient who has just secured a plan you accept -- just the kind of patient you want. But if you're not listed in the directory, or not listed properly, your chance to attract that patients just slipped through your hands. It's just as if your practice intentionally turned the patient away -- if your payer directory listings are not correct, the effect is no different. It may seem to you (as a sensible person) that payers should make sure their directories are accurate. And indeed they should. But, unfortunately, errors abound. Maintaining directories, it turns out, is a very difficult job. While it shouldn't be your job, unless you assume some responsibility for monitoring these listings, you can't be sure they're correct; if they're wrong, it's your business that pays the price. Plus, in some cases, online payer directories are adding features like photos and website links that can give your practice a promotional boost. You can't access these new features unless someone at your practice is engaging with these directories and keeping them updated and polished. Make checking and updating the directories of all your payers a top priority for the New Year. Finding and fixing even one erroneous entry can make a significant difference in

By Morgan|2022-01-01T22:51:58-08:00December 15th, 2015|

Ready for the deductible re-set?

It's almost that time again: deductibles re-set in less than a month. Got your game face on? For many practices, the end of the year is so busy, it's hard to think about planning for slow business in January, February and March. Ironically, the cause of the busyness in Q4 is related to the cause of slower demand in January: deductibles. At year end, patients are eager to bring any known problems or elective procedures in to practices, because their deductibles have been met or nearly so; in January, many patients delay care because their deductibles re-set to their original amounts (or even higher amounts in many cases). It may also seem like there's little you can do to deal with the deductible re-set. But you do have options, and making even a small dent in the downturn can make a big difference in overall profitability. So isn't it worth trying? If you're in a pediatrics, adult primary care, or OB/GYN practice, of course one of the best steps you can take to smooth your revenue is to let patients know you have availability for preventive services in the beginning of the year. Let them know that your practice may be less crowded (barring, of course, a wave of flu or another virus coming through your neck of the woods). Make sure patients are aware that preventive services usually come with no copayment or deductible. (It can be helpful to create a list of common tests and vaccines that are preventive per the USPSTF, to avoid confusion.) Here's where your EHR can shine: use list-generating capabilities to identify patients that are due for preventive services, or who have chronic conditions are overdue for a regular visit. For example, it's usually easy to isolate healthy patients you rarely see that are overdue for pap smears, hepatitis screening or check-ups. Tapping your system a little more creatively, you can identify patients that have just crossed a threshold to qualifying for a preventive service such as herpes zoster, pneumococcal pneumonia vaccine or cancer screening. Patients that turned 65 in 2015 may also be identified and offered an

By Morgan|2022-01-01T22:51:58-08:00December 8th, 2015|

It’s everyone’s responsibility, yet no one’s doing the job

Are some jobs at your medical practice just too urgent or important to assign to specific people? That's the argument some practice managers and physicians make, e.g: "Phones need to be answered by the first available person, whatever their job" "Everyone should keep an eye on the fax machine, and deliver faxes they see piling up" "Let's all keep an eye on the reception area, to make sure no one's waiting too long" "It's the entire team's job to make sure the patient bathrooms are clean and stocked" When the entire team is engaged on these important, urgent tasks, the theory usually goes, there will always be someone available to do them, right when the need arises. Everyone will have an equal stake in making sure they'll get done -- right? Alas, no. Have you ever heard the amusing little story about four people named Everybody, Somebody, Anybody and Nobody? It goes like this: There was an important job to be done and Everybody was sure that Somebody would do it. Anybody could have done it, but Nobody did it. Somebody got angry about that, because it was Everybody's job. Everybody thought Anybody could do it, but Nobody realized that Everybody wouldn't do it. It ended up that Everybody blamed Somebody when Nobody did what Anybody could have done.* There is a lot of organizational insight packed into that little verse. When something is everybody's job, it's effectively nobody's job. Nobody is actually accountable to do the work, and everybody can rationalize that they thought someone else would do it. When everyone has other work to do that they believe is important, they'll be more likely to assume someone else will take care of the group responsibility. We have worked with several practices that have applied this "everyone's job" idea and been very unhappy with the results. Laurie, they say, why aren't the staff answering the phones? We tell them over and over that everyone has to answer the phones! Instead, our messages are piling up, patients and other doctors are complaining, and nobody's getting the help they need when they call.

By Morgan|2022-01-01T22:51:58-08:00November 29th, 2015|

The upside of staff downtime, the downside of multitasking

Employees who are not always busy working are frequently a source of consternation to physicians. Sometimes, practices attempt to remedy the situation by restructuring staff jobs -- not always with good results. Consider the front desk, for example. In almost any practice, front desk workload will ebb and flow. Depending on variables like patient punctuality, the mix of appointment types, and the number of new patients, the front desk might be swamped or slow on any given day or during any clinic session. Sometimes, front desk receptionists may have no one needing their help or attention at all. Physicians and managers may be tempted to rectify the situation by, say, having the phones ring first at the front desk. For a typical, busy practice, that's a foolproof way to increase staff busyness! But does it improve productivity? In my view, usually not. One reason people appear busier when you ask them to switch back and forth between tasks -- or do multiple jobs at once -- is that it's harder to do any of them properly. They're more active, but not necessarily more productive. This makes intuitive sense, no? But we don't need to rely on intuition, thankfully. With multitasking so prevalent in modern offices, researchers have good reason to study it -- and the results suggest that multitasking is even more of a productivity drain than your gut would tell you. One study found that people lose as much as 40% of their productive capacity when trying to constantly do multiple tasks at once. When front desk staff are required to answer phones while also helping the patients that are standing in front of them, service suffers. Either the patient on the phone or the patient at the desk feels like they're in second place. And switching back and forth means the employee has to mentally regroup -- adding to the length of time it takes to complete each task. More effort is required to do the same tasks -- yet the patients staff deal with will perceive less effort made on their behalf. Lose-lose for both of the two patients being

By Morgan|2015-11-23T16:13:16-08:00November 23rd, 2015|

Obsessing about front office technology

Anyone who encourages me knows they'll get an earful about front office technology tools -- they've become a passion of mine. I'm referring to things like: Patient responsibility payment estimators (e.g., Wellero, Navicure, Zirmed) Check-in tablets and kiosks (e.g., Phreesia) Online patient payment tools like portals and pre-payment sites (e.g., SpendWell) Patient payment apps (e.g., Wellero) Online scheduling (e.g., Zocdoc, DoctorBase, EHR portals in some cases) Basically, I'm talking about add-on tools that work mainly with practice management systems and/or on the Internet to improve your practice's likelihood of getting paid by patients, reduce steps in front office workflow, and even make patients happier in the process. I am a big fan of these kinds of tools, for all kinds of reasons. One is that they're unshackled from the government's goals for EHR -- they basically live only to serve practices and patients -- and I think that's what makes this segment of the market so much dynamic than the EHR segment. The players have competition, and it drives them to innovate more; you see these vendors experimenting with many different ways (and platforms) to solve these problems. And these tools really make a difference in the workflow and collection rates of the practices that embrace them. I recently wrote a white paper that delves into the important role technology can play -- and is starting to play -- in front office operations. It's called "Technology to the Rescue: Putting the Flow Back into Front Office Workflow." Wellero sponsored it, and you can download it free on their site. I hope you'll check it out -- and get in touch if you'd like to talk about any of the ideas in it.

By Morgan|2022-01-01T22:51:58-08:00November 3rd, 2015|

Ready to take the CCM plunge?

As you may know already, I've been working on a series of papers on Medicare's chronic care management reimbursement program (CCM) for the Medical Product Guide. (Click on 'resources' after visiting the Medical Product Guide link if you're interested -- they're free.) Talking to practices that have already started working on CCM, along with others that have held back, has been a learning experience. The ability to take on CCM quickly depends a lot on your current practice set-up and, especially, your EHR. On the current set-up side, if you're working on or already have set up a medical home (PCMH), and have one or more case managers in place to support it, you may find it easy to use the same staff structure for CCM. Your case managers could become the coordinators for CCM as well -- perhaps personally contacting patients and doing the other care management tasks that contribute to the required 20 minutes per month for billing. Perhaps there will be overlap between the PCMH and CCM that could be beneficial -- if, for example, you're looking at a similar mix of conditions, that might allow for some standardized communications or tracking tools. Or perhaps you could add a group visit program that would serve patients from both programs. (A group visit program wouldn't contribute to the CCM monthly time requirement, since that's strictly non-face-to-face time, but it still could be well received, and fit with the patient engagement goal of the program.) On the other hand, if your practice hasn't yet taken on PCMH, CCM could be a stepping stone. Many primary care practices believe they're already doing many of the tasks that are meant to be compensated by CCM -- they're just not tracking them, and they haven't had a way to bill for them, either. That last problem is expressly addressed by CCM -- the key is solving the former problem of tracking. EHR vendors vary dramatically in this area. Some have already created dedicated modules that allow for templates for clinical staff contacts to be tracked, and for the time to be calculated. Others

By Morgan|2022-01-01T22:51:58-08:00October 31st, 2015|

Medley of creative practice models for physicians emerges – is one right for you?

The concierge practice emerged more than 10 years ago and centered on family practice and internal medicine. Since then, practices have adapted the model to suit their preferences and styles, and the concierge approach has even moved beyond primary care as private practice physicians of different specialties search for a more profitable and fulfilling career path. The concierge approach aims to improve patient care while collecting all or most of the practice’s revenue directly from the patient. Patients are attracted to more personalized service and less harried exams. Patients and physicians both feel better care is given and physicians find more satisfaction in their chosen career. Another practice model that evolved from the concierge approach is direct pay primary care (sometimes also called ‘direct primary care’). In this model, physicians collect all their fees directly from the patient Patients pay a subscription fee that covers most primary care services. For the practice, by eliminating the costs of dealing with private insurers such as complying insurance regulations, claims submission and managing the accounts receivable costs can be significantly reduced and services enhanced. This approach generally offers fewer frills than a true concierge practice, and so the monthly subscription fee is lower, too – usually $100 or less. The appeal of direct pay primary care is that many patients have high deductible plans and seldom, if ever, reach the threshold level where insurance kicks in each year. In effect their insurance is more like catastrophic coverage -- they pay for their doctor visits and diagnostic studies as part of their deductible. For these patients, a direct primary care subscription can offer greater access and better care for the same or even lower out-of-pocket expense. For physicians, having more time to spend with their patients allows them to develop strong bonds with them, improving communication and patient compliance with their treatment plan. It’s a win-win proposition for doctors, patients and caregivers. There are attractive benefits to alternate practice models, but converting an existing practice requires careful planning. If you are considering an alternative practice style that is not reliant on insurance payment, there

By Judy Capko|2022-01-01T22:51:59-08:00October 19th, 2015|

How empowered is your medical billing service?

Outsourcing your medical billing to a billing service has the power to make your practice much easier to manage. It can also increase your profitability. But as the world of reimbursement continues to evolve, it's important to stay involved with the process. If you've adopted a "that's off my plate now" approach to using a medical billing service, it's possible your service is too empowered. A properly utilized medical billing service will be an extension of your team. Your office staff must work well with them in order to maximize the benefit you gain from outsourcing. When everything billing-related is dropped into the billing service's lap, it's impossible for them to do their best work for you. And they may feel compelled to make decisions for you that they really shouldn't be taking on unilaterally. Here are a few examples we've seen over the past few years of billing services believing it was left up to them to make key decisions on behalf of practice clients -- leading to sub-optimal decisions as a result: A billing service for a primary care/infectious disease practice with predominantly older patients with multiple chronic conditions received documentation about the chronic care management (CCM) reimbursement opportunity from the CMS (i.e., code 99490). But the billing service already had trouble getting properly prepared claims and sufficient documentation from providers, even for office visits. Plus, the practice manager was inexperienced with billing, and typically deflected the service's questions with "you decide - that's your job." The service owner decided for the practice that pursuing CCM "wasn't worthwhile." She felt that the providers wouldn't have been willing to do additional documentation. The physician owner was unaware that the practice was likely leaving at least $120,000 of revenue on the table in 2015 -- revenue which could have helped the practice repair its difficult financial position; A pediatric practice assumed its billing service would "handle" all payer contracts. The billing service thought "handling" them meant simply dealing with information requests from payers, and alerting the practice when something needed to be done -- they certainly didn't expect to be negotiating new contracts, since that was far

By Morgan|2022-01-01T22:51:59-08:00October 11th, 2015|

Negotiation: It’s not always a two-way street

In any type of partnership or contract, a two-way street is ideal, where both parties give and take and find a mutually beneficial arrangement, but it doesn’t always work out that way in business or in our personal relationships. The art of negotiations and recognizing when there is a deal-buster is important. We don’t have to have it our way, but it is important to be respected even when you disagree. When negotiation is required, keep in mind that you are opposing the other party. Knowing the opposition and understanding how they will likely respond will strengthen your position. Here are some ideas that can help you have more effective negotiations. Be a detective Learn as much as you can about the opposition. Understand their objectives and be clear on yours. You will be able to uncover areas of potential conflict by identifying points that are significant to you, representing the interest of your practice and clarify points that are important to the opposition. You'll also learn what might be most important to the opposition. Explore their strengths and weaknesses and how you can you use these in your negotiation strategy. The more you know, the better you will be able to anticipate the responses you are likely to receive. It is also important to know where both parties are already in agreement. These shared objectives can help build essential rapport before opening up issues where there is likely to be conflict or disagreement. Have a plan Develop your strategy for negotiations carefully and be prepared to provide supporting documentation for your case. When possible, quote credible sources that share your position. This will help influence the opposition and strengthen your position at the bargaining table. Identify potential deal busters It is important to recognize that even with best efforts that are times when you hit an impasse that cannot be overcome. Those are the deal busters. Know what yours are before you begin negotiations so time is not wasted and you can work to end the process respectfully. It is important to honor each others' position in a way

By Judy Capko|2022-01-01T22:51:59-08:00August 12th, 2015|

Choose the right billing service, get more than professional billing

Choosing a new medical billing service is stressful. Few activities have more of an impact on practice profitability, after all. But with the risks of choosing comes upside, too -- and not just in the opportunity to have your billing handled by dedicated professionals. Switching to a third party billing service (or a new service) offers an opportunity to upgrade your technology at the same time. By making the platform(s) your new biller uses part of your evaluation, you can improve other parts of your practice business besides billing itself. Today's billing technology has continuously improved in recent years. Competition has spurred innovation and a wealth of new features. The cloud platform, especially, allows these vendors to roll out upgrades more cheaply and easily (and make them mostly painless for customers, too). Billing services that use the most up-to-date billing platforms can offer these advantages to their clients as part of the service. When you use a practice management system as part of your billing service relationship, that usually provides you with scheduling, reporting, reminders, verification, and other tools automatically. A more flexible, modern scheduling system can help you maximize provider productivity and reduce costly no-shows. Better reporting allows you to easily analyze the value of your contracted health plans. Verification tools built right into a practice management system save staff time and reduce costly booking mistakes. These are just a few of the benefits you can get by making top-tier billing/PMS technology a requirement of any new billing service you're considering. Of course, you don't necessarily even have to switch services to switch up technology -- if you made a good choice of partner in the first place, that partner will work with you to make a transition if you need to. (A small, independent billing shop -- even a one-person shop -- can be a wonderful solution for your practice, but it is very important that they commit to keeping up with technology trends and opportunities. In fact, great technology is one of the best tools independent billers can use to shine, by allowing them to focus on

By Morgan|2022-01-01T22:51:59-08:00August 10th, 2015|

Are you getting the best from your medical billing service?

I'll be presenting a free webinar on Thursday, July 16, with tips and strategies for managing your medical billing service. If you're thinking of outsourcing your billing, or if you already outsource it and aren't sure you're getting everything you hoped for from the relationship, this webinar is for you. This is part two of a serious of shorter, more digestible webinars on choosing and managing a billing service, sponsored by Quest Care360. I'm excited about this shorter, 30 minute format, because it's easier to attend during a lunch or coffee break (while still having time to grab a sandwich!). No fluff, just the information you need. As you may know, I wrote an ebook on this subject called "Get the Best From Your Medical Billing Service," and this webinar draws from it, as well as from recent experiences with real clients using outsourced medical billing to run their practices. I hope you'll join us!

By Morgan|2022-01-01T22:51:59-08:00July 14th, 2015|

Fixing physician databases — even the CMS’s — shouldn’t be your job, but it is

Another day, another news story spotlighting the problems with physician database information -- and the impact those inaccuracies can have on patients. This time, it's the federal NPI number database that has been revealed as less-than-perfect, as described in this story published last week by the Cincinnati Enquirer/cincinnati.com. The Enquirer's investigation found that "tens of thousands" (!) of records contain errors. If you've heard me speak on this subject or follow this blog, you won't be surprised to hear that, surprise surprise, I'm not surprised. Databases are challenging to maintain accurately -- it's much harder than you might think. Errors are easily introduced and, often, hard to detect. Even when the people managing directories work hard to keep them current, it's still likely that errors will occur. And then when directories depend on other databases and directories for their listing information ... well, that's going to magnify the problem, and make it much easier for an error to be introduced in multiple directories downstream before it's caught. Once that happens, the errors become the responsibility of people who are unlikely to catch them. While the Enquirer article points out many reasons the problems it uncovered with the NPI database are bad for patients -- all valid and worrisome -- these errors are, of course, bad for practices, too. Anything that can lead to a misunderstanding or misinformation that is relied upon by a patient, fellow practitioner, or payer is a potential problem for a practice. And the article also points out that a physician's NPI number can even be hijacked for fraudulent purposes. As with so many other issues related to directory data, the accuracy of NPI numbers and their associated information seems like it surely ought to be the responsibility of the people running the database. But many of the problems that can occur in a directory are too difficult for operators to catch with 100% accuracy (or even close) -- and the stakes are too high for your practice for you to leave the accuracy of your own information to chance. (According to The Enquirer, in this case,

By Morgan|2022-01-01T22:51:59-08:00July 14th, 2015|

New ZocDoc survey spotlights patients’ reluctance to seek care, even preventive care

ZocDoc just published a compelling new article and infographic pulling data from a survey they recently conducted about patient behavior. The data put a quantitative face on what many of us have been observing anecdotally and reading in blog commentary online -- namely, that patients are increasingly reluctant to see their providers, and costs and scheduling challenges are a big part of why. One tidbit that jumped out at me, since preventive care is something I consider a win-win opportunity for practices and patients, is that 80% of patients surveyed were putting off preventive care. Some of the key reasons ZocDoc found were the inconvenience of keeping an appointment during work hours (in fact, more than 40% said they would likely cancel because work took priority) and the inconvenience of making an appointment in the first place. Preventive care should be increasingly valuable to patients as deductibles and co-pays have grown across all types of health plans. But many patients don't realize that this is usually a way they can take advantage of their coverage without cost-sharing. Many other studies have shown that patients are more confused than ever about their health plans; this puts the burden upon practices to fill in the information gap (but that also spells opportunity for practices that do so). Are you doing all you can to engage patients and encourage them to take advantage of their preventive care benefits? Some ideas to consider: Consider offering an early morning or early evening appointment option at least once per week -- or even occasional Saturday appointments Look into online scheduling to allow patients to book appointments without having to make a call during work hours Use EMR list tools (remember them from MU?) and your portal to reach out to patients who haven't had preventive services or are overdue Put information about what's included in preventive care -- and why it's important -- on your website

By Morgan|2022-01-01T22:51:59-08:00June 29th, 2015|

Upcoming free 30-minute webinar on choosing a billing service

If you've been thinking about outsourcing your medical billing -- or switching medical billing services -- my upcoming 30-minute webinar can help. "Eight Questions to Ask When Evaluating Medical Billing Services" will be presented on June 25 at 10AM Pacific/1PM Eastern. If you've been wondering how to quiz your billing service options -- or just want to be sure you haven't left something out -- this short webinar will help you get ready for the evaluation process. This mini-webinar is part of a two-webinar series. (The second in the series, "Best Practices in Managing Your Third Party Billing Service," will be presented July 16.) This mini-webinar is free! And in addition to arming you with eight useful questions to ask prospective medical billing services for your practice, there will be time at the end of the webinar for your own questions to me about the process of screening and hiring a revenue cycle management partner. To sign up, visit this page -- hosted by our sponsor, Quest Care360.

By Morgan|2016-03-04T11:28:26-08:00June 21st, 2015|

The worst thing that can happen when patient deductibles aren’t well managed

What's the worst thing that can happen when you staff aren't trained to manage patient deductibles and collect up front? It's not that you won't ultimately get paid. There is something worse that can happen, and it's not that uncommon: your practice can end up losing the revenue for the service and losing the patient. Here's how it can happen. An ill patient comes in for a service and doesn't realize she's financially responsible for the entire cost. No one who interacts with the patient ahead of the service -- not the scheduler, not the person who calls her to remind her -- lets her know she'll be financial responsible, or estimates her costs. The patient arrives, hopeful she'll be paying just a copayment. And the front desk makes her day by charging only a copayment! "You might have a balance, we're not sure. Don't worry. We'll bill you," the receptionist assures her cheerfully. The patient relaxes. But when the patient receives the bill -- six weeks after that service she really needed -- she's shocked to find out that she owes hundreds of dollars more. Her insurance didn't cover any of her visit or her tests, because she has a $3,000 deductible to meet first. By now, though, this patient needs another visit for follow-up care. She calls to schedule the appointment. "WARNING: PAST DUE" pops up on the scheduler's screen. "Oh! I need to alert you that you'll be expected to pay your past due balance in full when you come in for your visit," the scheduler reminds the patient seriously. The patient is embarrassed -- and worried that she can't pay that full amount at her next visit. She needs the care, but, on the day of her appointment, she thinks about the prospect of being confronted at the front desk for an amount she can't pay in one lump sum -- and about the fact that she'll be adding to the balance due. She weighs her options -- and no-shows on her appointment. She needs to be seen, but the embarrassment outweighs that need in that

By Morgan|2022-01-01T22:51:59-08:00June 14th, 2015|

Thinking of outsourcing your billing? Or choosing a new service? Mini-webinar for you

If you've been thinking about outsourcing your medical billing -- or switching medical billing services -- my upcoming mini-webinar can help. "Eight Questions to Ask When Evaluating Medical Billing Services" will be presented on June 25 at 10AM Pacific/1PM Eastern, and will last about 30 minutes -- a quick hit of knowledge and you'll be on your way. This mini-webinar is part of a two-webinar series. (The second in the series, "Best Practices in Managing Your Third Party Billing Service," will be presented July 16.) This mini-webinar is free! And in addition to arming you with eight pointed questions to help you evaluate prospective medical billing services for your practice, there will be ample time at the end of the webinar for you to ask me your questions about the process of screening and hiring a revenue cycle management partner. To sign up, visit this page -- hosted by our sponsor, Quest Care360.

By Morgan|2015-06-13T10:47:48-08:00June 14th, 2015|

Webinar Tuesday (free): Patient Financial Responsibility (And How to Cope)

There's still time to sign up for my webinar "Patient Financial Responsibility: Tackling Your Practice's Biggest Profitability Problem." It's Tuesday, 6/9, at 10AM Pacific/1PM Eastern -- and it's free, thanks to our sponsors at Spendwell Health and Wellero. There will be time for questions, and the webinar will also be recorded, so you'll have the chance to view it later if you register and can't make it at the live time. Click here for details and to sign up.

By Morgan|2022-01-01T22:52:00-08:00June 7th, 2015|

New technology and services can help you get paid (really!)

It’s no secret that physician practices are challenged more than ever to get paid in full for the services they render. Deductibles keep getting higher – and more patients are facing them. What's more, new research from the Kaiser Family Foundation shows that only about half of insured American families have sufficient resources available to meet a $2,500 deductible with cash. Beyond the financial strain of higher deductibles, there is the ongoing confusion about how they work – confusion that stubbornly persists, even though these types of plans have become more typical. And what happens when people receive bills that confuse them – or are unexpected? Naturally, there’s a good chance the bill could be incorrect – which in turn may make them much less likely to pay it. What does it all mean for medical practices? Above all, it’s important to help patients understand their health plans, and to make it easy for patients to pay. These tasks have not proven to be easy, but help is on the way from a source you might not instinctively rely on: technology. There is such an evident need for tools to help both consumers and healthcare organizations wrestle the confusion created by health plan complexity, technology vendors have been innovating at a furious pace to create solutions – and many of the things they’ve come up with are very promising. Now … I hope none of you stopped reading because I used the dreaded “T” word! For some of you, the upheaval of EMR conversion is still top-of-mind. If that’s your situation, it may be hard to imagine technology as a true friend of the medical practice. But there are some key differences in this new wave of healthcare technology, including: It’s driven by patient needs and practice needs – not a federal mandate. These companies must perform to earn your business! There’s no MU payment to hide behind; New technologies are easier to implement – some are simply apps and websites your patients can use for payment. These familiar interfaces will attract patients and make it easier for them to

By Morgan|2022-01-01T22:52:00-08:00June 5th, 2015|

Patient receivables blues? Master time-of-service collections. Join my free webinar

The portion of your revenue that must come from patient collections has skyrocketed. If you haven't mastered patient collections, you risk losing more of your practice's earned revenue than ever before. But -- on the plus side -- there are more new ways to tackle this problem than ever before. I've got a new, free webinar on June 9 that shares some of the ways you can collect more while actually improving your patient relationships. To sign up, just visit this link: https://attendee.gotowebinar.com/register/351571408146784258 We'll have time for questions, and you'll even get to learn about some exciting new technologies. I hope you can join us!

By Morgan|2016-03-04T11:31:17-08:00May 22nd, 2015|

Silent profit buster: the quiet exam room

How many times do you walk down the hall and see empty exam rooms or alternatively, how often are they filled but you still have patients waiting to be roomed and the doctors are running behind? If nothing is going on in the exam rooms there is a financial cost to the practice; whether the room is empty or is occupied by a patient that is kept waiting. Ideally, if you have three rooms for each provider, this results in the physician in one room, the nurse rooming another or giving post visit patient instructions and a third room in transition by patient getting undressed or dressed and nurse preparing room for the next patient. It takes efficient and consistent facilities and processes, and optimizing the clinical staff’s time to make this happen. Depending on the specialty it may also require additional triage space or diagnostic space for pre-visit care such as cast removal, x-ray or blood work. The first step to finding out how efficient you are with your exam rooms requires taking a critical look of the use and function of space and human resources. Most EMRs now have the capability to track a patient through their visit from the time of check-in, when roomed and when the provider enters and leaves the room and when the patient is checked out. Use this information to analyze the variables and establish reasonable standards for the patient flow process that addresses how much time is needed for: Rooming a patient and preparing them for the visit; Clinical time each provider needs to spend with the patient; and Post-visit instructions and documentation Going through this assessment offers the practice an opportunity to identify which processes are efficient and standardized, and which ones have little or no value and can be eliminated or automated. It also allows you to explore how well you are using your resources and how to optimize them. For example, do you have the nurses doing everything their skill level permits to support the provider and is the provider consistently delegating processes to the staff that don’t require

By Judy Capko|2022-01-01T22:52:00-08:00May 16th, 2015|

Can the federal government solve the health plan directory problem? You should hedge your bets

Paraphrased from my Management Rx blog: The New York Times reports that the federal government hopes to fix a problem that many citizens complain about: inaccurate health plan directories. When health plan directories are incorrect, patients can wind up unintentionally receiving services out-of-network, which usually leads to unexpected, significant out-of-pocket costs. The administration is naturally concerned about the impact of directory errors on patients, but out-of-date directories are a huge problem for medical practices, too. Out-of-network errors mean the practice probably is paid less, and the patient may blame the practice for not catching the costly mistake. Patients may share their disappointment with others, via word-of-mouth or even publicly via a review or rating. And besides out-of-network errors that everyone would like to avoid, practices lose even more when they're not listed at all by a plan they participate in, or they're listed with the wrong address, wrong specialty, or wrong status (i.e., accepting new patients or not). When these errors occur -- and they're common -- the directory is turning prospective patients away from your practice. You can read the rest of my post at the Management Rx site. But the short version is, health plan directories are such an important source of information for prospective patients, medical practices can't afford to leave their accuracy to the insurers alone, even if the government gets involved. And on the plus side, health plan directories may be your single best source of new patients, and fixing and enhancing your listings is free! It's rare to find a marketing effort that can be so easy, so effective, and free. My practical, step-by-step ebook on the subject -- "The Quick Guide to Online Physician Reputation Management" -- will empower you or a staff member to take control of all your online directory listings, and start seeing the benefits of being easier to find online. It's just $6.99, but you can download a free sample at Amazon to try before you buy. (If you don't have either a Kindle device or the free Kindle reader on another device, you can also purchase a PDF version for the

By Morgan|2022-01-01T22:52:00-08:00May 12th, 2015|

Improve patient collections for immediate bottom-line improvement

The portion of your revenue that must come from patient collections has dramatically increased over the past decade. And higher copays and deductibles aren’t going away – in fact, they’re becoming the standard. A recent Kaiser Family Foundation study determined that average deductibles for patients on employer-sponsored plans have more than doubled, and now average more $1,200 per year. Collecting effectively from patients has gotten harder, and not doing it well has gotten more costly. That’s the bad news. But there’s good news, too! Best patient collection practices are emerging – and technology vendors are stepping up their game, too. And when you collect more effectively from patients, you can simultaneously improve your bottom line (without adding more patients or visits!) and even solidify your patient relationships. I've got a new, free webinar on June 9 that shares some of the ways you can collect more while actually improving your patient relationships. To sign up, just visit this link: https://attendee.gotowebinar.com/register/351571408146784258 We'll have time for questions, and you'll even get to learn about some exciting new technologies. I hope you can join us!

By Morgan|2016-03-04T11:32:21-08:00May 7th, 2015|

Small can be strong when negotiating with a payer

Many physicians we work with face the tough decision of whether to keep their practices independent or join a larger organization. Oftentimes, physicians and practice managers believe they must consider such a move to "gain a larger footprint" for negotiations with payers. The advantages of larger groups in payer contract negotiations versus small and solo practices are generally accepted. But should we assume larger groups automatically have an edge? Negotiating power can come from different factors. The most basic is having something the other side wants (or, ideally, needs). But it can also come from not wanting what the other side offers too much (i.e., being able to walk away). It can come from having something to offer that is better than alternatives. It can also come from the ability to be flexible. Bigger groups may give payers a convenient way to negotiate rates for a larger geographic area in one deal -- a plus the payer will appreciate. The group may be empowered to push for a higher rate for all providers in it -- and it might work. And the payer may feel it must deal with this large group, without the option to walk away, because it needs the coverage it provides. But the group will also likely be less willing to walk away in the face of a deal it perceives to be poor, because the negotiators have to represent the interests of everyone. The fact that neither side can easily walk away takes away some of the leverage that more size might otherwise provide. On the other hand, if a smaller practice has special qualities that a payer might value -- say, specialty coverage in an under-served area, or newer services that are rare in their market -- the payer might be willing to pay more, at least for certain codes, for that small practice. But that could be less likely if that small team is part of a larger group negotiating rates across multiple markets. Similarly, if a small group of physicians scores well on a health plan's internal quality measures, or if patients

By Morgan|2016-03-04T11:32:52-08:00April 16th, 2015|

Group visits: improve access, patient satisfaction, and practice revenue

Laurie and Judy have written two articles about group visits recently, for Kareo and Physicians Practice. (Click here for Laurie's, here for Judy's.) If you're looking for a creative way to spend more time with chronically ill patients, a group visit program might be a good fit for your practice. Under the group visit (or "shared medical appointment") model, each patient has a brief individual visit (often just vitals and a quick interview with the provider), and then shares the rest of their visit with a group of other patients who are managing the same disease. Each patient sits in on their fellow patients' visits -- and, of course, vice versa. Group visits aren't for every patient, but many people respond very positively to the opportunity to share their physician time with others facing the same challenges. The best part: everyone ends up spending an hour or more with the doctor. (Even though most of the time is not focused on any single patient, everyone typically ends up feeling that they've had more access, and more opportunity to share and get their questions answered.) Group visits have been more commonly started by primary care practices for conditions like diabetes that require lots of patient engagement and many visits -- but any specialty with a population (or multiple populations) fitting that description can potentially benefit from starting a group visit program. To learn more about what's involved, visit our article links above.

By Morgan|2015-03-10T09:46:02-08:00March 11th, 2015|

Eat your vegetables: make carrot cake! (Or, learn to love your EHR)

Photo of carrot cake (c) Fotolia.com Joe and I recently presented a webinar called "Finding the ROI in Your EHR" with Kareo. Joe remarked after that it might have been more appropriate to call it, "Learn to Love Your EHR." This is because one of the main points of our talk was that even though you might have initially purchased your EHR strictly to comply with government programs, you still can find benefit that are important to you beyond what those government programs. Based on our experiences working with medical practices, we believe that many administrators and physicians don't think about this at all. They don't ever look beyond the avoidance of Medicare penalties or earning of Meaningful Use incentives when considering the value of their EHR. They simply don't think of their EHRs the way they look at other significant purchases, because ROI didn't factor into the decision in the first place. But even though you bought the EHR because you felt that the government required it, that doesn't mean you can't derive benefits from it beyond what the government had in mind. The government may have urged you to buy vegetables -- but that doesn't mean you can't turn carrots into carrot cake! Most EMR/EHR systems have many excellent features that can really only be maximized once you've got a fair bit of experience with them. So if you've been using yours for a while -- even for several years -- it's not too late to think about how to get more value. In fact, being really comfortable with the basics of the system is essential to digging deeper. One of the most valuable opportunities your EHR offers is the ability to create lists of different populations from your patient base. (Remember that trick from Meaningful Use? It's a measure that is actually something you can use for other purposes, too.) For example, if you're a primary care practice, you can use the list feature to identify patients who are overdue for preventive visits. This is a great thing to do whenever cash flow or physician

By Morgan|2022-01-01T22:52:01-08:00March 9th, 2015|

Persuading providers to be more productive

When we analyze practices that are not as profitable as they'd like to be, the physicians that hire us usually expect us to focus on expense cuts. But while we sometimes find over-staffing, outdated service contracts or other expenses that can be shaved, more often than not, the critical issue is on the revenue side: productivity and visit volume. Providers don't usually like hearing that they need to be more productive. They may be nervous that they'll end up on a treadmill, running from patient to patient. Or they may feel sure that they're already seeing as many patients as they can -- and even more than their peers. If they're aware of workflow problems in the practice, they will also be concerned that the number of patients they can safely and efficiently see in a day is limited by the strain on their processes -- not by their own efforts. Changing providers' minds about productivity and workflow isn't always easy (and you can see why they'd be nervous). But there are a few tools we rely on that physician partners and practice managers can use, too, if you find you need to book your providers more fully, including: Workflow analysis. This is perhaps most important. A thorough analysis of your workflow can spotlight problems that are beyond providers' control but that impact their ability to see more patients in a day. Are there bottlenecks that cause providers to wait as patients wend their way through the practice to the exam room? Are providers wasting time looking for supplies and tracking down MAs? Get a handle on these issues before asking providers to be busier -- and be sure to explain the issues you've identified, ask providers to share any issues they see, and implement solutions before hitting the gas on booking patients more aggressively. Productivity benchmarks. Today there is great data available to help you understand how your providers' productivity compares against comparable practices -- and to illustrate to your providers where they rank. For a quick review of productivity based on weekly visits, the Medscape survey can't be

By Morgan|2022-01-01T22:52:01-08:00March 1st, 2015|

For doctors and administrators: great HBR post on dealing with disappointing performance

In our work helping medical practices improve their profitability and efficiency, it's not uncommon to find that employee morale, performance, and turnover are problems. Those problems, in turn, often stem from the relationships between staff and their leaders -- and staff perceptions about how physician owners and practice administrators regard them. Sometimes, there's a bit of a chicken-and-egg problem: are leaders coming down hard on employees because employees are under-performing? Or are employees under-performing because they're stressed and discouraged by standards they can't meet, delivered emotionally by demanding bosses? In some ways, it doesn't really matter how leaders address unexpected shortfalls. Good performers are typically hard on themselves already. They know when they've messed up. Often, what they really need is permission to regroup and fix the problem -- and to know that you trust them to do a good job. Getting angry usually doesn't help -- it's usually counter-productive. This is the point of this excellent post on Harvard Business Review -- well worth a read (you can access up to five HBR articles for free, and a few more if you register). To the article's great points, I would add that it's also important to determine if a structural problem inside the organization made it hard for employees to do what was asked. In a medical practice, for example, are employed providers not meeting productivity goals because they're unmotivated, because they haven't made an effort to grow their practices through referrals, or because there are patient flow bottlenecks that make it impossible for them to see more patients? Is a biller's accounts receivable growing because she's not billing fast enough, or because there's no system to put patients on payment plans ahead of large procedures? Are voice-mails piling up because the staff charged with answering the phone are juggling too many balls? Ask a few questions, take a deep breath before reacting to performance problems. Be sure you understand what's really behind poor performance before you react emotionally and trigger consequences that will only make a tough situation worse.

By Morgan|2022-01-01T22:52:01-08:00February 21st, 2015|

Reminder: EHR ROI webinar this week (2/19)

Please join Joe Capko and me as we present "Finding the ROI in Your EHR," a free webinar hosted by Kareo. Joe and I will be discussing many different ways your EHR can help your practice become more profitable and serve your patients better. We hope you'll take part on Thursday, February 19 (10AM Pacific/1PM Eastern) -- to sign up, visit this link. It's free, and we'll have time for Q&A, too!

By Morgan|2022-01-01T22:52:01-08:00February 16th, 2015|

Maintaining medical practice cash flow in Q1

As we've posted here before, almost all practices face the risk of a cash flow crunch in January and, really, through all of Q1, thanks to the deductible reset. (January's revenue collections are sometimes also hit lower volume in December because of the holidays -- a double whammy.) In our experience, the decline in revenue can be anywhere from 10-20% for primary care practices (pediatrics and family medicine typically get a little 'help' maintaining Q1 volume from winter viruses) to more precipitous drops for surgical specialties (especially when there's little downside to patients for delaying surgery). The most important step practices can take to cope with the drop-off is to plan -- now that it's February, well, it's a little late for planning for Q12015, but if you're suffering from shrunken revenues that you didn't expect, mark your calendar now to start planning for Q1 of 2016 at the end of this summer. With enough notice you can plan to set aside cash reserves so that you don't need to tap lines of credit, cut expenses or delay needed purchases when the squeeze hits. You can also make sure you're ready to take advantage of the upside of the deductible reset: patients will be anxious to schedule procedures in Q4, after they've met (or come close to meeting) their deductible. Alert staff that vacation time will be limited in the fall quarter -- perhaps even offer staff extra time off in January. And, above all, start marketing procedures and mining your EHR for patients who may have wanted and needed a procedure, but put it off for financial reasons. Even though we're now in the thick of crunch time, there are still a few steps you can take to nudge the cash flow back up. If your practice's bread and butter is high-fee procedures, look into financing options and review your financial policies. If you're able to offer payment plans, that can take the sting out of patient responsibility payments. Technology solutions that can help you offer payment plans that comply with HIPAA and other security requirements are more readily

By Morgan|2022-01-01T22:52:01-08:00February 10th, 2015|

EHR: the right thing for the wrong reasons? (Get ROI, not just MU incentives!)

Did your practice adopt an EHR primarily (or solely) because of Meaningful Use (MU) incentives? And is MU your main focus when it comes to using your EHR? If you adopted EHR technology mainly to meet MU, you may not be expecting to gain anything from it beyond government incentives (or penalties avoided). But, more likely than not, there are benefits built into your system that can help your practice -- benefits that offer untapped ROI. Joe and I will be discussing many different ways your EHR can do more for your practice at an upcoming (free!) webinar hosted by Kareo on Thursday, February 19 -- to sign up, visit this link. In the meantime, here's one quick tip we always like to share with all of our practice clients. Used properly, the workflow tools in your EHR can provide immediate insight into your patient flow processes -- it can tell you at what stages patients are waiting, giving you the data you need to optimize staffing (e.g., add MAs), scheduling (e.g., stagger new patient and established visits), or technology (e.g., enable patients to enter their own history and chief complaint). If you're entering your workflow in/out data accurately, you can get a quick view of the bottlenecks and wait times in your system that is a gold mine for maximizing patient throughput while keeping patients happier than ever -- but the key is entering information accurately. More on that in our webinar -- please join us!

By Morgan|2022-01-01T22:52:02-08:00February 2nd, 2015|