Yearly Archives: 2017

The power of you front desk to influence the patient experience – and your reputation

One of our previous clients decided to move on from her group practice to set up her own practice. After being in town for just a few short years it would be important for her to have a following of loyal patients. For this reason, I decided to research how patients were rating her, and discovered her average rating with several major sites was a 4+ stars. Sounds pretty good, doesn’t it? I decided to dig deeper and read some of the reviews. 4 out of 5 had wonderful things to say, but the one critical rating was brutal and contrary to the glowing comments other patients made about this fine doctor. The strong negative comments by this single reviewer related to his experience with the front office. I suspect this could have been avoided if the front office team took pride in their work and understood that a major part of their role is to greet each patient properly and make sure their needs are met, as well as preparing them for the visit. Such comments as: “I waited an hour in the reception and was completely ignored; the receptionist was rude and acted inconvenienced; I was a new patient and no one seemed to care” reflect a patient that feels discounted and gets upset before ever being escorted to the exam room to meet the physician. Unfortunately, it’s not rare to hear patients complaining about the way they are treated at the doctor’s office and how poorly it compares to their experience at Starbucks or their local bank. It’s time for medical practices to implement some training standards that put patients first. It starts with creating a culture where physicians and managers believe their staff is their number one customer. Staff will only treat patients as well as they are treated by their superiors and the respect and care they are given. A practice will not thrive unless the work environment is one of respect and appreciation – and it starts at the top! Hire good people and treat them right Be selective in who you hire. The

By Judy Capko|2022-01-01T22:51:48-08:00August 28th, 2017|

Improving front desk performance

Chronic problems at the front desk are a way of life for medical practices in most specialties, and it seems there to little effort resolve these problems. The painful reality is that the demands on the front office are often unrealistic. It’s unlikely that the staff can handle a high volume of inbound phones calls at the same time they are helping patients check in and out, updating patient information, collecting patient payments, scheduling follow-up appointments, and answering patients’ myriad questions – and do it all well. No wonder a recent MGMA survey reveals that the front office has the highest rate of staff turnover in the typical medical office! Front office staff is set up to fail These tasks all demand more attention and time than your front office staff have. Since there is never enough time to give any task the attention it requires, front office staff is set up to fail. There is never enough time to get the work done and give patients the service they expect and deserve. It’s time to get realistic about front office workflow Start by understanding the distribution of tasks in the front office. Instead of front staff being generalists that all do same thing, divide the work in a way that makes each of them an expert and gives them sufficient time to manage their workload. Study the job description(s) for members of the front office team and diagnose workflow. Include the team in the process of improving the function of the front office. Compare the written job descriptions to the actual tasks and responsibilities of the position. Probe staff to get their input about workflow and what happens during the work day that makes the job difficult and demanding. Map out the current workflow, identifying bottlenecks and what causes them. Seek to divide and group tasks sensibly. For example, doesn’t it make more sense for patient inbound calls to be taken away from the front desk, so the patients can be checked in and out without interruptions that irritate patients or allow patients to slip out the door without

By Judy Capko|2022-01-01T22:51:48-08:00August 2nd, 2017|

Technology for patients: Think good, not perfect

(c) Barclays PLC* A few days ago, the ATM turned 50. The first ATM in the world debuted in London in 1967; we got our first one in the US in 1969. Wow! I bet that the ATM has been around longer than many of you reading this. It's hard to imagine a time when this technology wasn't on every street corner. Yet when the ATM was first introduced, it was slow to catch on. In fact, it took about 30 of those 50 years for the ATM to be used by 2/3 of consumers -- and even as recently as 2013, more than 10% of consumers still had yet to pick up the ATM habit. The ATM's slow-but-steady path to everyday use got me thinking about technology in the medical practice. Technologies to connect patients and practices, especially on the administrative side, have emerged at a fantastic pace in the past few years. But many practices we've worked with have hesitated to implement them, for fear that the majority of their patients won't use them. Some practices that have implemented, say, a patient portal or online scheduling, have been disappointed because only a portion of patients seem excited to use it. "Laurie," they say, "we tried that. Only 20% of our patients used it. It was a failure, so we abandoned it." But when the ATM was first introduced, the adoption rate was much slower even than a 10% or 20% utilization your practice might see on its new payment portal or online schedule. So why didn't the banks give up? After all, implementing an ATM network is a massive, risky, very costly undertaking. So why were the banks undeterred by their meager initial results? And what can we learn from it for our own technology initiatives? The key is to focus less on the people who don't try the technology, and more on the people who do. For every one of those few customers who used the ATM in those early days, the bank could declare a victory. The consumer who wanted to use an ATM

By Morgan|2022-01-01T22:51:48-08:00July 4th, 2017|

Need to load up your Kindle for summer? We’ve got you covered — and we’ll even provide a beverage.

Image (c)Goir-fotolia.com Summer's here! If the change of the season has you thinking about reading ebooks on a beach, a back porch, a dock, or a hammock, we've got new reads to fill the bill. They're engaging reads, with stories of real practices, that are also filled with fresh ideas you can easily implement in your own practice. Plus, in celebration of Judy's latest edition of Secrets of the Best-Run Practices (released June 2017), we've got a special offer for ebook buyers. Buy both the ebook edition of Secrets and any three ebooks from Laurie's Management Rx series ($2.99-$9.99 each), and we'll send you a $5 Starbucks card you can use for the perfect cold (or hot) beverage of your choice. Here's how it works: Buy Secrets of the Best-Run Practices (3rd Edition) ebook edition Buy any three of the following Management Rx ebooks: Less Work, More Money ($3.49); Workflow Hacks ($4.99); The People-Profit Connection ($8.99 Summer sale! $4.99); Patient Flow Mistakes Smart Managers Make -- and How to Avoid Them ($6.99 Summer sale! $4.99); Workflow (bundle) ($8.99 Summer sale! $6.99); The Quick Guide to Online Physician Reputation Management ($9.99 Summer sale! $6.99) Send us proof of purchase: your emails from Amazon or other retailer (email "info" at capko.com) We send you your $5 Starbucks card! If you bought any of these items in 2017 and can provide proof of purchase, that works; you don't have to buy them at the same time. And if you want to buy the ebooks for someone else (like your practice manager), you can tap into the promotion up to three times. This promotion runs through Labor Day 2017 -- you must purchase both books by then. Prefer print books? We've got a similar promotion for print books -- visit this page. Questions? Feel free to contact us.

By Morgan|2022-01-01T22:51:48-08:00June 11th, 2017|

Need a summer read? We’ve got you covered — and we’ll even provide a beverage.

(c) Michael Jung-fotolia.com Summer's here! If the change of the season has you thinking about reading on a beach, a back porch, a dock, or a hammock, we've got the reads that you need. Judy and Laurie have both published new books. They're both easy reads packed with intriguing case studies of real practices -- the furthest thing from a dry textbook. And you'll find they're full of practical ideas you can readily implement to make your practice run more smoothly and profitably. (We'll understand if you want to wait until fall for that.) In celebration of Judy's latest edition of Secrets of the Best-Run Practices (released just in time for summer), we've got a special offer. Buy both Secrets and Laurie's book, People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice Business, and we'll send you a $5 Starbucks card you can use for the perfect cold (or hot) beverage of your choice. Here's how it works: Buy Secrets of the Best-Run Practices (3rd Edition) Buy People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice Business Send us proof of purchase: your emails from Amazon or other retailer, or even a photo of the two books will work (email "info" at capko.com) We send you your $5 Starbucks card! If you bought either book in 2017 and can provide proof of purchase, that works; you don't have to buy them at the same time. And if you want to buy the books for someone else (like your practice manager), you can tap into the promotion up to three times. This promotion runs through Labor Day 2017 -- you must purchase both books by then. Prefer ebooks? Visit this page for the ebook version of this promotion. Questions? Feel free to contact us.

By Morgan|2022-01-01T22:51:48-08:00June 8th, 2017|

Is someone stealing from your practice?

© Oleg Shelomentsev - Fotolia.com Most physician practice owners we work tell us they believe it is very unlikely that any employee would steal from them. But when you consider that an MGMA study found that 83% of members had worked in a practice where embezzling had occurred, it seems quite probable that some of those physicians will eventually employ a thief (or would-be thief) -- and that some don't realize they are being stolen from right now. Embezzling is easily missed by physicians and administrators for many reasons. One of the most common is that honest people, people who tend to respect protocols and rules, don't always consider the possibility that others don't share their boundaries. Physicians and practice managers who use a CPA to handle accounting and/or bookkeeping may assume those professionals can spot embezzlement, even though the tracks are almost certainly well-hidden in details that aren't part of a CPA's calculations (and usually aren't even accessible to them). The modern medical practice embezzler can also be an extremely creative thinker. We've worked with practices where the owners believed that embezzling couldn't happen in their practice because they don't accept cash or because the payroll and accounts payable aren't handled by any employee -- but physicians and administrators would be astounded (as we are) by the number of schemes that can tap into any flow of money in or out of the practice. New schemes are also constantly being devised by clever, determined thieves. Of course, for physician owners, another huge obstacle is the fact that most of their time is focused on patient care. This leaves less time and less energy for business details. Doctors need to trust people to manage most administrative matters for them. Unfortunately, embezzlers take advantage of that trust, often presenting themselves as the most loyal, hard-working employees in the practice, cultivating a "halo" that helps them get away with their crimes. Administrators and practice managers, the most trusted individuals in the practice, are generally among the employees with the most opportunity to steal, if they are so inclined. In some

By Morgan|2022-01-01T22:51:50-08:00May 30th, 2017|

Confusion about insurance terms shouldn’t be your problem, but it is

Did you know that a study in 2013 by the American Institute of CPAs found that more than half of Americans surveyed didn't know the meaning of at least one of three key health insurance terms (deductible, copay, premium)? And that more than a third thought that premiums were paid directly to doctors? Considering that health insurance is such an important part of personal finance, these results are rather shocking. But if you work in a medical practice, they're probably not surprising, especially if you happen to be a medical biller. If you're a biller, odds are that handling questions and misunderstandings about deductibles and other amounts billed to patients has come to occupy a significant chunk of your time. It doesn't seem like explaining health insurance terms should be your practice's responsibility. Shouldn't the vendor (i.e., the payers) take the lead in making sure the consumer knows how the product works? And what about employers who offer these products as benefits -- shouldn't they explain what their employees are receiving? In an ideal and logical world, practices wouldn't wind up having to explain how someone else's product works to their patients. But, unfortunately, the fact that patients don't understand how their financial responsibility is calculated (or even why they are being asked to pay) can have steep consequences for your practice. When patients don't understand what they owe, they're more likely to resist paying. The bottom line is that when patients don't understand their financial obligations, they are less likely to meet them. Even when patients do pay, collection costs rise when payment is delayed by misunderstandings. Even though educating patients about their payment obligations shouldn't be your practice's job, you must make it your practice's job if you want to be paid more reliably. Educating patients about their financial responsibilities should start before they arrive at your door. Working financial education into your practice workflow is more important than ever as deductibles keep rising. Learn more about the why and the how of clearing up misunderstandings about insurance in my webinar on 4/26. It's free -- hosted by

By Morgan|2022-01-01T22:51:51-08:00April 25th, 2017|

Distrust of medical bills: another obstacle in collecting from patients

Did you happen to catch this New York Times Magazine article last month? It begins with a moving story of an uninsured patient who suffers a terrible brain hemorrhage. Thankfully, she gets timely, effective treatment -- but her condition requires many expensive services, including an air ambulance. Her bills totaled about $500,000. Although the patient had assets like a vacation home and savings, the amount she owed was greater. As the article describes the patient's profound stress in dealing with huge, unexpected bills while recovering, it seems clearly headed toward a case for single payer. However, it takes a rather astonishing twist along the way. The twist? The piece proclaims that little-known villains are secretly contributing to skyrocketing patient bills and healthcare costs: medical coders. "The guerrilla tactics of providers' coders," the article argues, involve deliberately manipulating physicians' codes -- i.e., diagnosis codes -- to create higher bills. If you are a practice manager, biller, coder, or independent physician reading this for the first time while sipping your coffee, perhaps you just spit it out in shock (like I did). Because while there may be billers and coders out there who have been urged to make up diagnoses to generate higher bills, I've never encountered one. I can only imagine "guerrilla coders" are exceedingly rare. The billers and coders we work with have enough to do just trying to get their physicians properly paid for the work that they've actually done (!). Physicians, billers, and coders have to work with the codes our entire industry uses to determine payment based on services rendered. If they aren't careful and don't check that all services are properly coded, practices (and hospitals) will receive less than payers have promised them for the work that they do. This is the problem billers and coders are trying to solve: Making sure their physicians and organizations aren't underpaid for services performed. That a trusted voice like the New York Times is promoting such a sinister impression of medical coding (among other inaccuracies in the piece) really bothered me. But something else bothered me more. Among the

By Morgan|2022-01-01T22:51:51-08:00April 24th, 2017|

“The Patient of the Future” — free recorded mini-webinar

Phreesia recently invited me to present a short (20 min) webinar on "The Patient of the Future," and how practice managers can anticipate emerging preferences to do a better job attracting and retaining patients. We have an interesting advantage in our field in that we have a bit of a lag before the trends of today become cost-of-doing-business requirements. (Except, perhaps, for pediatrics and other specialties that serve millennials -- you've got to try harder to stay ahead of the curve. Lots of interesting data shows why.) I think you'll enjoy listening to it (I'm biased, of course :)). It's a little headier than our typical tactical webinar -- nice to have a little variety. And it's available on-demand, for free. Here's the link to sign up and view/listen on demand. If you do check it out, I'd love to discuss it or hear your feedback. Visit this page to contact me or any of us at C&M via email or phone.

By Morgan|2017-04-03T10:45:20-08:00April 3rd, 2017|

New ebook on the ROI of investing in the patient experience

Recently, the check-in automation company Phreesia invited me to write an ebook on one of my favorite topics: the patient-centered practice. It's called "Beyond Five-Star Reviews: Why the Patient Experience Matters, and How to Improve It," and it's available free with registration -- just click on this link. The idea of being more patient-centered and creating a better patient experience attracts more controversy and confusion than it should. The bottom line is that being more patient-centered fits with clinical goals as well as business ones, because it may help patients become more engaged and more receptive to clinical advice. "Patient-centered" is not about chasing positive reviews, and it's not about being patient-led. It's about understanding the patient perspective and communicating that you do, while also maintaining your practice's clinical integrity and mission. And it's about focusing on administrative processes patients interact with every day that can make your practice more or less welcoming and convenient for patients. The ebook contains some ideas that any practice can implement to improve the patient experience. I hope you'll check it out -- download it here.

By Judy Capko|2017-03-27T08:19:14-08:00March 27th, 2017|

When did you last review your E&M/office visit utilization? (DOWNLOAD free spreadsheet.)

Office visits represent a huge proportion of revenue for many practice types. Consistently accurate coding of office visits is important to avoid costly under-coding or inadvertently coding above the level that applies, which could lead to revenue take-backs. Since the E/M range constitutes such a huge piece of the overall reimbursement pie, payers are very concerned about accurate coding, too. That's why E/M coding can be a trigger for a payer audit if your practice's utilization appears unusual. One way to check your office visit coding patterns to see how they conform to other practices in your specialty is to compare your utilization of each code to published CMS data. If you find that your clinicians' coding diverges noticeably from national data, and the reasons aren't immediately clear, it could be time for a closer review or internal chart audit. Besides comparing against the CMS numbers, you can compare your clinicians' numbers against each other. In our consulting, we often find that physicians in the same practice will gradually skew in different directions (some coding a little higher than the average, some a little lower) over time. Sometimes, differences in utilization make perfect sense -- such as when the doctors see distinctly different patient populations. But not always. If the variances don't look logical to you, it's time to take a closer look. You may find it's time to bring in an E/M coding expert for a customized refresher course and/or chart audit. (If you need this help, we can refer you to excellent resources. Just contact us.) Getting your hands on the CMS data, then entering it into a spreadsheet, can be a bit time-consuming -- but we've taken care of some of the drudgery for you! Follow the links below to download a spreadsheet that already has the CMS data keyed, plus is set up with formulas to calculate your clinicians' or your practice's utilization of each code, and compare it with the national averages. Allergy and immunology Cardiology Dermatology Endocrinology Family practice Gastroenterology General practice General surgery Internal medicine Neurology Neurosurgery OBGYN Orthopedic surgery Otolaryngology Psychiatry Pulmonary

By Morgan|2017-03-27T08:11:52-08:00March 25th, 2017|

Despite punishments, health plan directory errors persist

Kaiser Health News, citing a new California Department of Managed Care analysis, has reported that health plan directories in California are still plagued by errors. In fact, it appears that health insurers' lists of physicians may actually be getting less accurate. The author of the state report said that 36 of the 40 insurance directories she evaluated had inaccuracies that will lead to fines. Last summer, California introduced legislation mandating that insurers keep these directories up-to-date. The state is concerned about incorrect directories because patients rely on these listings to choose doctors who accept their coverage. Inaccuracies are hassle for consumers. Worse, if a patient inadvertently chooses a physician who is not in-network for an expensive service, the patient can end up owing a large balance. More fines may be appropriate for the health plans who've failed to keep their directories current, but I'm doubtful they will improve directory accuracy -- at least not immediately. Inaccurate directories have long been a problem that causes trouble not just for patients, physicians, and health systems, but for the payers themselves. The challenge is maintaining directory data when managing a directory is not you core business -- as is the case with health plans. I've said it before, and I'll say it again: maintaining health plan directory data accuracy shouldn't be the job of practices, but you nonetheless must take responsibility for it. Otherwise, you risk missing opportunities to serve patients who can't find you if you're improperly excluded, and you risk inadvertently seeing patients who aren't covered when you're improperly included. It's a bit labor-intensive, but reviewing and fixing directories is not difficult. I explain out to do it in my ebook and my new print book. It's a great task to delegate to one or more staff members to work on a bit at a time during down-time.

By Morgan|2017-02-13T10:02:18-08:00February 13th, 2017|

Laurie’s new book is the top new release in practice management

We're all excited because Laurie's new book just picked up the "#1 New Release in Medical Management and Reimbursement" on Amazon.com. Wahoo! We love her book, and we think you will, too*. You can read an excerpt for free -- just visit managementrx.biz and fill in the form on the home page. Or look inside on her Amazon page. *We're not the only ones. Check out the editorial reviews on Amazon to see what some physicians who previewed the book had to say about it.

By Straight Talk|2022-01-01T22:51:51-08:00February 6th, 2017|

Avoid payment confusion while maximizing the service advantages of preventive care

When we work worth practices in adult primary care, OB/GYN, and pediatrics, we often recommend they consider proactively recalling patients for preventive visits. Because preventive visits are usually reimbursed entirely by insurance with no patient cost-sharing, helping patients stay current with preventive care can be a win-win for patients and the practice. A preventive visit recall effort can also help your practice address challenges like: Lower demand and productivity during the first quarter of the year, when patient deductibles reset Summertime revenue shortfalls because of lower visit volume Excess demand for pediatric check-ups during back-to-school and back-to-camp seasons Disengagement of patients who have lost touch with the practice and aren’t monitoring their own health Uncertainty about whether some patients are still connected to the practice Recalling patients for preventive visits allows you to better balance the demand for your clinicians’ time. If you add more preventive slots and book them during times when your practice is slower, you’ll also add predictable revenues. Your patients will benefit, too, because they’ll see their physicians when the practice is less hectic and more appointment options are available. When practices reach out to patients to book an overdue preventive visit, it’s usually a marketing effort that is well-received. Often patients hold off on booking a check-up because they are unaware that many preventive services are covered without a copay—so they’re delighted to hear that an annual physical is something that won’t cause financial pain. There is one avoidable snag in booking preventive care that often trips practices up, however, and it’s a pitfall that puts patient relationships at risk: Not all services that could be provided in a typical check-up are considered preventive from a billing perspective. That can lead to “surprise” patient costs and bills. These unexpected costs can be very upsetting. Even though the causes are usually just innocent oversights, some patients will feel they’ve been cheated or deceived. One way unexpected out-of-pocket costs occur is when a problem is discovered or revealed by the patient during a preventive visit. If the problem requires additional work or tests, that usually means an

By Morgan|2022-01-01T22:51:53-08:00January 26th, 2017|

It’s job-hunting season. Don’t discourage your best prospects.

Every January, employees around the country secretly resolve that this will be the year they find a better job. If you're hunting for new employees, this burst of interest in job-hunting is good news for you. But are you missing out on some of the best candidates for jobs in your medical practice? Candidates who are currently employed are often the best prospects. But in our world, getting out of the office for an interview during normal work hours can be a significant obstacle. This is especially true for employees at the lowest levels. While we've all occasionally used "doctor's appointment" excuses to depart early for an interview, that can be more difficult to do in a practice setting. Certainly, it's not usually easy to do that more than once in a while, making it hard for employees to take on multiple interviews. As a manager looking to bring on the best talent, one way to sell your opening more effectively is by making it less stressful to apply for it. Initial screenings that can be done by phone or Skype, in the evening or on the weekend, will accommodate more candidates who are currently employed -- and will allow them to speak with you without tipping off their employers about their job-seeking. When final candidates are identified, consider setting aside a Saturday or Sunday afternoon to meet with everyone they'll need to interview with at your practice. Working on free time is not everyone's idea of a good time, but it will help ensure you can speak with every great candidate. And if doctors need to be involved with the interviewing, they won't have to sacrifice appointment time during the week. If your process allows you to be more flexible in interviewing candidates, mention it in your postings, so people know they might have a shot at your job, even if they've held back on other opportunities because they worry about getting time off from work.

By Morgan|2017-01-15T13:41:45-08:00January 18th, 2017|

2016 “Straight Talk” blog year in review

2016 was a busy blogging year for us. Here's a rundown of our top five most-read posts of '16: "It's everyone's responsibility, but nobody's doing the job" "Are you missing out on excellent solutions to front office challenges?" "The upside of staff downtime, the downside of multitasking" "Copays are declining, and that's not good news" "Office squabbles? Three areas to look for a fix"

By Morgan|2022-01-01T22:51:53-08:00January 15th, 2017|

Patient rudeness affects physician performance — what should practices do about it?

A new study from the University of Florida found that patients' rudeness towards their physicians can have a "devastating" impact on medical care. Patient rudeness may play a critical role in medical errors, which by some analyses are now the third leading cause of death in the US. The Florida researchers determined that patient rudeness causes more than 40% variability in hospital physician performance. (By contrast, poor judgment due to lack of sleep led to a 10-20% variance.) The reason for the huge variance is that despite intentions to 'shake it off,' experiencing rudeness disrupts cognition, even when physicians are determined to remain objective. The researchers found that key cognitive activities such as diagnosing, care planning, and communication are all affected -- and the effects last the entire day. The study suggests that patients need to understand the potential for rude behavior to undermine their care, even when clinicians try their best to be patient and understanding, and even when the rudeness is driven by understandable frustration. But I think the results are also a reminder to practices to try to limit patient frustrations in the first place. Doctors often bear the brunt of patient rudeness when aggravation and anxiety boil over, even though most of what bothers patients happens before they even see their physician. Because administrative issues are frequently the source of dissatisfaction, it's possible for practice staff to prevent or ameliorate many blow-ups. Doing so may help patients have more productive visits with their clinicians, while also helping to protect the practice's reputation and maintain a pleasant work environment for the entire team. If you're concerned about emotional patients disrupting your practice, here are a few ideas to consider: Evaluate, minimize your wait times. A long, unexpected wait in reception is a sure-fire source of patient frustration. When it happens in your practice, is it a rarity or SOP? If running significantly behind is an everyday occurrence your practice, consider a review of your scheduling processes, to come up with a schedule that is attainable. And make sure your front and back office staff are working together

By Morgan|2022-01-01T22:51:53-08:00January 15th, 2017|