Yearly Archives: 2019

Have you seen Laurie’s popular article about the deductible reset?

Laurie's 2018 article for Phreesia's blog is one of their most popular posts. If you haven't seen it yet, here's a link to check it out. It includes time-tested ideas for dealing with the roller-coaster ride that is the transition from the busy-busy fall season to the slowdown in January, including: Identifying the patients who can benefit most from booking services they've postponed before the year ends Making sure staff are trained and confident they can explain the pros and cons of booking care before year end Deploying and taking full advantage of all the tech at your disposal that can make it easier for patients to pay Planning to make conscious use of downtime in the spring--whether by increasing patient visits through promotion, using the time for other important tasks you've put off, or both There's still time to make a plan to have your practice business's best fall/winter season yet. If you'd like to discuss more ways to do so--and how we can help--please get in touch!

By |2022-01-01T22:51:43-08:00November 10th, 2019|

Top tips to make the most of the fall season and prep for the deductible reset

It may seem hard to believe—I know it does to me—but we’re approaching the last quarter of 2019. The summer season goes by fast, probably for obvious reasons, and when autumn arrives, it feels like it sneaked up on us.Of course, for many practices, there’s another reason it feels like a stealth attack by the calendar: the workload can go from one of the slowest times of the year to one of the busiest, seemingly overnight. This time of year can be crucial for your profitability. With many patients wanting to book services before the end of the calendar year, especially those who’ve met high deductibles, it’s an opportunity to meet patient needs and make more money. Now’s the time to plan how you’ll make the most of this busy time of year, without unnecessary stress. Here are some of our favorite tips for maximizing the upside of this season—while also staying well and enjoying what this high-productivity time of year. 1) Set a plan and get everyone on the same page Many of our practice clients seem to have an allergy to staff meetings! We understand the fear of wasted time. But at this crucial time of year, a group huddle can help make sure everyone knows what to expect and, above all, understands why the season is so important to practice health and stability. (This is likely obvious to physicians and practice managers, but it may not be to your staff.) Patients who know they’ve met their deductibles will be anxious to book care that they’ve put off. That means staff may need to be a little more patient when patients are less so. Patients will also likely be confused about their insurance, so making sure everyone knows the right way to answer their questions is critical (even if the right answer simply means knowing who to transfer their call to). If anyone on your staff is rusty on your technology capabilities or the billing/scheduling rules they’ll need to explain make sure you encourage them to speak up without feeling ashamed. Review your scripts and manuals, and assess

By |2022-01-01T22:51:43-08:00September 17th, 2019|

Are you an in-house medical biller or billing manager?

Are you an in-house medical biller or billing manager? We are looking to speak with a few billing professionals (either currently working as in-house billers, or who have been employed by practices in the past) for a project. If you are willing to speak with us for about 5-10 minutes for our research project, which focuses on attracting, motivating, and retaining medical billing staff, please reply contact us. We're looking for five to ten qualified respondents. Besides our gratitude, you'll receive a $5 gift card :) Better still, your responses will also help physicians and practice administrators better lead and manage billing teams. Thank you!

By |2019-09-12T14:49:06-08:00September 12th, 2019|

Teaching patients about their health insurance shouldn’t be your job–but it is

If you are frustrated by how confused patients can be about their insurance, and by the conflicts this confusion often leads to (especially about patient balances), you have good reason. Insurance is provided by employers, who theoretically should be able to explain it (it's an important part of employee compensation, after all). And it's offered and managed by insurance companies, who set and enforce the terms. There seem to be several good ways, logical ways to get information about insurance rules. So why do many patients misunderstand how it works? A few things are obvious. One is that health insurance can be very complicated. (It is complicated for those of us who work with it every day, even.) And the training and information patients have access to from their employers and insurers is simply not clear or accessible enough for many patients and many situations. This gap shouldn't be your problem. But it ultimately becomes your problem, since you'll have to deal with patients' confusion and corresponding reluctance to pay. All of which is a long way of saying that helping patients understand how their insurance works may not be something you should have to do, but it is something you're better off doing. And the earlier in the relationship you start the education process, the better. The clearer patients are on their financial responsibility before they receive care, the less likely they will be surprised by a large balance they didn't expect to owe. There is an old saw in marketing about how you have to repeat a message seven to ten times before anyone really absorbs it. The seven to ten is not regarded as a scientific analysis by anyone. But the idea that you have to repeat things, usually more often than you expect, and ideally via different media, is well accepted. (There's a reason you see and hear advertising by the same companies in different places and via different channels.) To this end, we often suggest to medical practices that they have some explanatory material at the front desk that covers common insurance issues--things like what

By |2022-01-01T22:51:44-08:00September 3rd, 2019|

The way we speak about colleagues matters [practice management tip: leadership]

Do you tend to refer to staff or their roles in your practice with generic terms like “billing person” or “someone on phones”? These descriptors seem like innocuous shorthand. But when physicians and managers speak about people in this generic way, it can send an unintended message that you view your employees as interchangeable cogs. Employees may assume that their career progress will never be recognized, or that employees’ specific contributions are not appreciated. Morale may suffer, and, over time, that can mean higher costs due to turnover. Productivity may be suppressed, too. Whether you’re a physician or a practice administrator, you worked hard to earn the respect that comes with your title. Feeling recognized for your achievements and contributions enriches your work life. The “billing person” who is working to bring money in your door may have invested in education to learn their profession, too. Though the training is nowhere near as competitive or lengthy as medical school or climbing the management ladder, becoming a skilled medical billing professional takes energy and commitment. Perhaps you now have an expert biller on your team, where you once had an eager novice who needed to apply herself to becoming proficient—a point of pride for her, and a financial benefit for you. Even roles like receptionist that have few education or experience requirements can be done with inspiration and excellence when your staff is engaged—benefitting your patients and your practice. On the flip side, if your staff is disengaged and going through the motions, you’re missing a big opportunity for your practice to stand out. Regardless of the roles they play, most of your employees spend more time working in your business than doing anything else. An atmosphere where there are a few valued players at the top and everyone else is considered interchangeable is not one where motivated people will want to work for long. Investing some time in creating (and using) meaningful titles for your employees costs nothing—but may earn a lot in improved morale and stability. A happier workplace with a more positive atmosphere means lower costs -- and

By |2022-01-01T22:51:44-08:00August 4th, 2019|

Don’t let the bastards get you down

We recently found out that another client of ours has been embezzled. Yes, I said "another." Employees stealing from practices unfortunately happens way too often. Though not rare, even just hearing about it is jarring. I find it sticks with me for days, like a black cloud reminding me that people can be awful. Of course, the effect it has on us is trivial compared to the impact it has on the actual victims of this terrible abuse of trust. The point of this post is not to advise you on how to reduce your risk of embezzlement. (We can do that, so contact us if you want to learn more, or start with our short quiz on the subject. But this post is about the emotional impact of having been robbed and deceived by someone you trusted.) If you've discovered that someone you relied on stole from you, here are some things I would like you to know. It's not you, it's them.Becoming a victim of embezzlement has nothing to do with your intelligence. Read that again: being a victim of embezzlement has nothing to do with your intelligence. Too often, victims of embezzlement feel ashamed that it happened to them. But though embezzlers are often clever, the difference between you and them is more about worldview than intellect. In some cases, people who were once honest find ways to rationalize their first theft while working for you. In other cases, embezzlers are repeat offenders who treat their crime as a trade, moving from employer to employer to ply it. Either way, it's clear embezzlers have a completely different sense of what is right and wrong than you do. In all likelihood, you didn't suspect them because you'd never consider doing something like this yourself. It's wrong to blame the victim of any crime, even when the victim is yourself. The only person to blame is the perpetrator. But you can put your intelligence to work for you by learning how to avoid a recurrence. You'll need to look at the world in a different way, so that you

By |2022-01-01T22:51:44-08:00July 15th, 2019|

New EMR/burnout study: Can your practice benefit from its findings?

A new PAMF (Palo Alto Medical Foundation) study on the connection between EMR and physician burnout is getting a lot of attention. The study has limitations (e.g., it focuses on one organization, one EMR and set of workflows, and it aims to infer much from a single question). But despite the need for caveats, the study is valuable because it confirms what intuition suggests about EMRs and physicians' stress. What's more, the authors tested workflow modifications and found they helped alleviate EMR-related burnout at PAMF. You can read about the study here. To summarize it, the study validated that when EMRs encourage message overload, they significantly increase physician stress. The study found that about half of all messages the physicians in the PAMF study received were EMR-generated--i.e., things like health maintenance alerts and medication reminders that the system generates automatically. The researchers found that many of these messages could be handled, or at least triaged, by other members of the care team. For example, medication messages could be routed first to a pharmacist, who would involve the physician only if needed. Nurses and MAs could also handle much of the automated message volume, such as follow-up appointment reminders. Not surprisingly, when PAMF experimented with diverting these lower-complexity messages to others, the burden (and stress) on physicians decreased substantially. Can PAMF's solution work in your practice? PAMF is a large, integrated healthcare organization. Healthcare Dive reported that PAMF launched an initiative called MIST--Multi-Disciplinary Inbox Support Team--to test the idea of sharing the message workload. One year in, MIST seems to have helped reduce physician message loads (and stress) substantially. But what if your practice is not a huge organization with IT and workflow experts or pharmacists on staff? In our consulting work, we often recommend practices involve staff in more meaningful work. To enable physicians to focus as much as possible on tasks that only they can do (working at the top of their licenses), everyone else needs to do as much as they can. Expanding the roles of staff -- within their skills and scope, of course -- can help

By |2022-01-01T22:51:44-08:00July 7th, 2019|

Hiring your best new medical practice administrator

Since administrators play such a critical role in practices, recruiting a new one for your practice may provoke a fair bit of anxiety. If you’ve been left with little time, you may feel rushed. If your previous practice manager was a flop, you might even be feeling dread. Addressing the challenge head-on and systematically can help get you the result you desire. One familiar mistake we see is failing to define your needs thoroughly. This is not just a matter of “minimum of five years experience” – it’s a matter of understanding your practice’s mission, goals, and culture. It’s a matter of identifying what success looks like with the right administrator in place. Without mapping your practice’s needs and culture to a candidate’s qualifications and characteristics, you’re left merely hoping for a good outcome. Considering the lost time, productivity and general disruption that comes along with a poor hire, you need the odds in your favor. If you have infighting among your staff, which isn’t uncommon unfortunately, you may need a no-nonsense administrator with more of a hands-on approach as opposed to a spreadsheet genius who prefers to stay locked in her office all day. On the other hand, perhaps you have a mature and well-functioning staff and feel that you need a candidate with particularly strong financial management skills—for example, if growing your practice by adding a new office or even acquiring a competitor is on your agenda. Whatever you decide, you may want to create a spreadsheet table so that you can rate each candidates on the dimensions you think are most important - a simple 1-5 rating is a great start. You may want to use weighting as a tool to further refine your analysis. The old management saying of “be slow to hire and quick to fire” is useful to keep in mind along with some caveats. While it’s certainly important to find the best possible candidate, the cost of stop-gap management can be high. We see many practices where some staff is “temporarily” filling in as the practice administrator – often poorly attending to many

By |2022-01-01T22:51:44-08:00July 2nd, 2019|

Let’s talk staffing levels

Many administrators and physicians struggle to find the optimal staffing level.  When patient volume is especially high or an employee has called in sick, it can seem like you’re horribly short-handed.  On the other hand, seeing staff idle can make physicians feel as though they are paying for nothing at all – hardly a comfortable thought when profits are being challenged in multiple fronts.   Evaluating your ongoing staffing needs in a methodical, evidence-based manner can be a challenge, but it’s well worth the time and trouble. While it’s natural to look to other medical practices to see how you compare, don’t give undue weight to such comparisons.  While staffing levels typically fall between 3-6 FTE staff per clinician, it’s underappreciated that the strongest, most profitable practices often have more staff per provider.  To the extent staff assists the physicians in working efficiently, they increase the revenue potential of the practice.  Every task that a physician does that a staff member could do is a lost opportunity.  When we visit our medical practice clients, we almost always notice productivity gains that could be made with existing practice staff.  If your practice is like most, you can benefit from looking carefully to see if more tasks can be done by staff generally.  And here’s a great little secret: if you have staff who sometimes feel a little bored or underappreciated, simply asking them how efficiency can be improved can yield immediate results. Even after decades of experience, we’re still surprised by how many excellent ideas can come from even the most junior staff.  But more than that, staff feels more valued, engaged, and committed to the practice when you recognize their knowledge by asking their opinions. Also keep in mind that there may be tasks staff would be motivated to do during brief down periods that are beneficial to your practice. For example, many practices fail to update their websites and social media on a regular basis. This type of work can be a perfect fit for slow times at the front desk if you have a person who has the enthusiasm

By |2022-01-01T22:51:44-08:00June 14th, 2019|

‘Accept that almost anybody is a volunteer’: what does it mean to your medical practice?

We've started a new website feature you might like. We're listing some of our favorite famous inspirational management quotes (along with a few of our own). Classic quotes are fun and useful because the gurus who said them figured out how to succinctly express management ideas that can sometimes be obscure in practice. One of our favorites deals with a brutal truth of managing employees: Peter Drucker's advice to "accept that we have to treat almost anybody as a volunteer." You've got the title and you sign the paychecks. In theory, that gives you a lot of leverage. You can insist on having everything your way, at least for a little while. Eventually, though, a dissatisfied employee can put on his or her walking shoes and go work somewhere else. This freedom to hit the road goes double for people in high demand. (Like, say, physicians in practically any specialty, or talented administrators or billers.) If you're finding your practice is experiencing a lot of turnover in key roles, it can be very costly for your business. And even before they leave, unhappy employees can harm your practice with low productivity, negativity, and, in extreme cases, even sabotage. So how can thinking of employees as "volunteers" help you improve morale and retain key people longer? Here are a few things to consider: The idea that employees are "volunteers" means more than just "they can leave." Modern employees want to be inspired by their work. They want workplaces that align with their values -- just as they would if donating their time. This doesn't mean you should retool your practice culture to match the preferences of every new hire. What's more important is to know your culture and be clear about it when hiring. That will help you avoid a costly revolving door of employees whose expectations weren't met. And what if you suspect parts of your culture or your work standards could use an upgrade? The upside of better morale and lower turnover is a good reason to consider making needed changes. Money is important. Make sure you're not notably

By |2022-01-01T22:51:44-08:00March 19th, 2019|

Should you buy the practice down the street? [on-demand webinar]

In recent years, many of our clients and friends have been involved in practice acquisitions or mergers. In many of these cases, a practice in a nearby area has come up for sale, perhaps due to retirement or death of a physician owner. These can be exciting opportunities, but stressful, too. There is usually pressure to respond quickly. And, of course, the decision usually involves a significant investment. The need to move fast often makes it hard to even think through all the questions you want to ask -- much less get answers to all of them. When the pressure's on, fear of missing the opportunity may take over. But if you move too fast, you may "win" the opportunity without realizing what it really costs. "Buying the practice down the street" may be a fantastic way to quickly expand your practice, but it's not without significant pitfalls. Information and a solid plan are your best tools for protecting your interests. In this short webinar (about 30 minutes), Laurie Morgan outlines some of the key questions to consider when deciding whether to buy a nearby practice. To view the recording, click the link. You'll be asked to register on the video page. Once you've watched, we'd love to hear from you if you have questions. And, of course, we're at-the-ready to help you with consulting services before you make a purchase decision (or before you put your practice on the market). Use the contact form to email us or give us a call.   "Should You Buy the Practice Down the Street?" [on-demand recording - registration required]  

By |2022-01-01T22:51:44-08:00March 14th, 2019|

Time for a review of your E&M/office visit utilization? (DOWNLOAD free spreadsheet.)

Office visits represent a huge proportion of revenue for most practice types. It's easy for small errors in coding to become habitual, and the resulting inaccuracy can be costly for your practice. Under-coding can mean lost revenue -- multiplied by hundreds or even thousands of visits per year. Accidental over-coding can lead to revenue clawbacks that create accounting hassles and make it more difficult to accurately project revenue. Payers are very concerned about E/M accurate coding, too. That's why any variation (not just over-coding) can be a trigger for a payer audit. Checking your E/M coding patterns against Medicare's utilization data for your specialty is a quick way to spot possible problems. If your or your practice's code utilization differs significantly from national data and the reasons aren't immediately clear, it could be time for a closer review or internal chart audit. 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 grunt work for you. Follow the links below to download a spreadsheet that already has the CMS 2017* data keyed. It includes  formulas to calculate your clinicians' or your practice's utilization of each code, and compare it with the national averages. Just enter your data and get your results immediately. Allergy and immunology Cardiology Dermatology Endocrinology Family practice Gastroenterology General practice General surgery Internal medicine Neurology Neurosurgery OBGYN Orthopedic surgery Otolaryngology Psychiatry Pulmonary disease Rheumatology Urology Need a different specialty?  Contact us and we'll pull it together for you, provided the CMS has published data for it. Besides comparing against the CMS numbers, we recommend you compare your clinicians' numbers against each other. 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, contact us.)   *here's a link to

By |2019-02-27T15:32:20-08:00February 27th, 2019|
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