In the 1st and 2nd editions of Secrets of the Best-Run Practices, the final chapter was “The Practice of the Future.” After much deliberation, we decided to eliminate this chapter in our 3rd edition published a few months ago. This was partly because we touched on some of the most important trends elsewhere in the book – especially those related to technology, but also the possibility of exploring new service lines to make a career change or reinvigorate revenues. But there was another realization that held us back: the unpredictability of the medical market, which we realize is translating to difficult decision-making for many physicians. (A lot could happen by the time the publisher got the book into the market. So it seemed to make sense to focus on the "Secrets" that would apply no matter what.) Still, that doesn’t mean we think physicians should be in an indefinite holding pattern with respect to their businesses. Definitely not! Here are some of our observations on grappling with the future and uncertainty. Indecision We find some physicians are discouraged by political implications and big government in general. They feel they have no power over the way they practice and how much they are paid. This results in frustration that can lead to acceptance of their current situation and sometimes actually believing the future of their practice is not in their own hands. Physicians must remember that not deciding is in fact a decision to maintain the status quo and not take important steps that can improve practice results and their own attitude. Of all the negative effects of our uncertain environment, this one troubles us the most. Too many physicians are missing out on opportunities to improve their practices today, simply because they are distressed about uncertainty about tomorrow. All businesses deal with uncertainty – and most face much more than we do in medicine. Don’t miss out on important opportunities to run your business more efficiently or enhance patient service because you’ve voluntarily committed yourself to a holding pattern. Failure to use data This sense of paralysis about the state
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
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
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.
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
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
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
A key factor in the patient-centered movement gaining traction is the Affordable Care Act and its intention to improve population health and reduce healthcare costs in the United States. This is expected to be accomplished through improved patient satisfaction, coordination of care and better clinical outcomes. The Patient-Centered Medical Home (PCMH) is viewed as a path to accomplish this and CMS is offering financial incentives to primary care practices that become recognized as a PCMH. The idea of PCMH was developed through a consortium of the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association. Together they developed joint principles for the PCMH including the provision that each patient would have their personal physician and their care would be directed by the practice, ensuring care was coordinated and/or integrated as deemed appropriate with an expected level of quality, safety and enhanced access, as well as establishing appropriate payment for these efforts. There is national growth in practices achieving recognition as a PCMH with the front-runner of recognition programs being offered by the National Committee for Quality Assurance. In 2011 NCQA’s standards increased to include guidance on developing chronic care management programs, enhancing patient engagement and improving patient outreach, and aligning with EHR and the new healthcare Meaningful Use criteria. NCQA’s program promotes goals to: Improve the patient experience Recognize clinicians’ efforts Provide confidence for purchaser: value for money spent on quality care CMS led the pack with financial incentives for the PCMH, but other payers have also emerged with bonus and payment systems that recognize the PCMH, improved outcomes and patient satisfaction In 2013 NCQA announced the Patient-Centered Specialty Practice recognition program. The development of this program was motivated by the discovery of reporting discrepancies between referring physicians and specialist. The PCSP program is designed to improve communication and access. Yes, there’s a lot of buzz about the focus on being patient-centered and improving the patient experience, but the programs are only growing in importance. If you haven’t already done so, it’s time to get information, make the commitment
Hospitals are acquiring or partnering with medical practices at break-neck speed and for good reason. It makes sense to align with physicians in a changing marketplace. It will strengthen the hospital’s position for both bargaining power and marketing their brand. Physicians on the other hand, fear the unknown and are often uncertain about the strategies they should take to protect or improve their future. If you are approached about the possibility of joining forces with a hospital do you know what you would do? Here are some things for you to think about. The first step in consider partnering with a hospital is to clarify the opportunity by gathering information. Examine your own motivations. What is it you hope to gain and is it realistic? At the same time, it’s important to understand the hospital’s agenda and determine if, in fact, their motivations are clearly aligned with yours. Remember all successful relationships are built on trust. You can avoid a head-on collision if you ask the difficult questions and get honest answers upfront. At the same time, you must we willing to be open in your communication by discussing what you want and hope to gain, and what concerns you may have. Whether it’s about their motivations, their leaders or how they want to structure the contract. If it doesn’t feel right, it probably isn’t going to work unless you resolve the issues that make you uncomfortable with the deal. It is only through honoring your differences and negotiating in earnest that you can work toward common goals that align motivations and lead to success. In order to share your future you must develop trust and common goals, and build a vision that everyone stands behind. Check out my free mini-webinar on working with hospitals and systems without losing yourself, presented by the AOA -- part of the Power Up series.
It’s not too soon to think about the holidays and how you are going to honor staff for everything they’ve done to get you through the year. Will it be the typical holiday party and a gift exchange or do you plan on giving Christmas bonuses – which can be troublesome? I say this because most practice leaders just aren’t sure how to handle bonuses. I mean, really, maybe staff has just come to expect a bonus and don’t even realize it is intended as a reward or gift of gratitude. Maybe Andrea doesn’t understand why Heather, who has been with you less than a year got the same amount she did. Sometimes staff are actually disappointed – expecting more and feeling the bonus is paltry. It is not that unusual for staff to assume the practice can afford much more. This is unfortunate for the practice that struggles to maintain a reasonable profit during these difficult times. Is it time to change how you manage holiday giving how you recognize staff? Do you need to deal with the mindset of staff and get aligned? Is it time to educate the staff that it isn’t business as usual and profits have been sliding or are being threatened by healthcare reform? And do you even know if you are paying staff appropriately in the first place? This all seems burdensome to deal with, but it is that time of year again. I suggest practice leaders get a jump start on addressing holiday bonus and recognition programs and analyze how they financially honor staff once and for all. Begin by getting a grasp on your current pay scale to make sure you are paying market rate for each position based on the qualifications and responsibilities that each job requires. This will ensure you attract and keep the best employees. If you want staff stability and longevity you must create and maintain a desirable workplace environment where staff is respected and treated fairly. Next, think about the value of the paid holidays you already provide for staff. Not all practices are equal here.
The culture of the medical practice is shifting dramatically: the way we think, the way we work and the way we care for our patients. It’s no longer simply about what’s the matter with the patient; it’s time to focus on what matters to the patient! The patient-centric practice is in the limelight and being fueled by the Affordable Care Act, which places more emphasis on the patient relationship. The ultimate goals are to: Improve compliance Reduce healthcare costs Obtaining better outcomes Achieve a higher level of patient satisfaction This is a major shift for many medical practices that have previously focused primarily on the tasks required to diagnose a patient’s condition and create a treatment plan with the assumption that patients would follow its orders. Think strategically when it comes to creating a patient-centered culture. Managers and physicians need to accept the responsibility to make the changes required to accomplish this and commit to success. How can you pose issues effectively and what obstacles must be overcome to get team buy-in to changing the way things are done? You start by building the change management team. Determine who will be the champion for this project and increase your odds for success and which team members will contribute to creating an effective plan that will be endorsed by staff. The champion needs to be someone that is trusted and respected by everyone and believes that the changes the practice makes will lead to greater success in strengthening the relationship between the patients and the practice. The change management team will be required to establish standards and method of accountability that involve everyone. No balking allowed and no sacred cows! The plan needs to be structured and supported by management. Once the plan is agreed upon and in place, the champion must sell the vision and be the role model that inspires organizational change by leading the efforts, keeping the communication open and celebrating steps of progress. Check out my free mini-webinar on this topic, presented by the American Osteopathic Association -- part of the Power Up Your Practice series.
Most medical practices aim to establish scheduling parameters based on perceived capacity and the appointment time needs or constraints of the physicians and providers that see the patients. But there’s so much more to maintaining an ideal schedule that meets demands of patients, offers smooth workflow for physicians, and ensures the physicians achieve ideal productivity standards. Begin by taking reviewing the schedule of the past 30 days. What went wrong (no shows, idle providers), what went right, and why? For example, what is the average number of visits per day for each provider? And is it consistent? How many holes are left in the schedule? Is this because schedulers are leaving gaps, or are missed appointments the problem? Identifying what's sabotaging your goal of an efficient schedule is the first step. The next is figuring out what can you do to fix it. It can be fixed, and one thing is for sure, ignoring it guarantees you will continue to experience the same (or greater) inefficiency then you have in the past and that’s going to hurt your profits. Toss out past habits and be willing to give your scheduling system and the attitude behind it a fresh start. Physicians must learn to maximize the percentage of their time spent with patients. Patients should be physician-ready when the doctor enters the exam room and that staff is properly trained so the physician can delegate tasks that do not require their level of expertise. Honor the appointment schedule. Let staff know what your expectations are and hold them accountable and above all – start on time to stay on time. This is the beginning of respecting the schedule and running a smooth system. If you don’t value the appointment schedule neither will your patients or your staff and you can bet the loss productivity this causes will cost you plenty. Medical practices are already feeling the pinch of constraints and changing dynamics brought on by marketplace and regulatory trends. Physicians and managers are concerned about the unpredictable future of private practice. But the best way to take charge of your future
Group visits can be a great complement to many medical practices that provides many benefits. The emergence of group visits, sometimes referred to as shared medical appointments (SMAs), began when physicians and their managers recognized access for patients with chronic illnesses was inadequate. Patients with chronic conditions such as asthma, COPD and diabetes ended up coming in when their symptoms were exacerbated and out of control. This was either because they couldn’t get an appointment sooner or they were simply non-compliant with keeping regular appointments. Their health condition was being compromised and physicians were frustrated because there was not enough time to address complications sufficiently during the typical time allotted on the schedule. Group visits enable a practice to bring a small group of patients with the same disease together to discuss the common issues they share and how to better manage their chronic condition. At the same time, each of the attendees has individual time with the physician or other provider for an examination and specific treatment recommendations. In 2002 this was defined as a revolutionary access solution in a Group Practice Journal article authored by Edward B. Noffsinger, PhD, a pioneer in the development of group visits. The first clinical applications of this mod Many patients like the group practice visit and getting support from people that share their problems. It can be very affirming. The shared visit often contributes to improved compliance, as some patients report their condition improving when they adhered to their treatment regime. It’s a win for the patients, the practice and the payer as access improves, cost of care goes down and better clinical outcomes are achieved. Physicians can actually see more patients in less time and the practice gets paid for the level of care provided, since each patient is billed the same as an individual appointment and the co-pay amount remains unchanged. The insurance companies don’t seem to care as much about where the patient is seen as they do about the level of service the patient is getting. It is expected that the group visits will expand rapidly to provide
A feature in June's issue of the Los Angeles County Medical Association's Physician Magazine put the spotlight on increasing efforts by hospitals to "align" with doctors -- whether by creating customized contract arrangements designed to better match doctor and hospital incentives, or whether through compensation structures implemented after acquisition of physician practices. (Naturally, acquisitions make alignment even more important, as hospitals race to make these costly investments pay off.) In fact, the article pointed out that -- based on American Hospital Association (AHA) data -- more than one-third of the surveyed hospitals use integrated physician salary models today. This all seems familiar to me as I recall the flurry of primary care practices seeking opportunities for hospital acquisition back in the late '80s. The motivation for physicians then was the fear of managed care combined with the lure of hospitals offering attractive purchase prices and lucrative guaranteed salaries. Physician-hospital alignment didn’t work so well back then, but will it work now? I’m not so sure. The first time around the objectives of the physicians were in stark contrast to those of the hospitals, which wanted to secure referrals and gain a competitive advantage. Physicians bought into the security of employment and a guaranteed salary with little thought about the implications of becoming hospital employees. The physicians within these acquired practices did not do well when demands were made by their new employer. Physicians also assumed that large hospitals with more business savvy would be better equipped to manage medical practices efficiently. However, hospitals with corporate mindsets, slow decision-making processes and no experience with running practices were not prepared to manage the acquired practices. The relationships became adversarial. Soon hospitals began to see some of these practices as simply a sea of red ink. Soon consultants across the country were recruited to deal with the situation and unwind the deals. Fast forward to 2014 and there are some major differences in the healthcare climate surrounding alignment. A new fear has emerged for physicians. It is the Affordable Care Act and its potential implications. Mature physicians wonder if private practices will be
On July 8th Medscape presented a thought provoking discussion with three primary care physicians titled “The Good and Bad of Patient Satisfaction Measures.” This fuels the ongoing debate of the value and scores as part of physicians’ payment for their patient services -- a subject of keen interest to me. In March 2012 the Archives of Medicine published a study conducted by Joshua Fenton, MD, MPH, and colleagues at the University of California, Davis. The study analyzed data from more than 50,000 adult patients, indicating the most satisfied patients were 12% more likely to be admitted to the hospital and their healthcare and prescription drug costs were 9% higher. One of the most interesting findings to the study’s readers was that the report revealed more than 26% of these patients were more likely to die. What a startling fact! One of the strengths of this study was its nationally representative sampling. The findings were derived from the assessment of satisfaction based on 5 measures from the well-known CAHPS survey, emergency department visits and inpatient admissions. The tension between patient satisfaction and patient outcomes and cost savings continues two years after the study was released. There is discussion about whether physicians motivated by payment structures based on patient satisfaction are influenced in the ordering of diagnostic studies typical treatment standards in order to keep patients happy. An article in appearing in Forbes on July 21, 2013; “Why rating doctors is bad for your health” by Kai Falkenberg discusses this issue. "THE MATH IS NOW SIMPLE FOR DOCTORS: More tests and stronger drugs equal more satisfied patients, and more satisfied patients equal more pay. The biggest loser: the patient, who may not receive appropriate." When physicians are pressured and financially incentivized to keep patients happy an ethical dilemma occurs and some physicians succumb to appeasing patients by ordering tests they might not otherwise order. Forbes reported that the South Carolina Medical Association asked its members whether they’d ever ordered a test they felt was inappropriate because of such pressures, and 55% of 131 respondents said yes. Nearly half said they’d improperly prescribed
Medical practices are taking note of the importance of strategic planning, as they tread the unknown waters of healthcare reform and adapt to changes they may not have invited if given a choice. But do the key stakeholders of most private medical practices really understand what it takes to succeed with efforts to create and successfully execute a strategic plan? Do they know the importance of developing an authentic and that in order to be authentic it must be driven by the practice mission? If the strategic plan is not authentic in consistently delivering on the mission it is likely to fail. But if it is authentic, it will guide the practice in achieving its strategic goals. Start on your path to strategic success by keeping these essentials in mind while going through the strategic planning process. Begin the strategic planning process by making sure the plan encompasses what the practice is all about and what it represents to the community. This means the goals and the decisions outlined in the strategic plan must be aligned with the practice’s mission and vision. It is important to articulate the significance of this from the onset and revisit it as you go through the many processes of strategic brainstorming, goal-setting and formulating the written plan. This helps ensure that the decisions and actions identified in the strategic plan are authentic to your very purpose in being a medical practice. Next, identify what differentiates your practice from its competition. It is critical to examine market data to understand external factors that may impact the practice now and in the future. It is also critical to take an objective look at the practices strengths and weaknesses, exploring what opportunities this presents and what obstacles must be overcome. Sometimes, this is referred to as a "SWOT" analysis, for "strengths, weaknesses, opportunities and threats." These analytical steps help the practice address issues it must contend with and make appropriate strategic decisions based on the reality of your market position. Practice-wide engagement is needed to succeed with implementing a strategic plan. This means communicating your strategic goals
In 2013 NCQA rolled out the Patient-Centered Specialty Practice, PCSP, Recognition Program to distinguish specialists that achieve specific marks with: Developing and maintaining referral agreements and care plans with primary practices; Providing superior access to care (including electronically) when patients need it; Tracking patients over time and across clinical encounters to ensure patient care needs are met; and Providing patient-centered care that includes the patient, and when appropriate, the family or caregivers, in planning and setting goals. The motivation behind the PCSP program began when reporting discrepancies were identified between referring physicians and the specialists they refer to. For example, referring doctors claimed that between 25 and 50% of time they were unaware if the patients they refer are actually seen by the specialists. Another discrepancy was the specialist claiming they sent consult reports 80% of the time, but the primary care physicians state they receive this information only 60% of the time. With the PCSPs intent on improving care coordination and communication between specialists and their primary care physician, managing chronic and acute conditions across continuum of care will be better accomplished. The PCSP program also evaluates medication management, test tracking and follow-up and information flow over care transitions. This recognition program is expected to result in a better patient experience and improved outcomes.
It’s a common error for physicians to think their manager and the staff can do anything they ask of them. Although it’s admirable, it may place an unfair burden on everyone. And if the practice has grown, but the staff hasn’t, you may be expecting too much. If you have major projects that get put on the shelf or get derailed, you may be missing out opportunities or losing your competitive edge. And, if you find yourself picking up the slack for staff that is inundated with their workload demands and things just aren’t getting done, it may be time to outsource your pain. Even if staff has enough time, you might be asking someone to take on a responsibility they don’t have the acquired skill set required to get the best outcome. Physicians and managers also face tremendous demands that sometimes cause them to put off important projects that would help the practice become more robust and put you in control of your future. For example, most practice leaders don’t have time to take on something as important as a developing a strategic plan. Such a project requires tremendous upfront research and analysis, prepare the report and plan the strategic planning retreat? Hire an expert to do the leg work and facilitate the retreat and you will not only get the job done, but you’ll get it done on time. And how about using a payroll service with automatic deposit to the employee’s account? You can select a service designed to track accumulated paid time off, and allows you to download the employee time records, which is a real relief to managers. This is a cost effective way to get a reliable outcome and allow the manager’s time to deal with other pressing issues that need attention. Whether it’s outsourcing a specific one time project, ongoing responsibilities like revenue cycle management or an important daily task like seeking a technology partner to electronically manage appointment reminders, you can find a good match for your needs. Check with your colleagues, do research on-line and take advantage of those annual conferences
The buzz about being patient-centered is not just hype, the patient-centered movement is very real and there is much to gain. The primary premise of the patient-centered movement is that by building stronger relationships with patients they will be healthier. Healthier patients mean a healthier population. A healthier population reduces healthcare expenses which have soared in the United States over the past few years. Reducing these expenses is a goal that health plans are increasingly willing to pay practices to help achieve. Understanding what it means to be patient-centered is a complex process as it intends to recognize patients in terms of their own social worlds. This means throughout the patients’ healthcare experience they should be respected, listened to, informed and involved in their care. It is believed that shared decision-making results in better compliance and reduces health risk factors. Focusing on individual patient’s needs an applying evidence-based medicine is meant to improve the healthcare population. Insurance companies, recognizing these factor,s are in the process of implementing financial incentives and bonus structures based on key elements that improve the delivery of health care and manage costs by reducing complications and emergency room visits, and by complying with best preventive practices. Your intentions to be more patient-centered can be reached by: Strengthening the patient clinical partnership; Promoting communication about things that mater to the patient; Helping patients know more about their health and healthcare needs; Facilitating patients’ and caregivers involvement in the patient’s care; and Setting metrics to measure improvement. Being patient-centered is rewarding for your practice in so many ways: happier patients, potential financial upside, and stronger relationships between providers and patients. All of these themes are discussed in greater depth in my and Cheryl Bisera’s new book: The Patient-Centered Payoff (click the link to see the book's page on Amazon).
Conducting an internal chart audit require team effort to plan, execute and analyze the results. You will get far more out of the audit by involving team members from different departments and presenting it as an exciting time to learn more about the inner works of the clinic visit and their implications on practice finances. A team of five is perfect; a receptionist or scheduler, a biller, a nurse or medical assistant, a medical records or data entry person and a physician or other provider. Begin by gathering five random patient records per each provider and selecting one date of service for each patient; the date of service should be three to six months prior. This allows adequate time for insurance processing and receipt of third party payment on the records being reviewed. Staff should break into teams of two – preferably one administrative staff and one clinical staff person. Each team should review a minimum of five charts and document discrepancies. When the review is completed, they should analyze the results to determine if the same errors are recurring or if there are different areas of the practice or service where problems occur. They should then calculate the potential cost of the errors over a twelve month period. The next step is to make a recommendation on how to approach correcting the deficiencies for long term benefit. Common problems detected: Discrepancy in evaluation and management level of service (E&M code) Wrong diagnosis Missing dictation Incomplete charge slip Missed office charges: Procedures, lab, x-ray Missed hospital charges: ER visits, consultations Insurance write offs taken that are not justified (payment overlooked or discounted by payer) Patient balances written off on Medicare patients All of these problems have the potential to both cost your practice money in the short term (e.g., by causing denials or delays or down-coding) or in the long term by triggering an audit by Medicare or a private payer. By conducting your own internal audit, not only will your staff learn what kinds of mistakes you've unwittingly been making (and be able to correct them), everyone will understand
Auditing charts is nothing new; Medicare has been doing such audits for years. They are looking for coding irregularities within a practice to determine if they want to do a more extensive audit. That's when a practice gets the dreaded notice to prepare and submit charting documentation on a selected number of charts and submit them to CMS for a detailed review. Often when this happens the stakeholders in the practice have no idea what they have done to trigger the audit. We suggest you take a proactive approach to understand your coding patterns and whether you are coding appropriately based on the services rendered and the documentation essential to support the codes you billed for. Here are steps you can take to prepare for a practice-wide internal audit, which may help you avoid the dreaded Medicare audit – or at least be ready to pass with flying colors. Empower staff to understand the importance of their individual actions in helping the practice get paid for the services performed. A mini audit involves everyone in analyzing charge and payments for services rendered. The staff teams up to examine documentation of services rendered, diagnostic coding for encounters and the payment received for those services. Increase the staff’s awareness of the significance of accurate documentation and its relationship to revenue generated in the practice. By examining charts and billing information the staff will begin to understand how important it is to account for every single service rendered. With reduced reimbursement no office can afford to drop a charge or to neglect following up on an inappropriate reduction in reimbursement. For example if you missed charging for one EKG and one Urinalysis a day, it would add up to as much as $12,000 a year in lost revenue. If you missed charging for one hospital consultation a month per doctor in a four doctor practice, you would take an annual hit of $6,000. Increase the reimbursement IQ of reception and nursing staff, as they examine EOB’s and see a 30 to 40% adjustment in the payment rendered by third party payers. This will
2014 will be a winning or losing game for medical practices – depending on their patient payment policies and efficiency with collecting patient payments. Patient responsibility has spiked over the years and has taken a quantum leap in 2014 with annual deductibles of $5,000 and more. Patient share of responsibility beyond the deductible can be as much as 20%. So if you haven’t already done so, it’s time to beef up your patient collection procedures and track performance to ensure you are collecting at the time of service. Here are a few key ways to get paid sooner rather than later. Train staff on how to ask for money. Give them scripts and practice so they are comfortable. Help them understand it is appropriate to expect payment at time of service. I mean, like where else do you go and not pay for services at the time you receive them? Start at the beginning. Staff should explain your payment policies when they are scheduling a new patient. For established patients that are scheduling appointments on the phone, remind them of an existing balance and inform the patient that payment of an existing balance must be paid at the time of their scheduled visit – if not paid in advance. You might even consider asking the patient to pay their previous balance with a charge card at the time they are scheduling their appointment and be ahead of the game. Plan ahead. Every day assign someone in the office the responsibility of reviewing the next day’s schedule to verify insurance coverage and plan for Use technology. Automate confirmation phone calls or text messages to be placed 48 hours before a patient appointment. The script used should include a message reminding the patient that any balance remaining on their account must be paid at the time of the visit. Avoid exceptions. Keep providers out of the payment discussion. Help physicians by giving them the script for a reply to patients that want to talk about payments. Something as simple as “Mary, my main concern is your health, our billing department manages collection.
A medical practice performance dashboard is a great time-saver to help keep your finger on the pulse of practice performance and understand your position in real time. It is similar to the one in your car – a set of indicators provide a simple, practical way to know what’s going on and to let you know when you’re headed for trouble. The dashboard is a metric reporting tool that makes it easy to look at business performance so you know when the practice is doing well and are alerted when something is wrong. Dashboards provide a layered interface that conforms to the way you work. When performance dashboards are aligned with the practice’s operations, productivity, finances and strategic plan, managers and physicians begin to work more efficiently and effectively toward achieving shared objectives. Typical indicators revealed on the dashboard focus on practice productivity and finances. However, the power of the dashboard can be extended to include other data. For example, if a new provider was added recently or you opened a new satellite clinic, monitoring growth and financial progress of this entity can be added to the dashboard. The dashboard can be designed to compare internal performance from the prior year or to look at how you compare to your colleagues across the nation. Medical Group Management Association’s (MGMA) has conveniently packaged a set of dashboard metrics with its Cost Survey on disc. This enables the user to create a dashboard based on six indicators that are benchmarked against other practices in a few short minutes. The spreadsheet used to prepare the dashboard shows your ranking when compared to the MGMA database. If you find yourself on information overload with management and financial reports screaming for attention, think about implementing dashboard technology to monitor your practice's business performance at-a-glance. With web-embedded technology some applications can update information automatically eliminating the need to repopulate the spreadsheets. Charts and tables can be configured to support drill-down capabilities. Keep in mind, though, that dashboards are only as good as the data that supports them. Success is dependent on the quality and flexibility of
There are lots of reasons to spend time in the exhibit hall when attending practice management and other medical conferences. By visiting the exhibit hall you will learn a lot about what’s going on in the industry, how vendors are seeking to meet your future needs and what technology changes have emerged that can make a practice more efficient and profitable, while improving service and outcomes. Yes, there are lots of reasons to get down to the exhibit hall, but it's also important to plan how you can do this without being overwhelmed or wasting your valuable time. Forget about seeing everything – it’s just not possible and can lead to unnecessary frustration. However, with thoughtful planning you can see those things that can make a difference in your very own practice. Get off to a good start. Conference materials at the convention will include a list of all the vendors that are exhibiting. Match these with your interests. Then check-out their location on the exhibit floor. This will allow you the opportunity to plot your course. Visit your selected vendors, by covering one section of the floor at a time. It’s a strategic move that will get you off to a good start. Refer back to your vendor list as you move through the convention. You might want to take photos using your mobile phone or make notes. This will be valuable for follow-up and decision-making when you get back to the office. Pace yourself. Be realistic in evaluating how much time must be spent on the floor of the exhibit hall to achieve your goals and meet with the different vendors you have targeted. Allow an average of 5 minutes for each of the vendors on your list. When you meet with an exhibitor, it’s important to be a good communicator and get right to the point. Let the sales representative know what information you want and why. At the same time, if the sales rep is not a good listener you could be wasting valuable time. Don’t allow him or her to lead the conversation to information
We were recently called into a group practice where the physician owners of Struggles Medical Group were disillusioned with the practice of medicine. Their concerns were typical, shrinking reimbursement, dismal profits and the threat of new competition, as a large urban academic faculty practice was beginning to penetrate this suburban community. Sound familiar? This is happening around the country as a response (or reaction) to healthcare reform, where larger healthcare organizations see new opportunities to get a bigger piece of the revenue pie. Struggles timing was perfect for bringing this consulting team in and here’s why. We performed a detailed practice assessment, examining the implications of past decisions and analyzing the current state of Struggles Medical Group in primary areas of performance including practice structure, finances, human resources, billing, clinic operations and work flow and marketing. One physician owned this practice and the other physicians and providers were employed. We soon discovered the physician owner had a history of making bad decisions. They did not analyze return on investment (ROI) before making investment decisions that would impact the practice operations, finances and possibly patient care. A perfect example of Struggles poor decision-making was buying very costly diagnostic equipment that they were unable to use because payers were contracted with a lab to provide these services. This meant the investment was rendered useless to the practice. Besides this, with new models on the market every six month,s there was no way to attract another buyer for the equipment. There were other equally disastrous investments Struggles made over the past two years. The most recent strategic error was changing the direction of the entire practice. In their quest for new revenue opportunities the practice decided to focus on expanding its service to workers compensation patients. Attracted solely by somewhat higher gross reimbursement rates, they went ahead with this in this in 2013 without thinking of the implications with would have on staff, workflow and profit. This was a costly error. Workers compensation is a practice model that is significantly different from other payers and requires specific expertise in report writing and tremendous
This is certainly a reasonable question to ask considering the rapid-fire change, threats and unknown factors medical practices face due to the Affordable Care Act. But here are a few things you can do to deal with all of this. First, keep your eye on the ball. Don’t throw up your hands in frustration, but follow the news and the legislation that is likely to impact the way you practice medicine, your future stability and the care and service offered to your patients. Read everything you can and keep your cool. In other words, don’t throw your hands up in despair. Put the emotions aside and be prepared to respond. If you know what’s coming down the pike you can be practice-ready and take strategic actions rather than wait, feel the panic and be reactive, which typically leads to poor, costly decisions. Well thought out decisions will explore not only the potential threats, but the opportunities that are available to you and your colleagues without compromising your integrity or patient care and service. Next, look at the numbers. How well did your practice perform compared to prior year and compared to other practices in your specialty? Benchmarking will help you examine the trends so you can examine areas where performance was disappointing and seek ways to bolster them for next year. The numbers tell the story of past performance and give you an opportunity to set future goals that keep the practice stable and on financially solid ground. Don’t make squeezing cost a primary focus. Sure, it’s normal to focus on costs when reimbursement is tight and may get tighter, but in reality you can only squeeze costs so much. If you focus most of your efforts on costs you are likely to reduce quality and service. The highest expense for a medical practice is staffing, but the old saying: “You pay peanuts, you get monkeys” is true. Hire well – highly skilled and experienced people; respect them, pay them well and set high expectation goals and staff well help your organization to me more profitable. Physicians and managers can
Leadership sets the tone for the entire practice. Staff will model your commitment and follow your expectations. Much of the manager’s role focused on managing practice finances, maintaining practice viability, and keeping a highly motivated and efficient staff that is respectful and trustworthy. Add to the list a new yardstick that changes how physicians get paid based on a patient experience that improves compliance to result in better outcomes. Develop a plan and set up programs to help staff understand how the patient experience relates to both outcomes and practice finances. Show your commitment through continued communication and actions that reveal a consistent effort to improve the patient experience. Give staff the education and tools to succeed in delivery consistency in your customer service organization-wide. Coach staff to improve performance. Provide them with the support and encouragement with implementing essential changes on the road to being more patient-centered. Manage progress well. This means conducting a baseline patient satisfaction study based on key performance areas and periodic follow-up to be sure targeted areas of improvement results in satisfactory results. Set your goals for becoming a best practice. Be explicit in what you expect and intend to achieve. Honor each person’s contribution and celebrate successes that achieved along the way. Leaders have the ability to set the stage for success, instill a sense of pride and hope within the organization, and meet the challenges of strengthening the relationship between the clinical practice and the patients they serve. In the end, we seek to improve the health of our patients, enjoy the relationship we have with patients and be among the best.
I will be conducting a webinar called “Nothing but the Facts: Find out What Your Patients Really Think, hosted by Kareo, on January 15th, 2014. Physicians and staff typically focus on what’s clinically the matter with patients and how to make them better. No question this is paramount, but there’s more to the patient experience. It’s time to find out if you are really meeting the patient’s expectations. This webinar will talk about the importance of conducting patient surveys to get the real facts about your patients’ level of satisfaction. You will discover key factors that influence the patient experience, and why healthcare reform is making this a priority. You will discover the impact of patient satisfaction on the overall practice performance. You will learn the technical details involved with conducting surveys that tell you what your patients need from you, and how to get the most out of the feedback information you gain. You cannot assume how patients feel about your practice. Your patient service performance depends on getting facts and learning what it takes to be a best-practice when it comes to the patient experience.
Healthcare reform is placing the relationship between the patient and the medical practice front and center in hopes of improving compliance and clinical outcomes. It’s all about strengthening the relationship between patients, their physicians and the entire practice and making patients feel valued. Although physicians are working hard to strengthen their relationship with the patients, the staff seems to fall short. In 2013 Capko & Morgan conducted a patient satisfaction survey that spanned five metro areas of the U.S. It revealed staff is falling short on making patients feel valued by their practices. 37% of the respondents felt the staff performed only adequately in terms of making them feel valued and respected, another 7% rated staff poorly, and suggesting there is much room for improvement. So what can you do to get staff on board with providing a better patient experience? Talk about it. Help staff understand that they are a reflection of the practice to every patient. It is an important role and they hold the key to making patients feel valued. Build in accountability. Schedule a customer service planning meeting with staff to collectively set some performance standard dealing with staff-patient interaction. New Patients: Every employee is expected to honor new patients and making them feel comfortable Get rid of the sign-in sheet. Introduce yourself and make a statement that welcomes them or thanks them for choosing your practice. Don’t just hand patients a clip board, explain why you need them to provide information and let them know you appreciate their cooperation. Thank them when they are finished. When rooming the new patient give some information about her new physicians to provide important reassurance that she is in good hands. All patients: Greeted with a smile and by name within one minute of arrival for a visit Kept informed of expected wait time in reception room and exam room Before ending the conversation with a patient ask “Is there anything I can help you with?” On the phone Staff will identify themselves by name. Callers will not be kept on hold more than 30 seconds without further communication
When is the last time you analyzed your practice's payers? Too often, physicians and practice managers feel powerless against health plans -- and don't even question whether to continue to accept a particular plan. Yet, even if your practice is located in a market in which you've found it increasingly difficult to negotiate higher reimbursement, that doesn't mean you must simply accept all other aspects of every payer relationship without question. Even when reimbursement amounts are similar across payers, differences in payer behavior -- what we refer to as 'hassle factors' -- can actually mean that some payer relationships are unprofitable. What are some of the hassle factors that add hidden costs and reduce payer profitability? They include: Consistently slower reimbursement than other plans Repeated requests for referral or authorization Frequent complaints from patients Poor support when help is needed to resolve problems Are multiple hassle factors a reason to drop a plan on their own? Not necessarily -- if you're reliant on a plan for a significant share of your revenue, or it reimburses better than others for important codes, putting up with the hassle may be necessary. (However, in that case, you will also want to do what you can to address some of the ongoing hassles with the payer.) I shared some further tips on analyzing your payers' hassle quotients in this article for Kareo -- and if you need further help evaluating and segmenting your payers, we hope you'll get in touch to learn more about our capabilities in this area.