Laurie Morgan

About Morgan

Learn more about my background at: linkedin.com/in/lauriemorgan

Don’t believe the hype: patient portals aren’t “largely unused”

A provocative headline got my attention recently. It proclaimed that patient portals are "largely unused." It caught my eye partly because it didn't sound all that plausible -- and because taking such a headline at face value could be unhealthy for your businesses, dear clients and friends of Capko & Morgan. I decided to dig into the matter. The article text actually mentioned that 37% of patients have recently used portals. Could the author actually believe that 37% utilization is trivial? That seemed to be what they were saying, yet it's hard to imagine they believe that. (Would a 37% decrease in salary leave one's pay "largely" unchanged?) Perhaps, you may be thinking, this was just a forgivable, inadvertent misuse of "largely." But I tend to think not. This type of exaggeration is just too common in modern media, even in our world of the business of healthcare. I tend to think the headline intended to sensationalize. Yet even if that wasn't the intention, it's still not a benign error, which is why I'm calling it out. Mischaracterizing portal adoption has a hidden cost Clients often tell us they've held back on technologies that could make their practices more efficient because they're concerned patients won't use them. But that thinking usually means practices miss out on significant benefits, since the tools they delay adopting (or forgo altogether) could make interaction easier for patients or make their practices more profitable (or both). This tendency to hesitate has been especially true for patient portals, and it's often very costly. Somewhere along the way, the idea took hold that portals aren't worthwhile unless nearly every patient uses them. But this is not true. It's not even close to true. If even a small percentage of patients regularly uses a portal, those patients will benefit -- and their physicians will save time, too. (And that's strictly on the clinical side. Portals have the potential for even more dramatic benefits on the payment and administration side, even when utilization is very low.) What's more, relative to other recent technologies, portal adoption is arguably not that

By Morgan|2022-01-01T22:51:45-08:00December 20th, 2018|

Credentialing: is it time to upgrade your process with software?

Credentialing can be a frustrating, mysterious, time-consuming process. It can seem like a black box: you throw your (copious) data in (with no idea what will happen to it), then hope you'll get what you want out of the other side (eventually -- you have no control over when). Worse, unlike most other administrative tasks your staff handles, credentialing has seemed immune to process improvement. It's no wonder so many practices outsource this tedious, unpredictable paper-pushing. But that can lead to another set of problems. For example, when delays occur, how do you know whether there's a problem with the application, the payer is just slow, or your credentialing service dropped the ball at some point? Constantly checking in with a credentialing service for updates wastes valuable time on both sides -- especially since your credentialing service has no more control over how long it takes payers to respond than you do. Thankfully, dear reader, you and I are not the only people who've observed the built-in productivity drains in credentialing the old-fashioned way. In recent years, technology whizzes have stepped in to improve the process. There are still frustrating pieces of the puzzle that technology can't yet fix -- like the need for physicians to gather all that information in the first place, and like the uncertainty about where submitted applications stand with payers. But technology can help with: maintaining a single source of credentials -- to avoid submitting out-of-date information or incomplete information tracking key dates enabling physicians to enter their own information via a portal -- to avoid double entry of data, and the associated costs and errors automating the completion of many forms in some cases, automatically updating or communicating electronically with important third parties like CAQH If you are not yet using a credentialing software product, now is the time to check your options out. And if you're outsourcing, it may be more efficient to bring the task back in house, supported by up-to-date software. Or if you continue to use a credentialing service, be sure that your partner uses a cloud-based system that you

By Morgan|2022-01-01T22:51:45-08:00December 4th, 2018|

From manager to leader [practice management tip: leadership]

Working in a medical practice, whether on the clinical or the administrative side, amplifies any tendencies one might have to try to do and control everything personally. Given the potential for serious consequences (to both health and finances), it’s not surprising that responsible healthcare professionals focus intensely on getting every detail right. The problem is that trying to do it all yourself has serious consequences of its own. It can even lead to the very problems you’re trying to avoid. When an employee first takes on management responsibility – such as when workload grows, and staff are added to handle it – personally doling out tasks may seem like the best way to utilize a new staff resource. But it’s not scalable. As the team expands, it gets harder and harder for a supervisor to manage the workflow while overseeing tasks so closely. That puts a hard limit on the amount of work the team can accomplish – and it puts the supervisor at high risk for burnout. The staff in these roles will also find them stifling – which can lead to poor morale and turnover that cut productivity. Designing jobs so that employees feel a sense of growth, independence, and accomplishment is a key competency for new managers who want to become leaders. The goal should be to help all employees reach their potential through work. Allowing employees to stretch and learning to trust them with critical jobs can be challenging for managers who’ve been promoted because they have been the best in those same roles. But if managers don’t learn to do this, they hurt the practice. They will also limit their own professional growth. Planning for succession is an essential part of managing well. If your practice or a key department would fall apart if the manager leaves, that’s a management failure. A strong manager always adds value in the job, but also organizes their team so that work gets done without micromanaging. If you’re a practice owner or a practice leader who manages other managers, give some thought to how well-prepared your teams are to

By Morgan|2022-01-01T22:51:45-08:00November 28th, 2018|

Our Thanksgiving letter

We're grateful for the opportunities we've had to work with you, for your support of our books and presentations, and for the work you do keeping patients healthy. Our Thanksgiving tradition is to make a charitable donation on behalf of our clients and friends. Usually, we keep the focus on medical organizations. But this year, many of our neighbors in both Northern and Southern California have suffered terribly due to the devastating wildfires at both ends of our state. So we've decided to add organizations that provide relief to wildfire victims to our 2018 list, which includes: American Red Cross - Disaster Relief California Fire Foundation GlobalGiving - California Wildfire Relief Fund Conquer Cancer Foundation If charitable giving is part of your year-end traditions, we encourage you to give these options consideration. Resolved: A Prosperous 2019 Every January brings another opportunity for your practice business to have its best year ever. We're at the ready to help with fresh ideas; new books, webinars, and other content; and customized consulting. Trends suggest that independent medical practices are poised to resurge and thrive. The challenges that make it more difficult for complex conglomerates to efficiently and profitably provide quality care are becoming very clear. And burnout is a greater risk for physicians in high-pressure, low-control employment situations. Now is the time to turn your own practice into your ideal employer and your source of pride. It's easier and more cost-effective to work with us than ever. If you're ready to make 2019 the year your practice takes off on a more profitable, more rewarding, less stressful trajectory, let's talk! Year-end round-up: Did you miss these popular blog articles? These are the top five most-read posts on capko.com's blog this year. Click on the headlines to check them out: "It's everyone's responsibility,but no one's doing the job" "Improving front desk performance" "Reducing the cost of no-shows at your practice" "The power of your front desk to influence the patient experience -- and your reputation" "Fix the problem, not the blame" Stay in touch and never miss a post! Here are

By Morgan|2022-01-01T22:51:45-08:00November 21st, 2018|

How will you make the most of year end — and prepare for the deductible reset?

I just published an article for Phreesia's blog about how to make the most of year end (when many patients with fulfilled deductibles may rush to get care) and prepare for Q1 (when the deductible reset causes some patients to delay care). Please click here to read the article to get the full scoop. In a nutshell, here are the suggestions I made in the post: Alert patients to the deductible reset and the benefits of receiving services before December 31 Try to identify patients who opted to delay care earlier in the year and contact them personally Offer financing options for patients who need them Make sure your reminding approach is up to snuff Prepare to promote preventive services in January-March Consider how you might use the lighter load of Q1 to your advantage One additional idea to think about. Remember that you may feel your workload slow down in January and February, but the impact on your revenue will lag a bit. (In January, you'll still be collecting some payments from the end of the year.) So if cash flow is a concern, remember that you may still feel the pinch as late as April, depending on how quickly your volume rebounds. I also strongly recommend you use this time of year to review your technology set-up. Keeping patients informed about insurance, making it easy for patients to pay, and improving your practice productivity can all be made easier with the latest technology options. If you're not sure how to evaluate your technology infrastructure, Capko & Morgan can help with a cost-effective review. Contact us for more information about that.

By Morgan|2022-01-01T22:51:45-08:00November 16th, 2018|

Cost-cutting: pick your battles wisely

We recently worked with a smart, energetic practice administrator who was very motivated to improve his practice’s bottom line. He’d already found significant savings by switching billing and phone services (even getting better billing results, to boot). Spurred on by those successes, he’d turned his attention to clinic staffing. While the physicians in his practice mostly used conventional medical assistants (MA) for support, a few of the doctors and non-physician providers (NPPs) had opted to use “scribe assistants.” These hybrid staff help clinicians by both scribing during the visit and handling typical MA tasks like test orders and scheduling follow-up care. Because of the extra duties, and because they were hired through an agency, their hourly cost was a bit higher than for the MAs – a 15-20% differential that caught the administrator’s attention. The administrator estimated the hourly cost of hiring a new MA would be about $20, including taxes and benefits. The scribe assistants, meanwhile, cost the practice about $24 per hour. The scribes did some tasks the MAs weren’t trained or expected to do – notably, scribing. But the administrator believed that at least one of the NPPs who was currently using a scribe assistant could do just fine with an MA (she was a recent grad and tech enthusiast). So the administrator decided to suggest gradually switching some of the contracted scribes with employed MAs – and was surprised that his idea met with resistance. (After all, 18% would be a significant cost savings – yet even some of the partners resisted the idea!) As the administrator repeated his idea at a few monthly meetings in a row, the resistance grew into a testier conflict. Was the conflict a sign the administrator was wrong to bring up the idea of saving money on clinical staff? We wouldn’t say “wrong” per se – but we might have not have prioritized this particular cost-saving avenue. It’s natural for clinicians to be wary of any changes to clinic staffing. Clinical support staff is essential to physicians’ productivity. Anything that disrupts clinic flow can make it harder for physicians to

By Morgan|2022-01-01T22:51:45-08:00October 15th, 2018|

You’ve got a marketing advantage: capitalize on it [practice management tip: marketing]

Medical practice management is filled with unique challenges. But there's also a unique marketing advantage that practices have -- at least traditional, insurance-based practices. When your practice accepts insurance, the insurance plans you contract with, and even patients' employers, become a potential funnel of patients. The key is to be sure your practice is able to take advantage of it. Consider the process a patient will likely follow when looking for medical care. If the patient needs a new primary care practice, they'll almost surely start with their health plan's physician directory. Even if they ask for recommendations from friends and family, they will still want to confirm that your practice is in their network. And even if the patient needs a specialist and gets recommendations from their primary care physician, that in-network confirmation will still be crucial. Despite how critical it is for patients to know whether a physician is in-network for their plan or not, payer directories are often inaccurate. Any mistake in a directory can mean that your practice misses out on a patient that would have come through your doors. Some errors are particularly damaging -- like leaving a physician out of a plan altogether, displaying an obsolete or inaccurate location or phone number, or showing "not accepting new patients" when the physician is, in fact, accepting new patients. It seems logical that payers should want these directories to be accurate -- and they probably do. But it's harder to keep them updated than it might seem, and that means errors are common. Even if it's not technically your practice's responsibility, payer directory accuracy is too important to leave in the payers' hands. Someone on your practice should periodically check all payer directories, to be sure that they're sending patients to you and not passively turning them away with incorrect information. Besides the basics of accurate information, many payer directories now offer the opportunity to enhance your listings with photos and other information. Take advantage of it! It's your chance to stand out versus the competition in the best free marketing resource around.

By Morgan|2018-07-21T16:35:20-08:00September 30th, 2018|

Creative ways to support more services — and more patients

A few years ago, my partners and I worked with an open-access pediatric Medicaid clinic that had a very creative approach to helping as many patients as possible. Their ingenious ideas helped them bust many of the assumptions about Medicaid (especially the big one: that patients can’t be served without losing lots of money). One of their biggest gambles was investing in a small bus to transport people who couldn’t get to the clinic because they lacked transportation or child care. Ultimately, the bus wasn’t much of a financial risk at all, since it brought patients in when the clinic was typically less busy. Plus, if a parent had one sick child and one well child, everyone could come to the clinic on the bus. The well child could be seen for an overdue check-up at the same visit as the sick sibling. This allowed the clinic to deliver more timely preventive services to more of its at-risk patients, while also generating more revenue. It helped address a clinical challenge while also improving the clinic’s financial picture. With the list of preventive screenings always seeming to grow, finding creative ways to accomplish more in less time—without putting more pressure on clinicians or the budget—is essential for any busy clinic. Of course, providing open access or transportation for patients is not an appropriate solution for every pediatric or family medicine clinic. But every practice can discover novel ways to do more with the same team by thinking creatively and questioning long-held assumptions. Here a few ideas that are a bit more conventional than adding a shuttle bus, but still might spark your practice team’s creativity about how to provide more services without adding stress: Group visits. Transportation and child care are common obstacles for Medicaid patients. Establishing evening group visits might make it easier for families who are in the same neighborhood to travel together for wellness checks. Because everyone in the group attends everyone else’s visit, messages about the importance of screenings and vaccines can be amplified. For example, if the nurse or physician asks one parent about lead testing

By Morgan|2022-01-01T22:51:45-08:00September 20th, 2018|

When communication becomes overwhelming, the web and social media can lighten the load

It can happen to any practice at any time. Your practice is humming along like fine-tuned machine. Your schedule is booked up. Clinicians are running on time. Patients are getting the appointments they need. Everything’s working like clockwork. Then, out of the blue, boom! A story about a possible new link between a drug many of your patients rely on and a dangerous side effect blasts hits the national media. Suddenly, the hum of efficiency is replaced by the sound of phones ringing off the hook. Nervous patients are clamoring to speak with their doctors, and your staff struggles to reassure them. Patients who need appointments have trouble booking them, because your lines are overloaded. Many are frustrated because they only reach your voicemail. Even the best-run practices can be temporarily disrupted by factors outside their control: drug and device recalls; unexpected research findings; power outages; and severe weather are just a few examples. These disruptions can be severe enough that your practice can suddenly feel very understaffed. Of course, most of these types of unpredictable disruptions existed before the internet age. The internet has allowed news to spread more quickly, though. Sometimes, inaccurate information and questionable advice gains just as much traction as useful advice – and that can mean more nervous patients calling your practice with questions. But the good news is that when it comes to rapid communication, that same internet that spreads anxiety and uncertainty like wildfire can also help your practice spread smart answers with a lot less effort. And it can make dealing with unforeseeable problems a bit easier, by scaling your communications and allowing your patients quick access to trustworthy answers. One of our pediatric practice clients recently faced a double whammy of communication problems. First, their phones went out. Then, in truly unlucky fashion, their website also chose that same moment to go down. They were unable to respond to phone calls and couldn’t even access their email database. They still had a couple of resources available to them, though – and those tools turned out to be lifesavers. First, the practice

By Morgan|2022-01-01T22:51:46-08:00August 21st, 2018|

Responding to external trends that threaten practice profitability

When we work with physicians and managers who've found their financial results have inexplicably declined, they often wonder why the profit numbers changed when the practice is still managed in the same careful way as before. It's a puzzle and a disappointment and a huge source of frustration! But therein lies the rub: As managers, our job is often to respond to changes that happen outside our business. Doing things the same way, even when executing perfectly, is often not enough to assure good results. Things are happening in the broader market that affect our patients and their behavior. It's our job to recognize when trends that have nothing to do with medicine still require a response from our industry. One really powerful example of a completely external trend that is nonetheless affecting every practice business is the rapid adoption of online payments by consumers. If your practice hasn't responded to this trend, it's probably already affecting your collections negatively. The shift in payment behavior by consumers has been dramatic. I created the chart to the left using USPS data showing that single-piece stamped mail has declined more than 50% in the past decade. The Post Office attributes this decline to shifting consumer preferences, especially for bill payment. The days when it was normal behavior for consumers to sit down once a month and review paper statements, write stacks of checks, stuff the checks in return envelopes, then stamp the envelopes and drop them into the mail are rapidly disappearing. Patients' strong preference for paying electronically is both an opportunity and a threat to your practice business. Give patients an easy way to pay online -- better yet, give them electronic statements, too -- and you'll get paid faster, with less labor required, and reduced paper and postage costs, all while making patients happier. Now that's some serious upside! But if you don't make online payments possible, you're also risking getting paid more slowly, with higher collection costs. That's because it's not just a matter of patients preferring to pay online. They're organizing their budgets and managing their money in

By Morgan|2022-01-01T22:51:46-08:00July 21st, 2018|

You can’t cut your way to growth [practice management tip: financial management]

Practice management literature often offers advice about cutting expenses – advice that promises cost-cuts improve margins and “directly boost the bottom line.” Many physician owners and practice managers seem to have internalized the idea, so they’re always on the lookout for things to trim. But is this the best way to strengthen your practice business? Some expenses do nothing to improve your practice. Paying more for identical supplies or credit card processing, for example, won’t serve patients better or boost efficiency. Once you start routinely cutting staff, technology, marketing, or materials, though, the risk of undermining productivity or the patient experience increases. It can creep in so slowly, you might not notice until profitability turns sharply south – when it can be much harder to turn things around. For example, if you’re busy, it may seem like you can “get by” without marketing. But today’s new patients probably reflect marketing efforts started months or even years ago. Cut marketing and you may see little difference – at first. By the time you notice a slowdown, you may be facing a year or more of significant investing before your volume returns. Staffing is another common focus of penny-pinching. Even a little bit of staff downtime can seem wasteful. Trying to trim staff so that employees are busy 100% of the time risks bigger problems, however. Without a bit of “excess” capacity, the impact of disruptions like employee resignations, sick time, or unexpected increases in demand can be much more expensive than the cost of a few “extra” employees. What’s more, too little support also undermines physician productivity, which has a much bigger impact on profit. Global consultants McKinsey & Company published an excellent study showing how continuous efforts to improve margins – rather than build the business – can actually undermine profitability after a few years. Their advice: consider whether expense cuts you’re contemplating will negatively impact customers (patients), your ability to compete with other practices, or both. If you’ve been focusing on expense cuts for a while, you could be in the danger zone. Be sure to give building the

By Morgan|2022-01-01T22:51:46-08:00July 6th, 2018|

Fix the problem, not the blame [practice management tip: operations and workflow]

“Fix the problem, not the blame” is a well-known Japanese proverb. It sounds like common sense – isn’t fixing problems what we all ultimately want? But when mistakes happen, the search for culprits instinctively begins – and with it often comes demoralization and tension. Worse, the search for a scapegoat usually won’t keep problems from recurring. Bad systems create more problems than bad employees. When workflow is faulty, the mistakes are built into the process. Figuring out who was working the process when it failed does nothing to prevent failure in the future. As organizations grow and silos (i.e., departments) form, so do opportunities for workflow inefficiencies to masquerade as staff incompetence. We’ve worked with medical practices that have grown so fast, they haven’t noticed their processes aren’t keeping up. But even more than growth, market evolution has put new tasks on everyone’s plate. These tasks may not fit well with jobs as originally configured – and that may mean more errors. Here’s a common example. Insurance has become increasingly complex for patients and staff alike. Higher deductibles have also made front desk collections a priority, but it’s a new priority added on top of everything else. Are front desk employees already trying to answer phones, check patients in, answer questions, collect demographic information, and verify insurance? When patients are seen and it turns out they weren’t covered or aware they owe a deductible, it may seem “obvious” that the front desk staff is to blame – especially to your billers, who must deal with the errors. But more likely, front desk employees are simply juggling too much. As jobs evolve, mistakes may increase. Resentments can fester between departments. But the answer isn’t to find someone to blame – it’s to find out where the process breaks down. In the case of the front desk, a better response would be to reconfigure roles, to let staff focus on the tasks in front of them, without multitasking. As work gets more complex, making people feel embarrassed and afraid won’t help them do their jobs better – retraining staff and refining their

By Morgan|2018-06-11T16:36:02-08:00June 27th, 2018|

Reducing the cost of no-shows at your medical practice

(c) Sheri Swailes - fotolia.com No-shows can be a huge drain on medical practice finances. Time that is booked but ultimately generates no revenue is a loss that comes right out of your bottom line. It’s similar to what airlines experience when they have an unsold seat – which is why airlines so often resort to overbooking, and some practices do, too. But if you've seen the negative media coverage about the impact of flight overbooking on passengers, you already know what a stressful gamble the double-booking “solution” is. It's all but impossible to predict which patients will fail to show up -- so you could end up with too many arriving at the same time. Even when overbooking helps reduce lost revenue, it can create other problems -- like long waits, rushed visits, and stressed out physicians -- that lead to unhappy patients and higher marketing costs. Practice managers and physicians often throw up their hands in frustration about how to deal with no-shows, especially if they’re already taking steps to remind patients, or perhaps even charging a no-show or late-cancel fee. There’s no doubt about it, trying to improve your practice no-show rate can be challenging. But there are a few ways to look at the problem that practices sometimes miss. Consider if any of these ideas might help you reduce the cost of no-shows to your bottom line. Reevaluate Your Appointment Slots Practices often have standard appointment slots that they haven’t reviewed in a while. We recently worked with a practice that had used only two slots for over a decade: 30 minutes for established patients and 45 minutes for new patients. When we looked at how long visits were actually taking, we found that more time was usually set aside for the visit than was necessary. Besides reducing the overall number of productive slots the practice had available, these over-long slots amplified the impact of any no-shows. Even a single no-show usually left a 45-minute hole in the middle of the schedule – ouch. By tweaking the timings just a bit (30 minutes for

By Morgan|2022-01-01T22:51:46-08:00June 11th, 2018|

Cutting long-term staff to improve profitability? Not so fast [practice management tip: human resources]

A practice we worked with recently was struggling to improve profitability. The practice’s new manager wanted to make an impact fast, so she decided to try replacing longer-term staff with less expensive newbies; since staffing was such a big practice expense, she reasoned that this was the best way to improve profitability. The physician owners were surprised not just that the strategy hadn’t worked, but that we questioned the decision. “Isn’t that the kind of thing you practice management consultants recommend?" they asked. But cutting experienced staff members who perform well just to save a few dollars isn’t something we’d recommend trying. Those exiting employees will take with them all the knowledge they’ve accumulated – knowledge that is easily taken for granted. While cuts might boost profits temporarily, it likely won't take long for patient service to deteriorate. Service will also be undermined by the panic felt by the rest of the staff. When employees see their most loyal colleagues being shown the door, they’ll wonder if – or when – the axe will swing their way. Once those doubts creep in, your most energetic and ambitious employees will begin job-hunting in earnest. Swapping out older workers for younger ones may draw a charge of age discrimination as well. Worst of all: the potential upside is probably small. Differences in pay for experienced versus new staff are typically large enough to cause a big swing in profitability. For example, a $5 per hour difference translates to $10,000 per year. The costs of recruiting and on-boarding a replacement could easily exceed these small savings. It’s natural to look critically at expenses when profitability is flagging. But insufficient revenue is often the main reason profits disappoint – and cutting your best people will severely impact your ability to fix that problem. Instead of cutting valued but ‘expensive’ employees, look for ways to refocus staff and make the practice more productive.

By Morgan|2022-01-01T22:51:46-08:00June 1st, 2018|

Resist the temptation to surveil your employees [practice management tip: human resources]

It’s easy to monitor your employees’ every move with modern technology. So should you? The temptation is understandable. The key question is: Are employees motivated to do a good job? Or does getting the most from them require constant oversight? Intuition might suggest the latter – but experience says otherwise. In the early days of business theory, the idea that management was primarily about surveillance (and “cracking the whip”) was popular. But over time, managers learned that employees aren’t just a cost – they’re an asset. Beginning in the 1980s, lessons from Japanese companies illuminated the value engaged employees bring to an enterprise. Toyota, in particular, found that by encouraging employees to be more involved in decision-making, they could improve product quality and productivity. Toyota’s success at improving manufacturing quality – which endures today – started with trusting employees. A culture of trust and respect tells employees their contributions matter – in turn, encouraging and empowering them go beyond the rote requirements of their job descriptions. With engagement tied to higher productivity, lower absenteeism, and better customer service, it’s easy to see how engaged employees can uplift a medical practice. But it won’t happen without trust – and electronic monitoring is a sure-fire way to communicate that you don’t trust your employees at all. Rather than trying to control your employees with surveillance, consider setting goals and incentives that encourage the behavior you want. Rely on reports and data, not constant monitoring, to evaluate how employees are doing. Start by hiring carefully, so you don’t have doubts about trust right out of the gate. And relax a little: Most people want to contribute and do their jobs well. Give them the structure to do it, and you won’t need to watch them all the time. Another thought to consider: If the huge potential benefits of an engaged staff aren’t enough to make you rethink surveillance, remember that every minute a practice owner or manager spends on monitoring is one that can’t be invested elsewhere. Surveillance is very time-consuming (read: costly). Odds are there are more valuable ways to use that

By Morgan|2018-04-29T12:24:55-08:00May 23rd, 2018|

Enter through the front door [practice management tip: patient service]

In a typical medical office layout, there’s a front door that’s used by patients and a rear door (or staff entrance) for employees. Of course, this can be quite convenient, especially when connected to employee parking. But an interesting consequence of this configuration is that physicians and managers never experience the reception area from the patient’s perspective. Next time you head out of the office during the day, come back in through the front door. Have a seat in the reception area. Are the seats comfortable? Are there enough of them? Are they spaced appropriately or too close together? (Imagine yourself sitting next to a sneezing flu patient if you need helping deciding.) If there’s a television, is it audible, but not too loud? Are there recent magazines on hand, or raggedy old ones from last year? What does the front desk activity convey to people waiting? Do patients look impatient – like they’ve been waiting too long? If so, does anyone behind the front desk seem to notice? In our consulting engagements, we almost always have comments on how the reception area can be easily and inexpensively improved. But you don’t need consultants to figure this out. It’s easy to self-diagnose – and the upside on improving could be huge. Patients start deciding how they feel about the quality of the care they receive the moment they walk into the office. Even ill patients will feel better about their visit – and their experience in the exam room – when their first moments in your practice reassure them they’re in a welcoming, professional, and caring environment. Patients view their entire practice experience as their “care” – not just the 15 minutes they get with a clinician. An inviting reception area is a cost-effective way to reinforce your practice’s caring attitude – and get the patient visit off to a strong start.

By Morgan|2022-01-01T22:51:46-08:00May 16th, 2018|

Patient service is your competitive edge [practice management tip: patient service]

Independent primary care and specialty practices alike worry about increasing competition from hospitals and integrated systems. It’s not uncommon to see hyped-up headlines pronouncing independent practices “doomed” and the consolidation trend “inevitable.” But the naysayers always conveniently overlook a big advantage independent practices have versus larger organizations: the personal touch. In consumer settings, small players often find ways to compete against giants – and win. Maybe your town has an auto mechanic who outshines the dealer shops, thanks to better prices and more convenient hours. Perhaps your neighborhood has a family hardware store that’s going strong in the shadow of a big-box store, thanks to expert staff and a unique range of products. Or, if your area’s like mine, maybe you’ve got weekend farmer’s markets selling fresh vegetables by the truckload, despite the supermarkets down the street. Of course, these are just a few examples – but you get the idea. “Little guys” can flourish – if they find ways to serve their customers their super-sized competition can’t easily match. Competing against bigger, deeper-pocketed opponents can be scary. But it’s easy to forget those competitors have weaknesses as well as strengths. In medicine, it’s hard for a large, bureaucratic organization to provide the personalized experience a smaller practice can. And in what setting could a personal touch be more valued than in healthcare? If you’re worried about a big player setting up camp in your backyard, start thinking about how you can attract and retain patients with better patient service. Take a seat in your own reception area – and think about how it can be upgraded. Start looking at metrics like wait times and overall visit length, and consider how you can improve them. Check online reviews for comments you can learn from, and do your own confidential surveys to give patients a chance to tell you what they value – and what needs work. You just might find that you practice won’t just survive – it will thrive.

By Morgan|2022-01-01T22:51:47-08:00May 9th, 2018|

Consider rolling recruitment for key jobs [practice management tip: human resources]

Do you find yourself reluctant to discipline difficult employees because they’ll be hard to replace if they quit? Is that same fear causing you to retain employees who’ve failed to improve, despite being counseled again and again?When the consequences of poor performance never materialize, underperforming employees will soon perceive they’ re exempt from the standards you’ve set for everyone else. Even worse, your better employees will have to pick up the slack and tolerate negative energy from complainers – increasing the risk you’ll lose the people you value most. Many practices feel squeezed for talent in their local markets. It’s understandable to be concerned about a key job staying unfilled for too long – but, still, keeping underperforming employees can harm your practice much more. Instead of going soft on performance problems, consider amending your hiring practices. For example, a little redundancy in your medical assistant ranks (e.g., maintaining one or two “extra” floaters) ensures coverage when someone’s out sick – or ends up leaving the practice. Those additional hands can also tackle valuable ad hoc tasks that might otherwise get skipped, such as recalls that serve patients better and generate additional revenues. A rolling system of recruiting can also ensure you don’t miss a chance to hire talented new grads. Establish recruitment relationships with local training colleges and med schools, and maintain key job postings for year round. (Be sure to use screening questions on recruitment sites and filters in your email software to help manage the applicant flow.) Even if you don’t need help immediately, being aware of available talent will allow you to hire opportunistically if someone exceptional becomes available. It will also provide a clearer picture of the current talent pool, so you don’t feel compelled to hold on to employees who aren’t measuring up.

By Morgan|2022-01-01T22:51:47-08:00May 1st, 2018|

Don’t confuse personal finance and business finance [practice management tip: financial management]

When presented with ideas to update your medical practice’s technology, better support your clinicians, or market your practice in a new way, is your go-to reaction “we don’t need that” or “we’re doing fine without it”? Is your financial management approach simply to always minimize expenses? (Perhaps because you remember the old maxim of taking care of the pennies and the dollars will take care of themselves – or, its more modern cousin, “the latte factor”?) If you’re thinking about business spending in the same frugal way personal finance experts recommend you run your household, you may be missing out on opportunities to grow and increase your profits. Keep it up long enough and you may jeopardize your practice’s future profitability. The good advice to skip a few lattes and pocket the money simply doesn’t correspond to many business expenses. While a latte is a fleeting pleasure, upgrading practice technology is an investment that can increase productivity for months or years to come. Similarly, keeping headcount at the number needed to “get by” may mean your physicians, NPs, and PAs will be less productive – an opportunity cost that quickly outpaces the “savings” from bare-bones staffing. Just because a business investment requires a decision doesn’t mean it is analogous to that forgone latte that puts money in the bank. Not pursuing an investment may actually cost more in terms of lost revenue and profit. Over time, under-investing in productivity tools, visibility for your practice, and modern, convenient patient service can make it harder to attract patients and retain staff. Rebuilding from that sort of decline can end up being much more difficult and costly than investing in keeping your practice up-to-date and well-staffed would have been. Before rejecting investments in your practice’s infrastructure, marketing, and staffing out of habit, be sure you’ve considered whether the upside you’ll pass up is greater than the savings.

By Morgan|2022-01-01T22:51:47-08:00April 17th, 2018|

Use an automated background check service [practice management tip: human resources]

Background checks in hiring are sometimes confused with reference checks. While both are important, the differences between the two are critical to understand. Reference checks involve conversing directly with a candidate’s former bosses and coworkers. It’s a subjective process that provides insight into a prospective employee’s strengths and weaknesses. Checking references helps you learn how well a candidate’s self-perception matches that of former bosses and colleagues. It can validate (or refute) key narratives shared by candidates, such as how and why they left their former job and what their work style is like. Background checks, on the other hand, deal with purely factual aspects of a candidate’s record. For example, did they earn the degree they claimed? Is the stated employment history accurate? And what about legal scrapes – is the candidate’s background free of convictions or sanctions that disqualify them from working in healthcare? There’s no escaping the time required to contact references directly, but technology has significantly streamlined background checking. With automated online fact-checking services, checks that once required numerous phone calls and faxes can now be done more quickly, completely, and reliably, at much lower cost. Background checks offer peace of mind in any hiring situation, but they’re even more essential in healthcare. For physicians and non-physician providers, verifying credentials and licenses is, of course, mandatory for patient safety and to avoid liability. HIPAA also requires care be taken to protect patient information; with medical identity theft on the rise, too, careful hiring is critical for every role in healthcare. Detailed background checks may even help protect against embezzlement – an all-too-common crime in medical practices. Technology can help you perform these crucial checks more quickly, thoroughly, and easily – usually for less than a few hundred dollars.

By Morgan|2018-04-01T14:14:47-08:00April 9th, 2018|

Hire slow, fire fast [practice management tip: human resources]

So what does this old saw from Silicon Valley really mean – and how can it help your medical practice? Just like in Silicon Valley startups, medical practice teams are usually small enough that every person has an important role to play. When a key position in your practice is vacant, near-desperation can set in if the right candidate doesn’t materialize quickly. That can lead to hiring impulsively and compromising too much on important traits, skills, or knowledge. Because even the best candidates will have a learning curve, you probably won’t realize you’ve made a bad hire for months. Those extra weeks that you “saved” by not extending your search to find a stronger candidate will, in retrospect, seem trivial in comparison to the lost benefits of having the right person in a key position. When a key role is held by an underperformer, your entire practice is dragged down. But – just like in the tech startup world – the small size of practice organizations can feel family-like. In fact, that’s one of the most appealing aspects of working in an independent practice. However, that close-knit culture can make it hard to confront under-performers, who wind up staying in their jobs longer than they should. Physician owners and practice administrators often move slowly in dealing with performance problems out of compassion for the underperformer – not recognizing that their other employees are picking up the slack and, in effect, being penalized for doing a better job. Hire slow, fire fast is an important lesson mainly because most people’s natural tendency is to do the opposite – hiring too fast out of urgency, and firing too slow out of misplaced kindness. Both of these can lead to having the wrong employees in place for far too long, dragging down performance and morale in your practice.

By Morgan|2022-01-01T22:51:47-08:00March 31st, 2018|

Does “personalizing” the patient experience sound impossible?

Personalized, customized service has become the norm in our lives as consumers. We've come to expect even everyday items like coffee and sandwiches to made to our specific preferences. But when we're talking about the administrative side of the patient experience, customizing can seem like a much bigger deal. With so many other demands on our medical practice processes, is the idea of personalizing beyond our reach ... or even a little nuts? It may seem that way, but it doesn't have to be. The wonderful thing about offering more choices in how to do business with your practice is that so many of the options patients seek can be cost-saving for you. For example, studies have shown that consumers prefer to pay bills electronically over sending checks. The trend towards paying online, on-the-go, at any hour of the day has become so pervasive, many people don't keep stamps or even checks on hand. If you're not allowing your patients to exercise this preference, instead hoping they'll mail a check (or only taking credit card payments by phone or in person at the office), you're making it harder for patients to pay. That probably means you're getting paid more slowly -- and at higher cost to your practice. But what happens if you do offer patients the ability to receive statements electronically and make payments that way, too? When patients can pay electronically, it's easy for them to do it immediately -- even if they receive your bill at 10:00PM. They avoid the unpleasant feeling of being behind on their bills, and your staff avoids the more unpleasant task of calling them to collect. And you'll get paid faster -- at less expense, since staff won't have to spend time on the phone with the patient or stuff an envelope with a statement. Best of all, when you implement an option like a payment portal or automatic debit, your patients will thank you for it, even as they're paying you more promptly and reliably. Electronic patient payments are just one of several examples of technology-enabled services that conserve staff resources

By Morgan|2022-01-01T22:51:47-08:00February 12th, 2018|

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|

[PINNED POST] How much do you know about embezzlement and internal controls? [5-MINUTE QUIZ]
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[PINNED POST] How much do you know about embezzlement and internal controls? [5-MINUTE QUIZ]

embezzlement, medical practice business

[PINNED POST] How much do you know about embezzlement and internal controls? [5-MINUTE QUIZ]

How knowledgeable are you about theft inside medical practices -- and preventing it? This quiz is designed to get you thinking about how you can protect the money you've worked so hard to earn. Embezzlement always leaves practice owners feeling violated. In some cases, when the amounts are large, a practice's profitability can even be jeopardized by an embezzler. Take the quiz -- it only takes about five minutes -- and feel free to get in touch with us if you have questions about the information. We're offering a free 15-minute call to any practice owner who takes the quiz and wants to discuss any concerns it brings to the surface.

By Morgan|2023-05-25T14:25:35-08:00June 6th, 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|

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