An article on Entrepreneur magazine's website spotlights four ways any small business -- including a medical practice -- can be the victim of crimes committed by employees. Worth a quick read: http://www.entrepreneur.com/article/227689?goback=%2Egde_4802172_member_266727166#%21
Join our founder, Judy Capko, for a free webinar sponsored by Kareo: "How to Implement a Successful Patient-Centered Program." The focus of the webinar is the Patient-Centered Medical Home (PCMH) -- how to implement it and what it means, revenue-wise, for your practice. Among the topics Judy will cover are: The seven guiding principles of the PCMH Key program standards and metrics used to determine and measure success How technology contributes to efficiency and reporting needs Appropriating payment based on value-added components To register -- for free! -- visit this page: http://go.kareo.com/webinar-info-web-20130821.html
Many practice managers do anything to keep staff busy -- lest doctors see them "doing nothing" and start to believe they're overstaffed. It's admirable to want to get the most from the team, but obsessing about staff utilization to the point of burdening them with unnecessary tasks is a pitfall. Here's an example: recently we worked with a practice that had very busy phones -- it was a psychiatric practice, and more than 80% of the calls were about prescriptions, and needed to be handled by the prescriptions nurse. The practice had experimented with a phone tree that allowed these patients to connect directly to the prescription nurse -- cutting down patient wait times substantially. But, once they did this, the front desk was somewhat less busy since they no longer needed to answer these calls and put them on hold while hunting down the prescriptions nurse (or taking a message for her). The doctors at the practice were concerned about the perceived 'down time' -- even though patients were being processed more attentively at the front desk, and with less waiting. So, they rationalized that the phone tree should be disabled, and that the front desk should answer all calls first, then forward them as needed. Once the receptionists began answering every phone call -- often putting them on hold while dealing with the patient in front of them -- they certainly seemed less 'idle.' But, patients in the office waited longer to be checked in, patients on the phone had to wait to be connected to the prescription nurse (or her voicemail), and the front desk environment was much more stressful. Worst of all, this artificial burdening of front desk staff meant that all staff were now perceived to be fully "utilized" -- i.e., no one was available for additional projects or important additions to their job content. On our visit to the practice, one of the first things we noticed was that the front desk was doing a poor job of collecting co-pays (routinely billing them instead of collecting them at check-in). Naturally, we urged the practice
Today's Physicans Practice blog has a great tip for primary care and urgent care practices: negotiate with payers for higher after-hours reimbursement. A key negotiating point: compare costs for seeing the patient versus referring them to the ER (that ought to get some payer attention!). It's important to understand the differences between several different codes that apply (99050, 99051, 99053) to properly bill for services, and to establish a pattern -- read the full post to learn how: How to Code, Negotiate After-Hours Reimbursement at Your Practice
The Washington Post has a great article today about criminals capitalizing on uncertainty and confusion about Obamacare to defraud patients, especially elderly Medicare patients. Scams involve contacting patients and claiming to be navigators from Obamacare calling to "set up your Obamacare card" or collect information "required to maintain Medicare." Fraudsters make these claims to persuade victims to reveal financial and medical identity information. Read the complete article here.
A new Harvard Business Review blog post spotlights the benefits of friendships between team members in increasing employees' commitment to their work and their organization's mission. A wide range of organizations -- from Southwest Airlines, to Google, to Zappos -- were noted as examples of companies that had achieved a high degree of comradeship, even a family-like culture, by instilling a sense of shared mission and purpose. In turn, this creates higher performance and lower turnover -- not to mention a workforce that gets excited about showing up every day and contributing. The idea that a shared mission can enhance teamwork and performance is great news for medical practices! Employees are often drawn to the healthcare field because they share a sense of service to patients. This common sensibility gives practices a big head-start on building bonded teams. Choosing employees who connect with your practice's culture and mission -- whether it be integrative medicine, leading-edge research, superstar surgery, sports medicine, community service, a high-touch, concierge model, or any other defining practice identity -- is the first step to creating a team that gels naturally. From there, the key is allowing teamwork and bonds to form, and encouraging them as they develop. Creating projects that allow staff to participate actively in extending your practice's objectives -- special clinics, marketing programs, patient satisfaction goals, etc -- is a great way to extend and build on natural connections between team members. Be sure your team feels they have both the means to contribute to the mission and a voice, and you're on your way to creating the esprit de corps that is a hallmark of a high-functioning team.
(c) John Kwan - Fotolia.com The AMA's National Health Insurer Report Card for 2013 provided powerful reinforcement for the need for physician practices to master time-of-service collections: average patient responsibility is now topping 20% for all but one payer evaluated in the survey, and some were approaching 30%. Even Medicare is requiring patients to contribute about 25% of the cost of their care. Now the unveiling of the health exchange plans in some states, including here in California, underscores the point further. All of the new Covered California plans include cost-sharing to keep premiums affordable, including copays for all visits except the annual wellness exam. Modern Healthcare reports that other state plans that have been revealed also feature significant patient responsibility. For people new to purchasing insurance and using it to gain access to care, the patient responsibility portion to providers (on top of premiums they may be unused to paying) may come as a surprise and cause confusion. (After all, patient responsibility payments routinely confuse people who've had such plans through their employers for years!) If collecting copays and other patient responsibility payments at the time of service is not SOP at your practice, you're leaving money on the table -- and could soon be giving up even more profit that is due your practice. Plus, if copays are routinely waived or ultimately written off, you're probably violating the terms of your payer contracts -- and, with more new members joining plans that require patient cost-sharing, plans could be expected to be even more attentive to these violations as the exchanges roll out. It's time to finally master front desk collections! (If you need help understanding how well your front desk operation is managing these collections, or with rolling out new procedures, Capko & Company can help with a one-day billing and collections review -- contact us for more information.)
Physicians: are you planning a vacation this summer, and worrying about coverage? Or, have you thought about bringing in extra help so you can take time off, but are worried about lost revenue? Hiring temporary physician help doesn't have to mean a deadweight loss of revenue for your practice. This helpful article from Physicians Practice spotlights billing for locum tenens help that you pay on a per diem basis. Take that much needed vacation! Get Revenue for Your Practice Even While on Vacation
The AMA's National Health Insurer Report Card (NHIRC) for 2013 was released today. In addition to illuminating data comparing the burdens/benefits of doing business with eight major US health plans, the report added a new metric that caught our attention: patient responsibility as percentage of allowed amount. Among the eight major insurers studied, patient responsibility was more than 20% of the allowed amount for all but one. Even Medicare now comes in at about 25% -- as shown on the NHIRC chart below: If you needed another reminder that your collections process is critical to your practice's profitability -- and getting more so every year -- here it is! Patient responsibility payments are here to stay. If your revenue cycle management processes don't include effective time-of-service collections, now's the time for improvement. (And if you don't know where to start, we can help -- contact us for more information about consulting services.)
Stress can be both good and bad for your individual well-being: it can be that extra shot of adrenaline that helps you give a great presentation or win a race, or it can be the unhelpful, grinding pressure that can undermine your mental and physical health. Organizations also collectively experience different types of stress -- the good kind that enhances performance, and the bad kind that insidiously undermines it. Start-up teams understand the good kind of stress. The pressure to perform is intense when you're putting your career on the line to create something that previously didn't exist. But, when you're working without a net, all progress is exhilarating, and the pursuit of a singular, world-changing vision is an intense bonding experience for team members. Leadership expert Jim Collins coined the term BHAG ('bee-hag') -- 'Big, Hairy, Audacious Goal' -- for the type of driving mission that allows some organizations to thrive -- and excel far beyond expectations -- under exceptional stress. Established medical practices, unfortunately, often experience the detrimental kind of organizational stress -- the kind that undermines performance and becomes contagious throughout the practice team. And, far too often, this stress is self-inflicted -- caused by organizational decisions and policies that make the fast-paced management of a practice harder than it needs to be. A key culprit: unnecessary variability in processes and policies. When a practice aims for flexibility in all ways this can severely and needlessly tax the systems that keep patients flowing through to their doctors. Does your practice allow rules like payment terms or cancellation fees to apply on a case-by-case basis? When staff have to seek out a physician to decide how to handle simple administrative issues, patients are kept waiting, the schedule falls behind, the operation experiences more stress, and productivity suffers. Does your practice allow every doctor to set his own policies for basics like scheduling, patient reminders, past-due collections or standard fees? Failure to standardize -- and enforce -- practice policies makes everything much harder (and more costly) than it has to be. Practices may aim for maximum flexibility because they
We give a lot of webinars, and we watch a lot, too! It can be so tempting to do other things while the webinar 'plays in the background' -- but, then you pop your head up and realize you missed one of the more valuable tidbits. You also realize that you're neither attending the presentation nor really doing a great job on your other work. A bit of a lose-lose, as opposed to the multi-tasking you were aiming for. One of the best things about the internet is that so many great people are sharing their knowledge with the world -- often for free or at a fraction of the cost of a conference. But, the information loses its value if you don't fully engage with the material. Today's Harvard Business Review tip discusses this very problem -- with a few great tips to get more out of any webinar. Really, it all comes down to taking it seriously -- just as you would any presentation you weren't able to watch while writing emails or wearing your pajamas. By the way, the HBR tips focus on turning a webinar into an event -- inviting colleagues, distributing notes, etc. But, if you're not able to do that, we have another tip for you: Watch the recorded version of webinars that contain really important data -- either on a weekend or after the workday (i.e., at a time when you can put other things aside). Here's the link to the HBR tip.
Practice managers and physicians often feel like they're fumbling in the dark when negotiating salaries with prospective employees, and feel unsure about whether their compensation structure is adequate to retain their best people. But, this is at least partly because they're not utilizing all of the tools available to stay on top of market compensation rates -- some of which have only really taken hold in the last five-ten years. For example, sites like Salary.com provide market data on job content and salaries -- all matched to your local market. (This type of data used to be available only in pricey salary surveys! On Salary.com, the base data is good -- but, more detail can be had for a fee.) Even scanning online ads, such as on Craigslist, can give you a quick read on what others are offering. We often work with physicians and practice managers who are very concerned about over-paying staff. If you're among them, take heart: as this story from Freakonomics observes, sometimes getting the 'best deal' on labor is no deal at all. I'm usually much more alarmed when practices are under-paying than over-paying by a bit. Freakonomics (via Marketplace): A Cheap Employee Is ... A Cheap Employee
Hiring an external billing service can be a huge source of relief, especially for smaller practices that worry they won't be able to keep up with staff training needs on technology and coding (e.g., ICD-10). But, too many practices we work with tend to "forget about" billing once they have hired a service -- thinking that it's "no longer our problem." This usually means that the practice will derive much less benefit from the service than they could have. There are many straightforward things you can do to manage your billing service to achieve a positive and productive relationship -- it's not hard to do it right, and both your biller and your team will benefit. I've shared some of Capko & Company's ideas for managing the billing service relationship for maximum value in a new paper, "Getting the Most From Your Medical Billing Service," available on the Medical Product Guide (it's free, but you have to register).
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Recently, we worked with a practice that had been victimized severely by internal theft. This theft was facilitated by the practice's failure to take advantage of EFT of payer reimbursements -- instead receiving checks from many of their contracted plans. The physicians had trusted the practice manager when she said that EFT had been elected whenever available (naturally, embezzlers always rely on goodwill from their employers!). But, had the physicians been on top of HIPAA rules regarding EFT -- intended to standardize and encourage EFT by January, 2014 -- they might have been more skeptical of the manager's claims that EFT either "wasn't available" or "was in process." Checks received at your office can be a temptation for would-be embezzlers. It's unfortunately not all that difficult to deposit checks made out to your practice to a different account (ATMs, for example, can be a way to deposit checks to an account with an entirely different name -- and, of course, some embezzlers are crafty enough to set up a new account for themselves with a similar name to your practice's). It's rare that a payer won't pay your practice electronically, direct to your account, if you ask them to -- and, in a few short months, there will be a standard for all payers to pay this way. Be skeptical if an employee claims that it is difficult or impossible to avoid receiving checks in the office. Even if you prefer to receive checks -- say, because you're concerned about matching up advice notices with payments, or because you're worried about direct deduction of payment retractions or other unexpected adjustments -- remember that a lockbox service at your bank can help keep temptation (and access) at bay.
Last week at the Florida MGMA conference, I had the pleasure of presenting to their lively group on a decidedly unpleasant subject: embezzlement and medical identity theft at physician practices. While internal theft is such a disillusioning topic -- embezzlement has frankly become part of far too many of our engagements recently! -- presenting ideas for preventing and spotting it to motivated practice administrators does at least have the upside possibility of helping administrators thwart would-be criminals before they get too far with their nefarious intentions. In fact, I was reminded by a participant that the very best way to stop an embezzler is not to hire him or her in the first place! When I put up a slide showing article clips and pictures of medical practice employees who'd recently been arrested and charged in FL for stealing from their organizations, one of the attendees raised her hand to say she'd actually interviewed one of them recently for a job. Thankfully, this administrator had noticed that reference checks were fishy -- references were unwilling to discuss the candidate for the most part -- until one person simply revealed, 'check arrest records.' This was all the clue the savvy administrator needed to dig deeper and find out what she needed to know to avoid hiring someone who'd recently been fired for stealing. It's stunning to realize that that the candidate was apparently interviewing for the job while out on bail (and charged with stealing over $1MM over several years from her prior practice), without, of course, admitting this fact. Kudos to the administrator for persisting when references were reluctant to talk. There is a common misconception that it is better to say nothing than to tell the truth of why an employee was dismissed -- even when not revealing the reason exposes others to potential harm. (What if the employee had been dismissed for stealing patient identities? Not alerting other practices to the risk could jeopardize patient information at the next practice that hires her -- and even expose the first practice to liability for not fully responding to the
A friend of mine recently shared a pretty disappointing experience she recently had with her primary care practice when she sought treatment for a painful, infected spider bite. Or, perhaps I should say, an experience she had with her former primary care practice, since the practice refused to see her -- stating that she was no longer a patient because she hadn't been in for a visit for three years, and therefore "couldn't be seen" until she scheduled a new patient wellness exam. My friend was told that this was the policy of the IPA that the practice was part of -- and that she had "no choice but to go to urgent care." In this context, urgent care was presented to my friend almost as sort of a downgrade -- like, "go wait in line at urgent care." It felt to my friend -- who was already a bit nervous about her injury -- like the practice really didn't care about her at all. Luckily, the urgent care center they recommended was friendly and appealing, and a doctor saw her quickly and treated her infection (which turned out to be spreading alarmingly fast) carefully and attentively. Not surprisingly, the doctor at the urgent care center was happy to let her know that he could also act as her PCP -- and, my friend is considering making the switch, even though she had been with her prior practice for nearly 20 years! Why did the PCP risk losing such a valuable patient? (Besides being a long-term patient herself, my friend has two teenaged children who will soon need to graduate from their pediatricians. So, that's three patients potentially sacrificed for lack of a recent wellness visit. Moreover, my friend is the ideal patient for primary care: pays her bills at time-of-service and is always diligently compliant with advice.) One guess is that the IPA doesn't want to miss out on the chance to bill for a new patient wellness visit at a higher rate. (The practice may not even realize this is an underlying motivation.) But, is that $50 or
Great post by Babylon Mediaworks about hackers' clever tactics in cafes -- and, it turns out, one of the ways is by leaving thumb drives behind that are loaded with malicious software! (The idea is to tempt curious users who see an opportunity to snag a free drive.) If you use a practice device in a cafe -- not something we necessarily recommend :) -- the post offers some valuable tips for keeping your computer safe, including never sticking an unknown thumb drive into your computer, and being wary of open hotspots that aren't affiliated with the cafe. Read all the tips here.
Since I started my career in the publishing world, Marketo's post today about their "Facebook Editorial Calendar" caught my eye. While the idea of calling Facebook posts "editorial" is perhaps a tad grandiose, the concept they're describing is really helpful for the idea-challenged social media maven. Their basic idea is to assign a post type for each day of the week -- famous quotes on Monday, statistics/infographics on Tuesdays and Thursdays, etc. A medical practice using Facebook could adapt this idea -- say, copy the motivational quote idea on Monday, have a nutrition tip on Tuesday, explore or debunk a news item on Wednesday, have a link to a helpful site on Thursday, etc. Have you experimented with the idea of organizing your posts into assigned daily categories like this? We'd love to hear about it! Here's a link to Marketo's idea.
As medical practice management consultants, we're naturally always looking for 'best practices' we can share with all of our clients. There is often a rub, though: what's 'best' for one practice (or one practice type) may not be right for everyone. When it comes to the best way to solve practice management problems, sometimes the only correct answer, as economists like to say, is 'it depends.' No-shows -- how to deal with them, how to minimize them -- are a great example of this sort of problem. I've been participating in a lively discussion on the subject on LinkedIn in the medical office managers group. The discussion was kicked off via a link to an article that seemed to have the definitive list of to-dos (and not-to-dos) to maximize show-rate -- except that the comments from participants in the group suggested it wasn't so simple. Example: "don't use postcards as reminders -- they're a waste of money and don't improve show rates." But, the data cited in the article pertained only to a residency-based family practice, and the study didn't provide any information about the wording of the reminders. But, other studies that weren't restricted to academic family practices showed otherwise, although the relative benefits of postcards versus other reminder methods were less clear. And other data show that multiple reminder types used together -- a combination of postal and SMS text, for example -- might deliver still better results. Given the lack of clear data on an issue like no-shows, you may need to try different approaches and aim to continuously improve your practice's performance. The answer to the problem of the right mix of reminders for your practice is likely to be "it depends" ... but, on what? The good news is, you can think through some of the possible factors that will influence reminder success pretty readily, since you already know a lot about your patient base. For example, you know something about the age of your patients. A practice with mostly older patients -- say, cardiology -- might find that postcards are still among the best
Today's Harvard Business Review tip on interviewing prospective employees is really useful. How do you know if the candidate really has the skills he/she claims to have? Drill down with 'how' and 'why' questions. For example, if a practice management candidate claims to have implemented internal controls, drilling down for examples can give you a better idea of how well she really understands them. Or, if a biller states that he chose a new PMS for his current practice, ask about the details of making that selection. Read the HBR tip here.
I used to do a lot of work on airplanes. But, that was back in the olden days when I flew for work internationally -- I had elite status and so almost never flew coach. It's a lot easier to get something done when you can actually fit your laptop on the tray-table in front of you (pretty difficult in coach these days -- especially if the person in front of you tilts back even a little). Besides the shrinking seat-space problem, Bloomberg Business Week adds a few medical reasons to skip cracking open the laptop: you're headache-y, you're forgetful, your heart's working harder, etc. (I'm still confused about why they seem to assume most people have hangovers, however.) But, they left out one reason that I think might trump them all: no privacy. Recently, I was on a flight and the person in the row in front/across from me opened up her laptop, clicked onto the plane's WI-FI, and began working in her practice's Practice Fusion EMR. (Yes, I could clearly see it was Practice Fusion.) Potential privacy violation? I wondered how many records the people directly next to her could see -- and what a morally challenged individual might do if she left her computer open while in the bathroom line. You really never know who you're sitting next to on a flying bus, after all.
Given the maze that is healthcare today, it makes sense that navigators to help patients understand the path to care would be a wonderful way to improve outcomes -- especially for the critically ill and under-insured. Research from Accenture shows they also improve the bottom line. Read the post on the Harvard Business Review blog.
Regarding my post of a few days ago about the marketing webinar Judy and I did for Kareo -- apparently a technical glitch has prevented Kareo from posting it. They're working on it and hope to have it up within a week. If you want to access it via an alternative source (gotomeeting's archive -- requires registration), send a message to our "info" email and I'll send you the details.
Branded thumb drives: isn't it great when you get one at a conference? They're so handy to have around! But, that handiness also makes them a risk for your practice. Even having a policy against downloading patient records to an external drive may not be enough to make thumb drives worth the risk: as this story from the Salt Lake Tribune illustrates, just having a policy isn't enough if people aren't aware of it (or choose to ignore it). Although the employee in the story -- who downloaded 6,000 patient records to a thumb drive, and then lost it somewhere en route between UT, CO and DC -- was fired, the missing records could still be found by someone with less-than-honest intentions. And, the woman's employer, a Medicaid claims processor, did have a policy against downloading patient records -- the "star employee" just didn't know about it. Of course, while this fired downloader seems to have had purely innocent intentions, the story also illuminates how easy it would be to download thousands of records onto a drive and slip it into a pocket -- and later sell those records to criminals. Some estimates put the value of patient medical identity data at $50/patient or more on the black market. That's why you probably won't see a Capko & Company branded thumb drive as a gift any time soon. Even though they're irresistible!
Just published a new long-form piece in PracticeLink magazine -- it includes so many great ideas contributed physicians and marketers from a wide variety of specialties (e.g., OB/GYN, rheumatology, radiology, urology, and more). Really creative ideas like forming your own networking group, using charitable work to expand your business, and bolstering your confidence about thinking outside the box. Real solutions from the trenches! Check it out at magazine.practicelink.com.
Judy Capko and Laurie Morgan presented a webinar on "Marketing for Medical Practice Profitability" sponsored by Kareo last week. If you missed out on the chance to join in, Kareo very kindly makes all their webinars available on their website at: http://www.kareo.com/resources/webinars -- this one should be available by the end of the day on Friday, March 29.
For those of you following the Healthgrades situation we've been working on -- i.e., hospitals 'claiming' individual physicians' listings without the physicians' permission, rebranding the pages with hospital logos and information, and diverting calls to a call center for the benefit of the hospital -- here is an update. On the plus side, Healthgrades did respond to our request to remove the hospital branding from our doctors' listings -- they referred to this as removing the hospital 'module.' The listings now show with the physicians' numbers only, and the hospital-branded wallpaper and other artifacts have been removed. Regarding our questions about why Healthgrades allowed this takeover of listings to happen in the first place, the response from them was less satisfactory. They asserted that "just like Facebook," they "own all the content" and "have a right to sell advertising against it." I pointed out that Facebook -- despite all the privacy criticism it generates -- does not actually do anything approximating diverting people to a third party's phone center. (!) Additionally, when I asked them why this was done without the physicians' permission, their answer was that "the hospitals all contacted the physicians" -- but, I know for a fact this is untrue. And, if Healthgrades "owns all the content," then why would it be the responsibility of an advertiser to validate Healthgrades' content? As an aside, I do have some personal experience that is quite relevant to this situation. I worked in media for more than 15 years, and even owned and published a yellow pages-style directory. It's simply not the case that diverting a prospect who is looking for a particular person or business to a call center for the benefit of a third party (or the directory) is typical revenue-generating practice in media. It is one thing to take public information to build directory listings -- that's acceptable and reasonable, and if the physician gets extra exposure and awareness from it, that's a good faith type of trade-off. But, leveraging the physician's own awareness generating efforts and referral pipeline development to drive callers to a hospital's call
The Wall Street Journal had a thought-provoking opinion piece by Scott Gottlieb, MD, on Friday entitled "The Doctor Won't See You Now. He's Clocked Out." Gottlieb asserts that the ACO model ObamaCare encourages is basically handing hospitals a monopoly in many markets, and encouraging them to buy up practices to take advantage of higher, 'facility' reimbursement rates from Medicare. And he adds that, once employed, physicians are less motivated to take ownership of the full spectrum of patient care (e.g., because they hand their patients off to another hospital physician at the end of their shift). The overall picture is higher costs and less productive physicians. As someone who's studied economics, I find it hard to argue with Gottlieb's analysis of the effect of market power: hospitals will inevitably use their monopoly (or quasi-monopolistic) positions in many markets to drive higher prices. I wonder, though, if that won't -- at some point -- create opportunities for more entrepreneurial doctors. To the extent that hospitals and other larger systems raise rates, that should make working with smaller, more nimble, and less expensive independent practices more attractive to payers. And, that may ultimately enable more entrepreneurial physicians to find a path to keeping their practices open and profitable, and even developing new models (as occurred with, for example, ASCs in the past).
Today I stumbled upon an intriguing, although somewhat troubling, blog post from last fall entitled, "Disrespect ... is the Elephant in the Hospital." The post referred to two academic papers by Lucian Leape of the Harvard School of Public Health that closely examine how a hospital environment that tolerates disrespect -- whether from doctors to nurses, staff to patients, administrators to clinicians or physicians to patients -- leads to all kinds of bad outcomes, including very demonstrably increasing medical errors. Tolerated disrespect isn't just a hospital problem -- it can happen in organizations of any sizes, including private practices. And, the potential consequences aren't just clinical. If a manager or physician creates the sense that staff aren't respected contributors to the team, it stifles staff contributions. Team members who are in a position to observe operational problems will be discouraged from pointing them out -- and so the practice misses out on an opportunity to improve. And, of course, the daily grind of disrespect will eventually cause your practice to lose its best employees. Once a pattern of disrespect is well-established, it can be tough to break. If a practice manager seems to treat staff dismissively or is demeaning to them, corrective action by the physician(s) he or she reports to is imperative. If a physician seems unable to interact with staff without condescension or bullying, an intervention (perhaps with the help of an outside coach) is needed, and it may be necessary to carefully structure how he or she works with staff. Above all, the first step to repairing an office environment that has become hostile is to provide the means for staff to confidentially (anonymously) provide honest feedback, without fear of retaliation. For a small practice, it may be helpful to work with a neutral outside party to gather employee opinions in a "safe" manner, and summarize them so that management can take corrective action.
